Diabetic Foot Ulcer

Ulcers are slow healing wounds on the skin. Diabetic foot ulcers occur on the feet of people with type 1 and type 2 diabetes . Up to 15% of people with diabetes are at risk for developing foot ulcers. Diabetic foot ulcers usually occur on the bottom of the foot.

  • Causes


    Diabetes can damage the nerves of the legs and feet. This may make it difficult to feel a
    blister
    or sore. If you don't care for a sore it may become larger and infected.

    Diabetes also can causes problems with blood flow. Poor blood flow can make it difficult to heal.


    The ulcer itself is usually caused by:

    • Repetitive trauma or pressure on the foot
    • Puncture wound on the foot
    • Objects in the shoe that can damage the skin (such as a small rock)

  • Definition


    Ulcers are slow healing wounds on the skin.
    Diabetic foot ulcers occur on the feet of people with
    type 1
    and
    type 2 diabetes
    . Up to 15% of people with diabetes are at risk for developing foot ulcers. Diabetic foot ulcers usually occur on the bottom of the foot.


    Foot Ulcer
    Foot Ulcers
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  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your primary doctor may refer you to a foot specialist.


    Tests may include the following:

    • Wound culture to determine if an infection is present
    • X-ray
      —to determine if there is evidence of infection in the bones (
      osteomyelitis
      )
    • CT scan
      or MRI scan—to evaluate a suspected pocket of pus called an abscess
      or to look for infections in the bone


    • Ankle-brachial pressure—to determine if blood is flowing well to your feet
    • Doppler or arteriographic studies
      —to assess for adequate blood flow to feet, which is necessary for healing
    • Blood glucose
      and glycohemoglobin (HbA1c) test
    • Complete blood count
      to determine if there is an infection—A high white blood cell count may mean that there is an infection.

  • Prevention

    To help reduce your chance of getting diabetic foot ulcers, take the following steps:

    • Clean your feet daily. Dry them thoroughly, especially 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. The extra moisture may attract bacteria.
    • Inspect 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.
    • 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.
    • 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.
    • 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.
    • Avoid smoking.
    • Talk to your doctor about exercise. Daily exercise will help to improve blood flow and blood sugar levels.
    • 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.
    • Ask your doctor if you should use a special infrared thermometer. It can check the temperature of your feet.
    • Improved control of your diabetes may reduce the risk of ulcers

    Ulcers that do not heal or develop a severe infection may lead to amputation of the foot. About 80% of leg
    amputations
    in the US started off as diabetic foot ulcers.

  • 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:

    • Neuropathy
      (numbness, tingling, or burning sensation in your feet)
    • Peripheral vascular disease
      (poor circulation in your legs)
    • Improperly fitted shoes
    • A foot deformity
    • Diabetes more than 10 years
    • Poor diabetes control (HbA1c > 9%
      )
    • Not wearing shoes

    • A history of
      smoking

  • Symptoms


    Tell your doctor if you have any of these symptoms:

    • Sores, ulcers, or blisters on the foot or lower leg
    • Pain
    • Difficulty walking
    • Discoloration in feet: black, blue, or red
    • Fever, skin redness, swelling, or other signs of infection

  • Treatment

    The sooner a diabetic foot ulcer is treated, the better the outcome. Talk with your doctor about the best treatment plan for you. Treatment options include the following: