Diabetic Foot Wounds as Discussed
by Podiatrist Dr. Sydney K. Yau, DPM
In the United States, diabetes affects approximately 25.8 million people and up to 25% of those people develop a foot ulcer during their lifetime. Diabetic wounds that are left untreated may lead to an amputation. In fact, one in five people with a diabetic ulcer may eventually require an amputation and diabetic wounds are by far the most common cause of non-traumatic lower limb amputations.
Diabetes affects the foot in multiple ways that increase the risk of ulceration. Diabetes affects the musculature of the foot and can cause an imbalance in the foot and change the distribution of pressure across the foot. Areas not meant to bear-weight may take increased stress and break down. This is further complicated by neuropathy, or a lack of protective sensation to the foot. Patients with a lack of sensation from diabetes are unable to sense pain and may develop a break in their skin without even knowing it.
Once ulceration occurs, it is important to have it treated quickly. Any opening in the skin increases the patient’s risk for infection. If the foot infection spreads too quickly, amputation may be necessary to salvage the limb and life of the patient.
Patients presenting with a diabetic foot ulcer should be tested for adequate circulation to the foot, as diabetes can also affect the circulation into foot. Adequate blood flow is needed to ensure proper healing of the wound – without blood flow the wound will not heal. Infected wounds need to be drained of any infection and treated with antibiotics. There will always be surface bacteria on the wound, but keeping the bacterial load in wounds down is one of the keys to healing a wound. Debridement of a wound, which means to cut away any dead tissue surrounding or within the wound, is one of the key ways to reduce the bacterial load in a wound.
After making sure there is circulation and that any infection is well controlled, one of the mainstays to treating a diabetic foot ulcer is to offload it. Since diabetic foot wounds develop often due to repetitive stress in a particular area, our goal is to distribute the pressure differently in order to heal the wound. Many modalities can be used for this and each modality can be beneficial. Modalities can include a total contact cast, walking cast, healing sandal, or orthotic. Some patients may require surgery either to realign deformities or remove bony prominences that may be causing increased pressure in the area of concern.
The prevalence of diabetes is increasing and with it diabetic foot wounds. Diabetic foot wounds may lead to amputation, so it is important to have them treated promptly by a professional. Podiatrists are experts in the field of diabetic foot wounds and we not only evaluate and treat wounds, but we aim to prevent them from recurring once they are healed.