What is a Diabetic Foot Ulcer?
Nerve and vascular damage are common diabetes complications, which can lead to the loss of protective sensation in the extremities and make detecting wounds difficult. As a result, people with diabetes can be more susceptible to infection and their wounds can often be slow healing. Special care needs to be taken of any abrasion or cut, particularly of those found on the feet.
What is a diabetic foot ulcer?
A diabetic foot ulcer is an open sore or wound that is most commonly found on the bottom of the foot. People with diabetes who are using insulin are at a higher risk of developing a foot ulcer, as are patients who have diabetes-related kidney, eye, and heart disease.
Diabetic foot ulcers are at very high risk of becoming infected, and sometimes they cannot be healed. Non-healing foot ulcers are a frequent cause of amputation in people with diabetes. Patients with foot ulcers may use wound dressings, skin substitutes, or other treatments to protect and heal their skin.
Wound dressings are medical devices that are used to protect ulcerated skin and assist in its healing. They can range from simple bandages that you can buy in the drug store to complex materials that contain antibacterial and antiviral substances.
Skin substitutes are products that help in closing the wounds of slow healing ulcers in patients with diabetes. They are made from human cells known as fibroblasts that are placed on a dissolvable mesh material. When the mesh material is placed on the ulcer, it is gradually absorbed and the human cells grow and replace the damaged tissue in the ulcer.
How do diabetic foot ulcers form?
Ulcers form due to a combination of factors: poor circulation, lack of feeling in the feet, foot deformities, irritations, and trauma. After many years, diabetes can cause neuropathy, which is a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk of infection. High blood sugars can also reduce the body's ability to combat potential infection and can slow the healing process.
How is a diabetic foot ulcer treated?
Once an ulcer is detected, seek the care of your podiatrist immediately. There are several key factors in the appropriate treatment of a foot ulcer:
- Maintaining good blood glucose control.
- Prevention of infection.
- Raking the pressure off the area, called "off-loading."
- Removing dead skin and tissue, called "debridement."
- Applying medication or dressings to the ulcer.
- Keep the ulcer clean and bandaged.
- Do not walk barefoot.
To heal as quickly as possible, foot ulcers must be "off-loaded." Patients may be asked to wear special footgear or utilize a wheelchair or crutches to reduce pressure and irritation to the ulcer area. Wounds heal faster, with a lower risk of infection, if they are kept covered and moist. Work closely with your medical team and your podiatrist to ensure the fastest healing possible.
How can a foot ulcer be prevented?
There are several precautions you can take to prevent a diabetic foot ulcer.
- Maintain good blood glucose control.
- See a podiatrist on a regular basis.
- Wash feet daily.
- Inspect your feet and toes daily.
- Maintain a healthy weight.
- Wear thick, soft socks.
- Stop smoking.
- Cut toenails straight across instead of rounding the edges.
- Exercise regularly.
- Be properly measured and fitted every time you buy new shoes.
- Do not walk around barefoot.
- Never try to remove calluses, corns, or warts by yourself.
You may be at high risk for a diabetic foot ulcer if you have uncontrolled blood glucose, have neuropathy, have poor circulation, have a foot deformity such as a bunion, and wear inappropriate shoes.
For people with diabetes, an ounce of prevention is truly worth a pound of cure. Keeping your blood glucose in good control and regularly inspecting your extremities for any cuts or abrasions can help keep your feet wound-free.
- American Podiatric Medical Association. Diabetic Wound Care. http://www.apma.org/MainMenu/Foot-Health/Foot-Health-Brochures-category/Diabetes-Foot-Health/Diabetic-Wound-Care.aspx. (Accessed 7/6/11)
- National Diabetes Information Clearinghouse. Prevent Diabetes Problems: Keep Your Feet and Skin Healthy. http://diabetes.niddk.nih.gov/dm/pubs/complications_feet/index.aspx (Accessed 7/6/11)
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James Joyce said that “mistakes are the portals of discovery.” I wonder if insulin levels have been our mistake. Could it be that this hellish week of blood sugars were somehow meant to be? Drastic times call for drastic measures, right? Maybe we were too afraid in the past to take the plunge into drastic measures. Maybe this is oddly what we needed. We had to be truly frightened in order to make bigger, bolder changes. ...