Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14-24% of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85% of diabetes-related amputations. Research has shown, however, that development of a foot ulcer is preventable.
A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer-related complication.
Regular diabetic check-ups by a podiatrist, with preventative trimming (debridement) of nails and calluses can significantly reduce the instances of lower extremity ulcerations and limb loss.
Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics, and older men are more likely to develop ulcers. People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.
Ulcers form due to a combination of factors:
Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem.
Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing.
Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage in your sock. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.
The best way to treat a diabetic ulceration is to not get one in the first place. To do that, please attend regular check-ups at our office every 2-3 months for a foot examination, trimming of thickened nails and calluses, and a thorough examination of the sensation and circulation to the feet.
Once an ulcer is noticed, you must visit our office immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce healthcare costs.
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing begins, the less chance for an infection. To do this, we use a multispecialty approach, making sure to align and coordinate our treatments with those of the other practitioners on the healthcare team, such as primary care doctors, endocrinologists, and nutritionists.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
Not all ulcers are infected. If it is determined that an infection may be present, however, a treatment program consisting of antibiotics, wound care, and, possibly, hospitalization will be necessary.
For optimum healing, ulcers, especially those on the bottom of the foot, must be off-loaded. You may be asked to wear special footgear, a brace, or specialized castings or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.
Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline and betadine to cutting-edge modalities such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal, there must be adequate circulation to the ulcerated area, which means consultations with other physicians, such as vascular surgeons, may be necessary.
Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.
A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or other bony bumps (exostoses).
Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.