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Diabetic Foot Ulcers

What are diabetic foot ulcers?

If you have been diagnosed with diabetes, you are at risk for foot complications. Diabetic ulcerations, particularly in the foot, are often one of the first signs of complications from diabetes.

Diabetes is the leading cause of non-traumatic 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.

The Vascular & Diabetic Foot Center at Baylor Scott & White The Heart Hospital - Plano is the only dedicated program in North Texas offering a comprehensive approach to diabetes and your feet, both from a preventative and a treatment perspective. Its mission is to rapidly heal wounds without affecting the functionality of limbs, as well as prevent a major amputation. The Center uses advanced diagnostic, surgical and wound care modalities to heal these difficult-to-heal wounds.

Call 469.814.3480 for more information or to schedule a patient for evaluation.

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Overview of diabetic foot ulcers

If you have been diagnosed with diabetes, you are at risk for foot complications. It's important for you to understand these risks to prevent potential complications or amputations.

  • Causes and Symptoms
  • Diagnosis and Treatment
  • Prevention

Causes and Symptoms

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as will as duration of diabetes. 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 often 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. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.

High-risk individuals include:

  • Native Americans
  • African Americans
  • Hispanics
  • Older men
  • People who use insulin
  • Patients with diabetes-related kidney, eye, and heart disease
  • Overweight
  • Use of alcohol and tobacco

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. Other symptoms include:

  • Drainage on your socks.
  • Redness and swelling
  • If it has progressed significantly, odor

Diagnosis and Treatment

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • ​​Prevention of infection
  • Taking the pressure off the area, called off-loading
  • Removing dead skin and tissue, called debridement
  • Applying medication or dressing to the ulcer
  • Managing blood glucose and other health problems
  • Keep wound covered and moist

Not all ulcers are infected; however, if your podiatrist diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To keep an ulcer from becoming infected, it is important to:

  • Keep blood glucose levels under tight control Working closely with your physician or endocrinologist
  • Keep the ulcer clean with topically-applied medications and bandaged with ulcer dressings, and skin substitutes
  • Cleanse the wound daily, using a wound dressing or bandage
  • Avoid walking barefoot
  • Adequate circulation to the ulcerated area

​The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:

  • ​Neuropathy
  • Poor circulation
  • A foot deformity such as a bunion or hammertoe
  • Wear inappropriate shoes
  • Uncontrolled blood sugar
  • History of previous foot ulceration
  • Smoking
  • Drinking alcohol
  • High cholesterol
  • Elevated blood glucose

Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day—especially the sole and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a healthcare provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible; no matter how simple they may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following "gold standard" of care:

  • ​​Lowering blood sugar
  • Appropriate debridement of wounds
  • Treating any infection
  • Reducing friction and pressure
  • Restoring adequate blood flow

Source: American Podiatric Medical Association, Inc

Frequently asked questions

Why should I "knock my socks off" and see a podiatrist?
I have been diagnosed with diabetes. What foot complications could I experience?
  • A loss of feeling in your feet
  • Foot ulcers or sores that do not heal
  • Amputation
Should I talk about diabetes with my community, family, and friends?
Yes! Those with diabetes, as well as those who are at risk, are encouraged to openly discuss the disease with family members because it can affect children and adults alike. Diabetes is often passed down from generation to generation. Don't be embarrassed to talk about it with those closest to you because diabetes is best managed as a team.
What are diabetic ulcers, and how can I prevent them?
Diabetic ulcerations are often one of the first signs of complications from diabetes in the lower leg. These ulcers can stem from a small wound or cut on the foot that is slow to heal. If left untreated, ulcers can become harder to treat and could lead to amputation. If discovered early and treated by a podiatrist, who specializes in diabetic wound care, ulcers may not lead to amputation. ​​​
Is there a special kind of footwear available for those with diabetes?
Yes! Certain types of shoes, socks, and custom orthotics are all created especially for those with diabetes. People with diabetes should never go barefoot and should make sure to keep feet protected to reduce the risk of cuts and scrapes on the feet, which can lead to complications.

Source: American Podiatric Medical Association, Inc.
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