Ulcers are slow-healing wounds on the skin. Diabetic foot ulcers occur on the feet of people with type 1 and type 2 diabetes. Diabetic foot ulcers usually occur in approximately 15 percent of patients with diabetes, and are commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.
Causes
Anyone who has diabetes can develop a foot ulcer. Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma. The longer one has had diabetes, the higher the chances of getting an ulcer. High blood sugar can damage the nerves of the legs and feet. This may make it difficult to feel a blister or sore on the foot. If you don't take care of a sore it may become larger and infected. Diabetes can also cause problems with blood flow. Poor blood flow can make it difficult to heal an ulcer. The ulcer itself is usually caused by:
o Repetitive trauma or pressure on the foot;
o Puncture wound on the foot;
o Shoes or objects in the shoe that can damage the skin, such as a small rock.
Risk factors
Factors that may increase your chance of diabetic foot ulcers include:
o Neuropathy -- numbness, tingling, or burning sensation in your feet;
o Peripheral artery disease (PAD) -- poor circulation in your legs;
o Improperly fitted shoes;
o A foot deformity;
o Diabetes for more than 10 years;
o Poor diabetes control;
o Not wearing shoes;
o A history of smoking;
Symptoms
Symptoms may include:
o Sores, ulcers, or blisters on the foot or lower leg;
o Pain;
o Difficulty walking;
o Discoloration in feet (skin that is black, blue or red)
o Fever, skin redness, swelling, or other signs of infection;
Diagnosis
On your visit to the podiatrist, you will be asked about your symptoms and medical history. A physical exam will be done. Blood tests and other test, such as a wound culture, test of your circulation and x-rays may also be done.
Treatment
The sooner a diabetic foot ulcer is treated, the better the outcome. Treatment options include the following:
Wound care: Good wound care is important to help the ulcer heal and prevent infection. Persons with diabetic foot ulcers should see the podiatrist as soon as possible. Wounds heal better when they are covered and should not be left open. Follow your doctor's instructions for wound care to keep the wound clean and change the dressing as the doctor orders to prevent infection.
No weight bearing: Constant pressure on the ulcer can make it worse and difficult to heal. Your podiatrist will give you a special shoe or cast boot to take the pressure off the ulcer area. This will allow the ulcer to heal.
Blood sugar control: High blood sugar levels can lower the body's ability to fight infections and keep the wound from healing. Infected ulcers can also raise blood sugar levels. Improved blood sugar control will help you fight infections and heal your wounds. This control is often done with adjustments in your diet, exercise or medications. Sometimes insulin shots are needed in the short-term to get you sugar under control.
Healthy habits: If you smoke, talk to your doctor about ways to quit. Smoking can also slow healing. Look at your feet every day, wear proper footwear and make sure it fits well.
Skin graft: Some large skin ulcers may have a hard time healing even with good treatment. They may need a patch of skin to help close the wound. Bioengineered skin graft or human skin graft may be used.
Medication: If the ulcer is infected, your doctor may order antibiotics to treat it. You may need to take the medication for four to six weeks. Do not skip doses. Finish the medication as directed. Your doctor may also recommend a medication to place on the ulcer. The medication may help speed healing.
Surgery: Dead tissue can build up inside and around the wound. This tissue will slow or prevent healing. You may need a surgery to remove the dead tissue and clean the wound. This surgery is called debridement. Bypass surgery may be needed to improve blood flow to the legs. The improved blood flow may help with wound healing, if the infection is too severe or does not respond to treatment. As a last resort, amputation surgery may be needed. This is the removal of a body part to stop the infection from spreading to the rest of the body.
Other treatments: Hyperbaric oxygen therapy may help with healing. This therapy is delivered in a chamber. Pure oxygen is pumped into the chamber. This helps to increase the amount of oxygen in the blood. The extra oxygen can improve healing. Another option to help speed healing is using negative pressure wound therapy. A vacuum device and dressing are used to create negative pressure on the wound. This can help the wound heal faster.
Prevention
To help reduce your chance of diabetic foot ulcers:
o Clean your feet daily. Dry them thoroughly, especially between the toes, before putting shoes and socks on.
o Do not wear garters and tight stockings around the legs.
o You may want to use petroleum jelly or an unscented lotion to moisturize dry, leathery feet. Do not put lotion between the toes. The extra moisture may attract bacteria.
o Inspec t your feet daily. Look for sores that you may not be able to feel. Use a mirror or the assistance of another person to see all parts of your feet.
o Your doctor should look at your feet and test the feeling in them at least once a year. If you find a sore at any time, make an appointment to see your doctor right away.
o People with diabetes may have toenails that are brittle and difficult to cut. You may also want to have a foot specialist trim your toenails regularly.
o Buy properly fitted shoes. Some insurance companies will pay for custom-made shoes with inserts. A doctor can give you a prescription for the shoes.
o Avoid smoking.
o Talk to your doctor about exercise. Daily exercise will help to improve blood flow and blood sugar levels.
o Calluses can increase the pressure on the foot and lead to foot ulcers. Have your foot doctor remove any calluses. This could reduce the risk of developing a foot ulcer.
o Ask your doctor if you should use a special infrared thermometer. It can check the temperature of your feet. Increasing foot temperatures may indicate something is going on in the foot.
o Improved control of your diabetes may reduce the risk of ulcers and help them to heal if you get one.
o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.
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