Diabetic Foot Ulcers: Why They’re Dangerous
What’s the Number One reason people with diabetes are hospitalized? Diabetic foot ulcers—chronic open wounds on the bottom of the feet.
J. Marshall Devall, DPM, Podiatrist at the Temple Santa Fe Center, discusses diabetic foot ulcers, how to treat them and how to avoid them.
What Is a Diabetic Foot Ulcer?
“An ulcer is a chronic wound. If you wore a new pair of pumps and went out dancing and got a blister on your heel, that’s not an ulcer. An ulcer is a chronic wound that stays open,” explains Dr. Devall.
“The goal of treatment is closing your wound as quickly as possible, since prolonged healing time increases your risk of infection, hospitalization, amputation and death.”
Unhealed diabetic foot ulcers are common and serious complications of diabetes. If they’re not treated properly, Dr. Devall says, they increase the risk of:
“Approximately 15 percent of diabetic foot ulcers result in amputations,” says Dr. Devall, “and foot ulcers are a contributing factor in more than 85 percent of all diabetes-related amputations.”
Recent studies show that patients with a history of diabetic foot ulcers have a 47 percent increased risk of death than diabetics who’ve never had a foot ulcer
What Causes Diabetic Foot Ulcers?
Corns and calluses. Typically, with diabetics, Dr. Devall says, ulcerations develop in areas where calluses or corns form:
- Places of bony prominence where you’re bearing excess weight due to:
- Mechanical imbalance
- Loss of fat padding on your foot
- Areas where your shoe rubs your foot
Neuropathy. “Diabetic patients often have neuropathy—loss of sensation in the foot. With neuropathy, the callus becomes thick, the patient doesn’t feel it, and it causes an underlying ulceration,” explains Dr. Devall.
Neuropathy is a potentially dangerous condition: The nerves in your feet that should send you pain signals aren’t functioning properly.
“I’ve had patients say that they couldn’t feel a tack or an insulin needle stuck in their foot. Sometimes they don’t feel their feet at all,” says Dr. Devall.
Poor circulation. Very often, diabetic patients will have poor circulation in their extremities. With poor blood flow, wounds have difficulty healing.
Poor vision. Diabetes affects vision; consequently, many diabetic patients cannot see their feet well enough to make accurate assessments of the condition of their feet.
What Is the Treatment for Diabetic Foot Ulcers?
Treatment for your foot ulcers depends on these factors:
- Assessment of skin changes around the ulcer
- Length, width and depth of ulceration
- Probe-to-bone test
- Condition of wound edges
- Whether the wound exudes pus
- Presence of dead flesh (necrosis)
- Presence of pain
Once your physician assesses your ulceration, he or she may recommend one or more of the following treatments:
- Debridement—your physician will cut away dead tissue and clean out your wound
- Oral or IV antibiotics
- Calcium alginates
- Growth hormones
- Skin substitutes
- Offloading—readjusting your weight to take the pressure off the bony part
- Hyperbaric oxygen therapy—a special chamber where you breathe condensed oxygen, helping your wounds heal more quickly
- Glycemic control
“The goal of treatment is closing your wound as quickly as possible, since prolonged healing time increases your risk of infection, hospitalization, amputation and death,” says Dr. Devall.
“But even with good wound care, the healing rates for diabetic foot ulcers are dismal at 31 percent,” says Dr. Devall.
How Do I Prevent Diabetic Foot Ulcers?
“The best approach to managing foot ulcers is prevention. Prevention doesn’t hurt, it often doesn’t require a shot, it often doesn’t require surgery,” says Dr. Devall
He recommends that you:
- Perform a nightly self-assessment of your feet
- Have a professional trim your toenails and remove corns and calluses monthly
- Wear the correct shoes that properly offload your weight
- Be certain you know exactly what causes diabetic foot problems (see above)
- Have your feet examined annually by a podiatrist (foot doctor) or more frequently, if recommended
- Notify your physician or podiatrist immediately when you suspect you have a foot problem
How Do I Do a Self-Assessment of My Feet?
Checking your feet every night is vital in finding the problems leading to foot ulcerations that can cause infection, hospitalization, amputation or death. Prevention is far easier than treatment.
To inspect your feet effectively, Dr. Devall suggests:
- Examining your feet every day — preferably at night — for:
- Open wounds
- Foreign material
- If you can’t lift your leg up to get a good view, place a mirror on the floor and sit on the edge of your bed (store the mirror under the bed and slide it out with your foot when you need it)
- If you have poor vision, have your spouse, partner, child, grandchild or friend check your feet for you
“Be aggressive in checking your feet. We don’t want you to wait until you have a disastrous complication,” advises Dr. Devall.