Diabetic Wound Care

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of diabetics, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complications.

In the United States, the leading cause of non-traumatic lower extremity amputations is diabetes. Approximately 14 to 24 percent of diabetic patients who develop a foot ulcer require an amputation. Although, research has shown that the development of a foot ulcere is preventable.
     

Who Can Get a Diabetic Foot Ulcer?

Anyone with diabetes can develop a foot ulcer. African Americans, Hispanics, Native Americans, and older men are more likely to develop ulcers. Insulin users are also at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and drinking alcohol or using tobacco also play a role in the development of foot ulcers.

How do Diabetic Foot Ulcers Form?

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

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk of infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow down healing.

What is the Value of Treating a Diabetic Foot Ulcer?

Seek podiatric medical care immediately once an ulcer is detected. There are many reasons for which diabetic patients should be treated for foot ulcers, such as reducing the chance of infection and amputation, improving function and quality of life, and reducing health care costs.

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible.  The quicker an ulcer heals, 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 dressings to the ulcer.
  • Managing blood glucose and other health problems.

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

There are several important factors to keep an ulcer from becoming infected:

  • Keep blood glucose levels under tight control.
  • Keep the ulcer clean and bandaged.
  • Cleanse the wound daily, using a wound dressing or bandage.
  • Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.”  Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

Over the past decade, the science of wound care has advanced significantly. The old idea of “let the air get at it” is now known to be harmful to healing. Wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, becausse it could lead to further complications.

Appropriate wound care includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

In order for a wound to heal there must be adequate circulation to the ulcerated area. Your podiatric physician can determine circulation levels with noninvasive testing.

Controlling Blood Glucose

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 accomplish this will enhance healing and reduce the risk of complications.

Surgical Options

A majority of non-infected foot ulcers are treated without surgery; however, when this fails to happen, surgical management may be neccessary. 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 bony “bumps.”

Healing Factors

A variety of factors effect healing time, 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.

How Can a Foot Ulcer be Prevented?

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, at least annually. He or she can determine your risk level for developing a foot ulcer and then implement prevention strategies.

You are at high risk if you:

  • Have neuropathy (nerve damage)
  • Experience poor circulation
  • Have a foot deformity (i.e. bunion, hammer toe)
  • Wear inappropriate shoes
  • Have uncontrolled blood sugar

Important to the prevention and treatment of a diabetic foot ulccer is the reduction of additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose. Wearing appropriate shoes and socks will also reduce risks. Your podiatrist can provide advice in selecting proper shoes.

Learning how to check your feet for warning signs is crucial in noticing a potential problem as early as possible. Inspect your feet every day, especially between the toes and the sole of your foot. Look for bruises, cuts, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Report any discovered problems to your podiatrist as soon as possible, no matter how minor it 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

The old saying, “an ounce of prevention is worth a pound of cure” was never as true as it is when preventing a diabetic foot ulcer.