About Diabetic Foot Ulcers
Diabetic foot ulcers
A diabetic foot ulcer is a sore or wound that often occurs in people with diabetes, a condition where blood sugar levels are abnormally high. Diabetic foot ulcers may be difficult to heal. Those that do not heal leave patients susceptible to infection and may lead to amputation of the affected toe, foot or leg.
Over 850,000 chronic diabetic ulcers are diagnosed in the U.S. each year. Approximately 15% of diabetic patients (approximately 3 million) will eventually develop an ulcer; and of those that do develop ulcers, 1 in 4 will have a foot amputated.
What causes diabetic foot ulcers?
People who have diabetes often develop a loss of feeling in their feet and have poor circulation. Because diabetics may not be able to feel pain or pressure on their feet, poor fitting shoes or an injury may damage their skin and an open wound can develop without them even realizing it. Loss of feeling is associated with nerve damage caused by prolonged high blood sugar levels. Diabetic peripheral neuropathy is the term used to describe nerve damage in diabetic patients that affects their extremities (feet and hands). Diabetics can also have poor blood flow to their legs and feet caused by a narrowing and hardening of the blood vessels. Diabetics with poor circulation are more prone to infections and their ability to heal may also be affected.
Pay attention to your feet
For diabetics, ordinary foot problems can quickly get worse and lead to serious complications. Diabetics may not even be aware of a foot problem because they lack the sensation of pain. This is why it is recommended that diabetics check their feet every day for sores or cuts. A diabetic foot ulcer may become a serious problem if it is not treated or it does not heal rapidly. The faster the wound heals, the less chance there is for infection and potential for amputation. After a foot ulcer heals, patients still need to take special care since scar tissue under the healed wound will be prone to break down easily. For this reason, protective footwear is needed to relieve the area from pressure to prevent the ulcer from re-opening. When a foot ulcer does not heal normally and persists for a long period of time, it is referred to as a chronic or non-healing ulcer. Foot ulceration is the most common reason for hospital admission among diabetic patients.
Treating diabetic foot ulcers
The most important goal in treating a foot ulcer is quick healing. The faster the wound is healed, the less chance there is for infection. The standard treatment for a diabetic foot ulcer includes cleaning and removing dead tissue from the wound (called debridement), frequent, regular application of moist topical dressings, and relieving pressure from the wound (off-loading) by continuous use of protective footwear. Antibiotics are prescribed if there is an infection. Although healing of any wound may take time, lack of healing progress (the wound is not decreasing in size or moving towards closure) after approximately 4 weeks is a sign that the standard treatment regimen is not adequate. Advanced wound care treatments that may be used in combination with the standard care regimen of dressings and off-loading include topical agents (creams, ointments, medications), mechanical devices and living skin equivalents to promote healing.
Prevention
Prevention is the best medicine for foot ulcers. Good foot care includes proper bathing, nail trimming, and wearing shoes that have been fit correctly. Recommended guidelines for ulcer prevention include regular visits to your physician, monitoring and controlling your blood sugar levels, checking your feet on a daily basis, and wearing appropriate shoes and socks to help prevent callus formation. If a wound does occur, patients should see a physician as soon as possible for treatment. The likelihood of an ulcer recurring after it has healed can be as high as 50%. Patients with healed diabetic ulcers should continue to use protective footwear to prevent wound recurrence.
