Never ignore diabetic foot ulcers

One of the hallmarks of good diabetes care is paying attention to your feet.  Good foot care involves taking time every single day to inspect your feet and to have your doctor do the same every single time you see them.  One of the biggest reasons why is to prevent foot ulcers.  People with diabetes often experience problems with their feet, caused by changes to the body that come with the disease. 

What are diabetic foot ulcers?

Diabetic foot ulcers are red sores that can occur most often on the pad or ball of the foot or the bottom of the big toe.  Ulcers can form for several reasons – poorly fitted shoes, wearing new shoes that are not broken in, taking an extra-long walk where you rub a small callus or blister on your foot, or dropping something onto your foot causing skin breakage.  If an ulcer is caused by improperly fitting shoes, they tend to form on the sides of the foot, the tops of the toes, or the heel of the foot.

Typically what draws your attention to a foot ulcer is drainage on your sock.  The drainage will be a fluid that may be yellow, brown, or red and may contain pus or blood.  

Normally, if you have good feeling in your feet, you will be aware of any pain or discomfort and will either put on more comfortable shoes or take care in protecting your feet better.  But, some people with diabetes may have developed nerve damage (neuropathy) which leads to a narrowing of the blood vessels, changes in the skin and changes in the size and shape of toes and feet. 

Neuropathy can cause a feeling of tingling, burning or stinging pain or loss of sensation or feeling in your feet.  It’s the loss of feeling that can be dangerous.  This means you are less likely to feel pain or extremes of hot or cold.  You may not notice if have a pebble caught in your shoe that has created a blister or that you have stepped on a sharp object while barefoot that can lead to the beginning of a foot ulcer.

Up to 10 percent of people with diabetes will end up with a foot ulcer.  Foot ulcers can cause the skin to wear away, most commonly because of the damaged nerves in the feet resulting from diabetes. 

Why are foot ulcers so serious?

The thing that makes foot ulcers especially serious is the soft tissues of feet.  This tissue is not like other parts of the body as infections can get to the muscle and bone very quickly.  If the tissue becomes infected along with poor blood flow, this can lead to serious complications. 

The scenario you want to avoid is having an amputation of a toe, part of your foot, the entire foot or your leg. This is why it is vital that once you suspect you have a foot ulcer, to see your doctor right away and do not wait to try to heal it on your own. 

Typically, your doctor will want to order an X-ray, and possibly an MRI, if the ulcer is worsening.  They will want to assess to see if the infection from the ulcer has gotten into the bone. 

How is foot ulcers treated?

To treat a foot ulcer depends on whether it is infected or not.  If the ulcer is not considered to be infected, a bandage will be put on your ulcer with your healthcare providing instruction on changing your bandage.  You may be instructed to clean the wound and change the bandage daily with the bandage containing medicines to help your ulcer heal. 

If your foot ulcer is infected, your healthcare provider will want to remove or debride any dead tissue. Debriding is to remove dead skin and tissue around your foot ulcer to help with healing.  When this tissue is taken off it begins the body’s natural healing mechanism.  A dressing will be applied to the wound which you will need to change regularly. 

Most likely your doctor will want you to avoid any pressure or “offload” on the affected part of your foot as continued pressure on the sore will only worsen it.  Therefore, you may have to wear a cast, surgical shoe or boot to keep weight off the injured site while the wound heals. 

The foot ulcer should heal within a month or 4 weeks. If it has not or you develop a bone infection, then you may require more advanced therapies.  One of the treatments that may be tried is to use hyperbaric oxygen therapy or negative pressure wound therapy to increase blood flow to the infected area. 

How to prevent foot ulcers

Good foot care is a must to help prevent ulcers or keep them from getting worse.  There are several things you can do to prevent diabetic foot ulcers from ever happening:

·       Every day, inspect your feet using a handheld mirror.  Look at and feel your feet by running your hands along the tops, bottoms, sides, and between and under your toes.  What you are looking for is anything out of the ordinary or something that has changed.  Check for any wounds, blisters, corns, and calluses.  Do not try to remove corns or calluses yourself – have your doctor or a podiatrist do that.  Always file or cut your toenails straight across.   

·       Keep your blood sugar levels under control.  Practice making healthy food choices, taking your medications as directed and monitoring your blood glucose levels daily.  

·       Wash your feet daily with soap and warm water.  Do not use hot water as this can injure your feet.  Dry your feet gently with a towel after you wash them and be sure to dry between and under your toes.  Put lotion or moisturizer on your feet but do not put it between your toes.

·       Protect your feet. Do not walk barefoot or wear your shoes without socks.  Check your shoes for rocks or other objects that can hurt your feet.  Wear cotton socks to help keep your feet dry and change your socks daily. Do not wear socks that are dirty or damp.

·       Wear shoes that fit well.  Wear shoes that do not rub against any area of your foot and choose shoes that are ½ to ¾ inch longer than your feet.  Walking or athletic shoes with laces or straps that adjust are best. 

Other steps to take to prevent diabetic foot ulcers include not smoking or drinking alcohol, maintaining a healthy weight, and to manage your blood glucose levels.