According to the American Diabetes Association, 1.5 million Americans are diagnosed with diabetes each year. About half of diabetic patients have some type of neuropathy (nerve damage).
Diabetic neuropathy (in addition to poor circulation caused by diabetes) makes patients more likely to suffer from foot problems. In this article, we will be focusing on diabetic foot ulcers.
What is a diabetic foot ulcer?
A diabetic foot ulcer is an open sore or wound on the foot. It’s a very common complication of diabetes, affecting about 15% of diabetes patients. Of those affected, 12-14% of patients with diabetic foot ulcers will require amputation. In fact, foot ulceration precedes 85% of diabetes-related lower-extremity amputations.
According to the American Podiatric Medical Association (APMA), 6% of diabetic patients who develop a foot ulcer will require hospitalization due to infection or other ulcer-related complications. An article published in the International Journal of Infection Diseases in 2015 put the incidence of diabetic foot infections at a lifetime risk of up to 25%.
So, it’s important to seek care for diabetic foot wounds early or take steps to prevent diabetic foot problems altogether.
Dr. Baravarian discusses diabetic foot ulcers
Why does diabetes affect your feet?
High blood sugar levels lead to nerve damage, especially in the feet and lower legs. Diabetic neuropathy prevents a patient from feeling sores, cuts, blisters, or other damage to the feet. Neuropathic ulcers occur due to the loss of feeling in the feet; unnoticed cuts or sores are left untreated to become more severe ulcers.
Diabetes also causes blood vessels in the feet and legs to narrow and harden, decreasing blood flow. People with type 2 diabetes are also at risk for peripheral arterial disease (PAD). With PAD, buildup on the walls of blood vessels causes them to narrow. Poor blood flow (ischemia) in the feet inhibits the healing of injuries and increases the risk of diabetic foot infections.
The combination of diabetic neuropathy and poor circulation put diabetics at higher risk for infections and more serious foot problems such as Charcot foot deformities, gangrene, bone infections (osteomyelitis), and even amputation.
Diabetic Foot Ulcer Symptoms
Many people who develop foot ulcers no longer feel pain in their feet. So, to detect diabetic foot ulcers early, you have to keep an eye out for other signs.
Common symptoms include:
- drainage or pus
- redness
- swelling
- odor
- open lesions or sores
- cracks
If you notice the symptoms of an ulcer (or any other injuries to your feet) contact your podiatrist or diabetes care team immediately.
Diabetic Foot Ulcer Risk Factors
Anyone with diabetes is at risk of a foot ulcer. People with peripheral neuropathy, poor glycemic control, and vascular disease are considered high-risk for ulcers and associated complications.
Other risk factors include:- smoking
- diabetic kidney disease
- previous foot ulceration
- insulin use
- obesity
To be fully informed of your risk, speak with a podiatrist to test for neuropathy. As nerve damage can occur without pain, your podiatrist can test your feet with a simple, painless tool called a monofilament. Patients who are unable to feel the monofilament are “insensate” and are 10 times more likely to develop a foot ulcer than their “sensate” counterparts.
Treatment of Diabetic Ulcers
As soon as you’ve noticed symptoms of an ulcer, get to your doctor. The goal for treating diabetic feet issues is to start as soon as possible to reduce the risk of infection and the need for limb amputation.
There are several key factors in the treatment of a diabetic foot ulcer:
Prevent Infection
High morbidity and mortality rates are associated with diabetic foot ulcers. Therefore, oral and topical antibiotics will be prescribed if there is any sign of infection. Plain gauze may damage the skin, so wound dressings are typically combined with antimicrobial agents. Alginate dressings keep the wound from drying out and accelerate healing. Their high absorbency for moderate to heavy exudate (drainage).
If the ulcer has dying tissue, hydrogels or dressings with collagen are most effective as they also help keep the wound moist.
Offloading
For the best healing, especially if the ulcer is on the plantar surface (bottom) of the foot, pressure must be taken off the ulcer. Known as “offloading,” pressure is taken off through the use of special footwear, braces, casts, or mobility aid (such as a wheelchair or crutches). These devices decrease pressure and irritation on the ulcer as it heals, speeding the healing process.
If you’re given a removable offloading device (such as a special shoe or brace) make sure to wear it as directed by your doctor!
Debridement
Debridement is the removal of calluses around the wound as well as necrotic tissue. In the case of an abscess, debridement of abscessed tissue will be required after professional drainage.
Dressing the Wound
You may have heard it’s important to let air get at wounds to heal them. We now know that advice to be harmful to healing. Wounds and ulcers heal faster and are less likely to get infected if they’re covered and kept moist. Wound management includes topically applied medications ranging from saline to growth factors (medications that trigger tissue repair) as well as proper wound dressings. Skin substitutes and collagen-infused dressings have been shown to be very effective in the treatment of foot ulcers.
An X-ray may be ordered to look for signs of bone infection.
Learn more about our wound management options here.
Diabetic Foot Ulcer Surgery
Most non-infected foot ulcers don’t require surgery. However, if non-surgical treatment fails, surgical management may be necessary.
Surgical care may include shaving or excision of bone and the correction of deformities (hammertoes, bunions, bony prominences).
For ischemic ulcers (ulcers related to poor blood flow in the feet), a vascular surgeon should be consulted.
For difficult ulcers that refuse to heal, more advanced therapies can be considered. Advanced diabetic foot ulcer wound care may involve grafts with recombinant growth factors, stem cell therapy, or hyperbaric oxygen therapy.
In the worst-case scenario, the ulcer can develop gangrene and your doctor may need to amputate the affected area.
How To Prevent Diabetic Foot Ulcers
“An ounce of prevention is worth a pound of cure.” Prevention of diabetic foot ulcers is the most effective treatment.
Proper management of diabetes and blood glucose levels not only helps promote wound healing and prevent chronic wounds, it also minimizes risk factors that lead to diabetic foot ulcers to begin with.
To care for your diabetic feet, it is essential you:
- Examine feet daily and report any ulcers or abnormalities to your health care team.
- Wash feet daily, making sure to thoroughly dry the feet and between the toes afterwards.
- Use high-quality foot cream to prevent skin from getting dry and cracked.
- Always wear footwear to protect your feet from accidental injury.
- Cut toenails straight across to prevent ingrown nails. Toenails can also be cut by a professional to decrease risk of injury.
- Have a foot exam with your doctor of podiatric medicine (DPM) every year and attend any follow-up appointments.
University Foot and Ankle Institute, the Best Choice for Diabetic Wound Care
University Foot and Ankle Institute specializes in all aspects of diabetic foot care and has expertise in all forms of ulcer treatment including specialized brace formation, casting technique, surgical wound closure, and genetic skin graft use.
Our physicians will carefully craft an individualized treatment plan for you, we never take a “cookie-cutter approach” to treatment.
Our nationally recognized foot and ankle specialists offer the most advanced podiatric care and the highest success rates in the nation. We are leaders in researching, diagnosing, and treating all foot and ankle conditions, specializing in diabetic foot complications.
At University Foot and Ankle Institute, we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations.
For more information or to schedule a consultation with one of our health care providers in the greater Los Angeles area, please call (877) 736-6001 or make an appointment now.
University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area as our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California.
Upon graduation in 2001, Franson accepted a three-year residency program at the Greater Los Angeles VA and UCLA County Hospital.
Dr. Franson specializes in several areas including total ankle replacement and sports medicine.
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