A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation.
Anyone who has diabetes can develop a foot ulcer. People who use insulin are at a higher risk, 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.
A Diabetic Foot Ulcer needs to be seen by a Vascular Specialist to test for proper blood flow. Not being treated properly can lead to amputation
Facts About Amputation
- 90% of all amputations are lower extremity
- 77% Males
- 3 million amputees in United States, estimated
- #1 cause – vascular
- 50% of vascular amputations are caused by Diabetes
- 80% of diabetic amputations are over 50 years old
- Majority of Diabetic amputations are preventable
- 50% of all amputations never had an angiogram (an X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery)
An angiogram can find a bulge in a blood vessel (aneurysm). It can also show narrowing or a blockage in a blood vessel that affects blood flow. An angiogram can show if artery disease is present and how bad it is.
A foot ulcer can form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma (ex. wearing tight shoes). Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling 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.
Diabetics are prone to have circulation problems too, hence why they often end up with venous stasis and arterial foot ulcers as well. The list of additional comorbidities that may lead to such foot ulcers includes, but is not limited to the following:
- Lymphedema and Inflammatory Diseases
- Peripheral Arterial Occlusive Disease
- Renal Disease and Kidney Failure
- Hypertension and Heart Disease
- Chronic Venous Insufficiency
- Unresolved Varicose Veins
- Deep Vein Thrombosis
The primary goal in 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 in the appropriate treatment of diabetic foot ulcer:
- See a Vascular Specialist, A Wound Care Specialist and A Podiatrist
- Prevention of infection
- Taking the pressure off the area
- Removing dead skin and tissue
- Applying medication or dressing to the ulcer
- Managing blood glucose and other health problems
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
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 applied to the wound (we have advanced wound care modalities), Healing may occur within weeks or require several months.
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrists on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer.
You are at high risk if you:
- Have neuropathy
- Have poor circulation
- Have a foot deformity ( i.e. bunion, hammer toe)
- Wear inappropriate shoes
- Have uncontrolled blood sugar
Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of diabetic foot ulcer. Wearing appropriate shoes and socks will go along way in reducing risks. Your podiatrist can provide guidance in selecting the proper shoes.
Here’s a great article on prevention and treatment of leg and foot ulcers in Diabetes Mellitus from from the Cleveland Clinic, a Center for Continuing Education. Click Here!
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