Common Health Issues

Diabetes Foot Ulcers

• By Rich Health Editorial Team
• November 07, 2021

An ulcer is open sore. In people with diabetes, especially those with sensorimotor neuropathy, ulcers commonly develop on the bottom of the foot or tip of a toe. An ulcer can develop from any source of irritation to the skin: a corn or callus that grows too thick, excessive pressure or abrasion of one part of the foot, or a splinter or other type of trauma that injures the surface of the foot. If you have neuropathy you may not even notice that you have hurt yourself or that your skin is irritated, because you can’t feel the pain. 

 

But the wound could still be doing you harm, even if it doesn’t hurt. If you continue to walk on your injured foot, you can make the ulcer worse. It may be slow to heal and is likely to become infected. An infection can be even harder to cure and may eventually penetrate the bone, a condition that could require amputation.

 

DIABETES FOOT ULCERS SYMPTOMS

The most obvious sign of a foot ulcer is an open sore on the bottom of your foot or toe. However, it is very likely that you will feel no pain. If you notice any open sore, bleeding or irritation, no matter how small, you may have an ulcer or be at risk for developing one. Even if you don’t have a visible ulcer, any sort of callus, corn or area of redness requires prompt attention. If there is any redness, swelling, warmth or drainage around the ulcer, you may have an infection.

 

DIABETES FOOT ULCERS RISK

Untreated ulcers can put you at great risk for infection and foot amputation. The risk is greatest among people with diabetes who maintain poor blood glucose control and among those who smoke. Among people with diabetes, 90% of all foot amputations occur in people who smoke. If you have any signs of neuropathy or peripheral vascular disease, your risk of developing foot ulcers and infection is greatly increased.

 

What You Should Do

If you notice any sort of cut, abrasion or open sore on your foot, call your doctor right away. The sooner you begin treatment, the greater you decrease the risk of infection. Don’t put off seeking treatment because it doesn’t hurt or the sore is not too big. You need to be seen by your doctor or foot care specialist. In the meantime, if you have any ulceration, do not walk on your injured foot and do not exert any pressure on the ulcer. This will only make it worse and increase the risk of infection.

 

Also make sure to keep your blood glucose levels under control. If you have an ulcer, you are at risk for developing an infection. You need a healthy immune system to fight off infection, and high levels of glucose in your blood impair the ability of your white blood cells to fight infection.

 

DIABETES FOOT ULCERS TREATMENT

Your doctor will evaluate the depth and size of the ulcer. Your foot will also be X-rayed to determine whether there is any foreign matter in your foot, whether there are signs of infection in the bone, and whether there is any gas or air deep in the wound. Gas or air in a wound is a sign of infection. 

 

Your foot may also be examined using a more sophisticated imaging technique, such as magnetic resonance imaging. Your doctor may also choose to biopsy your ulceration, especially if it is in an unusual place. Most foot ulcers develop on the toes or the ball of the foot. If you find an ulcer somewhere else, your doctor will want to find out what caused it. A biopsy may also be in order if the ulcer is not responding to treatment.

Your doctor will probably remove or debride any dead tissue present in your ulcer. Dead tissue makes it more difficult to heal and increased the chances of infection. Your doctor will also culture material from the ulcer to make sure there are no bacteria or other microorganisms present, which indicate infection.

 

While your ulcer is healing, you will need to keep it clean and dry. Your doctor will give you instruction on daily care, including how to clean it and what dressings to apply. You may be given an over-the-counter or prescription antibiotic solution or ointment to apply to the wound to prevent infection. Your doctor may suggest applying a wad of plain gauze that has been soaked in an antiseptic solution. This can be applied to the open ulcer once or twice a day. If there is any sign of a fissure or crack in the skin, treat it with an antibiotic ointment daily and cover with plain gauze.

 

A foot ulcer can take months to heal. It is important during this period to keep your blood glucose levels under control and to stay off your foot. Peripheral vascular disease can impair the healing of a foot ulcer. If you have significant blockages that are preventing blood flow to your legs, your doctor may suggest bypass surgery. Any evidence of infection could also be hindering the healing of your ulcer.

 

DIABETES FOOT ULCERS PREVENTION

You can take several steps to minimize the risk of developing foot ulcers and infections. Make sure to visit a foot specialist on a regular basis. You need to see a podiatrist who is trained in the care of the diabetic foot. Your podiatrist should examine your feet and check for signs of neuropathy, circulatory problems and any potential trouble spots. Your podiatrist will also trim your toenails and calluses before they become a problem. You should see your foot care specialist several times each year. If you have any signs of neuropathy, foot deformities, peripheral vascular disease or previous foot ulcers, you should schedule your appointments more frequently.

Your podiatrist should also determine whether you need any special therapeutic footwear or any orthoic devices to keep your feet well protected. You may find that a good pair of athletic shoes work just fine. Make sure to bring your regular shoes to your appointment so that your podiatrist can tell whether any changes are needed. 

 

Your podiatrist will also determine whether you need any special accommodations to reduce pressure points in your feet. You may need extra padding, insoles, orthoics, or special therapeutic shoes. Your podiatrist will also evaluate whether you need any sort of prophylactic surgery to correct any existing or developing foot deformities, such as hammertoes.

 

In addition to regular visits to your doctor and podiatrist, there are several steps you can take to prevent ulcers from developing or getting worse. You can start by inspecting your feet daily for signs of blistering, bleeding, abrasion, ulceration or lesions on the bottom of the feet and between the toes. Use a mirror to see the bottom of your feet and toes. Ask family member to help if necessary to ensure a thorough inspection. Make this a part of your daily routine, much like brushing your teeth.

 

Wash your feet daily with warm, soapy water. Dry them well, especially between the toes. When you are done, put on clean socks. Use a moisturizing lotion on your feet each day, preferably after they are clean and dry. Make sure to avoid any lotions that list alcohol as the first ingredient. Keep your toenails trimmed, following the curve of your toe. If you have a difficult time doing this, schedule regular, frequent appointments with your podiatrist, who will do it for you.

 

Don’t soak your feet. Also avoid the use of acids or chemical corn removers. If you have corns or calluses, schedule an appointment with your podiatrist as soon as possible. Don’t try any ‘bathroom surgery’ or try to remove corns, calluses or treat ingrown toenails on your own.

 

Avoid extremes in temperature. Don’t use any hot water bottles or heating pads, ice packs, or electric blankets on your feet. Before you get in a bathtub, test the water with your elbow.

 

Don’t walk barefoot, ever. Make sure you have a pair of well-fitting shoes that have been approved by your podiatrist. Before you put on your shoes, check inside for any tacks, rough linings, bumps, stones or foreign objects. Call your doctor immediately if you notice any redness, pain or swelling in your foot, or if there is any sign of ulceration or infection.

 

Also, over the long haul, develop good lifestyle habits to prevent neuropathy and circulatory problems. Eat sensible, well-balanced meals and avoid too much dietary fat. Keep your blood glucose levels as close to normal as possible, and don’t smoke. By following these guidelines, you can avoid the likelihood of developing foot ulcers that could lead to infection and amputation

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Prevention of Foot Ulcers in The At-Risk Patient with Diabetes: A Systematic Review by J J van Netten, P E Price et al

Classification, Microbiology and Treatment of Diabetic Foot Infections by Reza Ghotaslou, Mohammad Memar and Naser Alizadeh

The Diabetic Foot: Pathophysiology, Evaluation and Treatment by Dennis Bandyk