Diabetic foot ulcers are sores that occur on the feet of people with
type 1
and
type 2 diabetes. Up to 25% of people with diabetes develop foot problems. Diabetic foot ulcers usually occur on the bottom of the foot. They precede over 80% of legamputations
in the US. However, the sooner diabetic foot ulcers are treated, the better the outcome.
Diabetes can damage the nerves of the legs and feet so that you may not feel a
blister
or sore when it begins to appear. If undetected, the sore may become larger and infected. This may lead to an
amputation of a toe, a foot, or even a leg.
Risk Factors
The following factors increase your chance of developing diabetic foot ulcers. If you have diabetes and any of these risk factors, tell your doctor:
Symptoms
These factors increase your chance of developing a foot ulcer. Tell your doctor if you have any of these risk factors:
- Sores, ulcers, or blisters on the foot or lower leg
- Pain
- Walking with difficulty
- Discoloration in feet: black, blue, or red
- Cold feet
- Swollen foot or ankle
- Fever, skin redness or swelling, or other signs of infection
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your primary doctor may refer you to a foot specialist or podiatrist.
Tests may include the following:
- Wound culture to determine if an infection is present
- X-ray
—a test that uses radiation to take a picture of structures inside the body, especially bones; to determine if there is evidence of infection in the bones (
osteomyelitis)
- CT scan
—a type of x-ray that uses a computer to make pictures of structures inside the body; to evaluate a suspected pocket of pus called an abscess
- MRI scan
—a test that uses magnetic waves to make pictures of structures inside the body; to evaluate a suspected pocket of pus called an abscess
- Doppler or arteriographic studies
—to assess for adequate blood flow to feet, which is necessary for healing
- Blood glucose
and glycohemoglobin test
- Complete blood count
to determine if there is an infection—A high white blood cell count may mean that there is an infection.
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Medication
Regranex
gel is a medication approved by the Food and Drug Administration (FDA) for the treatment of diabetic foot ulcer. It has been shown to speed wound healing.
No Weight-bearing
Keeping pressure off the foot ulcer promotes healing. Sometimes special casts or boots are placed on the foot to “off-load” pressure from the ulcer.
Wound Care
Cleanse the wound regularly and change the dressings often to prevent infection.
Antibiotics
Antibiotics may be used to prevent an infection. You may need to take the medicine for 4-6 weeks.
Blood Sugar Control
Infected ulcers are likely to cause high blood sugar levels. High blood sugar levels lower immune response and prevent wound healing. Therefore, improved blood sugar control—with adjustments in diet or medications—aids in fighting infections and healing wounds. Sometimes insulin shots are needed in the short-term to achieve optimal blood sugar control.
Skin Graft
Bioengineered
skin graft
or human skin graft can be used to treat diabetic foot ulcers which fail to heal with conventional treatments. Skin grafts have been shown to speed the healing process.
Surgery
The removal of dead tissue around the wound, or
debridement, is often needed to clean the wound and promote healing. Bypass surgery to improve blood flow within the arteries of the legs may help with wound healing and spare amputations. As a last resort, amputation surgery may be needed to stop the spread of infection to the rest of the body.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy
may help with healing. With this form of therapy, pure oxygen is pumped into a chamber, which saturates the blood with oxygen. This oxygen-rich blood helps form new blood vessels. This process can improve healing.
If you are diagnosed with a diabetic foot ulcer, follow your doctor's
instructions
.
Prevention
To help reduce your chances of getting diabetic foot ulcers, take the following steps:
- Cleanse your feet daily and dry them thoroughly between the toes before putting shoes and socks on. Do not wear garters and tight stockings around the legs.
- You may want to use petroleum jelly or an unscented lotion to moisturize dry, leathery feet. Do not put lotion between the toes, since the extra moisture may attract bacteria.
- After cleansing your feet, inspect them daily for sores that you may not be able to feel. Use a mirror or the assistance of another person to see parts of the feet you may not usually be able to see.
- Your primary doctor should look at your feet and test the feeling in them at least once a year at your regular visit. If you find a sore at any time, make an appointment to see your doctor right away. You may be referred to a foot specialist or podiatrist for treatment of your foot ulcer.
- People with diabetes may have toenails that are brittle and difficult to cut without causing ingrown toenails. You may also want to have a foot specialist or podiatrist trim your toenails regularly.
- Buy properly fitted shoes. If you have Medicare coverage, once per calendar year Medicare (Part B) will pay 80% of the cost of a pair of properly fitted, custom-made shoes with inserts for people with diabetes. Costs may vary by state. The doctor who treats your diabetes must verify that you have a need for these shoes. Then you will need a prescription for the shoes from a podiatrist.
- Avoid smoking.
- Exercise daily, with the approval of your doctor, to improve blood flow and blood sugar levels.
- Calluses
can increase the pressure in the foot and lead to foot ulcers. Have your podiatrist cut any callus once you detect it. This could reduce the risk of developing a foot ulcer.
Foot Temperature Monitoring
According to studies, if you are at high risk for diabetic foot ulcers, checking the temperature of your feet—using an infared skin thermometer—can reduce the number of ulcers. The TempTouch thermometer used in the study costs $150. Ask your doctor if you should check the temperature of your feet.
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