A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, about 6 percent will be hospitalized due to infection or other ulcer-related complications. Diabetes is the leading cause of non-traumatic lower extremity amputations, with approximately 14-24 percent of patients who develop a foot ulcer requiring an amputation. Foot ulceration precedes 85 percent of diabetes-related amputations. However, research has shown that the development of a foot ulcer is preventable.

Causes

Anyone with diabetes can develop a foot ulcer. Certain demographics, such as Native Americans, African Americans, Hispanics, and older men, are more likely to develop ulcers. People who use insulin are at higher risk, as are patients with diabetes-related kidney, eye, and heart diseases. Being overweight and using alcohol and tobacco also play roles in the development of foot ulcers.
Ulcers form due to a combination of factors, including lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma. Patients with long-term diabetes may develop neuropathy, a condition characterized by a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels. Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk of infection. Elevated blood glucose levels can reduce the body's ability to fight off potential infections and slow healing.

Symptoms

Many people who develop foot ulcers have lost the ability to feel pain, so pain is not a common symptom. Often, the first sign is drainage on the socks. Redness and swelling may also be associated with the ulcer, and if it has progressed significantly, odor may be present.

When to Visit a Expert

If you notice an ulcer, seek expert medical care immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce healthcare costs.

Diagnosis and Treatment

The primary goal in treating foot ulcers is to achieve healing as quickly as possible. The faster the healing, the lower the chance of infection. Key factors in the appropriate treatment of a diabetic foot ulcer include:

Prevention of infection

Off-loading (taking pressure off the area)
Debridement (removing dead skin and tissue)
Applying medication or dressings to the ulcer
Managing blood glucose and other health problems
Not all ulcers are infected. If an infection is diagnosed, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To prevent an ulcer from becoming infected, it is important to:

Keep blood glucose levels under tight control
Keep the ulcer clean and bandaged
Cleanse the wound daily using a wound dressing or bandage
Avoid walking barefoot
For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” You may be asked to wear special footgear, a brace, specialized castings, or use a wheelchair or crutches to reduce pressure and irritation to the area with the ulcer.

Advances in Wound Care

Wound care science has advanced significantly over the past decade. It is now known that wounds and ulcers heal faster and with a lower risk of infection if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking is not recommended as these practices could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes, which have been shown to be highly effective in healing foot ulcers.
For a wound to heal, there must be adequate circulation to the ulcerated area. Circulation levels can be determined with noninvasive tests.

Surgical Options

Most non-infected foot ulcers are treated without surgery. However, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and correcting various deformities such as hammertoes, bunions, or bony “bumps.”
Healing time depends on several factors, including wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and the treatments applied to the wound. Healing may occur within weeks or take several months.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development. Seeing a podiatrist regularly can help determine if you are at high risk for developing a foot ulcer and implement prevention strategies.

High-risk factors include:

Neuropathy
Poor circulation
Foot deformities (e.g., bunions, hammertoes)
Wearing inappropriate shoes
Uncontrolled blood sugar
History of a previous foot ulceration
Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, is essential in preventing and treating a diabetic foot ulcer. Wearing appropriate shoes and socks will also reduce risks.
Learning how to check your feet is crucial so you can find potential problems early. Inspect your feet daily—especially the soles and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any abnormalities. Each time you visit a healthcare provider, remove your shoes and socks so your feet can be examined. Any discovered problems should be reported to your podiatrist as soon as possible, regardless of how minor they may seem.

The Key to Successful Wound Healing

Regular podiatric medical care ensures the following “gold standard” of care:
Lowering blood sugar
Appropriate debridement of wounds
Treating any infection
Reducing friction and pressure
Restoring adequate blood flow
By following these guidelines and working closely with Dr. BharatKumar Chaudhary, you can manage diabetic wounds effectively and reduce the risk of serious complications.