Foot ulcers are a common complication of the “diabetic foot”. They allow a portal for infection to occur.
What is a Diabetic Foot Ulcer?
A Diabetic foot ulcer is where an area of skin has broken down and you can see the underlying tissue. Most skin ulcers occur on the lower legs and feet as a result of these areas being subject to weight bearing, these include
- Bottom of the feet
- Tips of the most prominent toes
- Heels of feet
In Diabetic people, or those with poor circulation, the skin on the feet does not heal as quickly and is prone to develop ulcers. The reduced blood flow to the foot results is slow healing and low sensitivity. As a result, diabetic foot ulcers are responsible for more hospitalizations than any other complication associated with Diabetes.
What Causes Diabetic Foot Ulcers?
Foot ulcers are caused by a range of problems but are not limited to poor fitting shoes, nerve damage, poor circulation , damage to the foot and infections.
POOR FITTING SHOES
When you wear poor fitting shoes you may get red spots, sore points, blisters, and even pain associated with wearing shoes. This is because shoes may rub and cause friction or be too tight and constrictive on the foot. Common foot abnormalities such as flat feet, bunions or hammer toes also cause diabetic foot ulcers from the pressure and friction associated with shoes that fit incorrectly.
People with long-standing or poorly controlled Diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.
Because of the nerve damage, a person may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
A person with Diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
Especially when poorly controlled, Diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
TRAUMA TO THE FEET
Any trauma to the foot can increase the risk for a more serious problem to develop.
What are the Symptoms of Diabetic Foot Ulcers?
It is not unusual for patients to have Diabetic foot ulcers for some time before presenting to doctors because they are frequently painless and therefore unaware that they. Symptoms of Diabetic ulcers include but are not limited to:
- Persistent pain
- Redness especially when surrounding a wound, or of abnormal rubbing of shoes or socks.
- Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation.
- Localized warmth perhaps from wounds that won’t heal or that heal slowly.
- Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection.
- Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete’s foot, and ingrown toenails may lead to more serious bacterial infections.
- Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
- Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
People suffering from Diabetes should look for cuts, scratches, bruises and sores on the foot, changes to the toenail. Use a mirror if you cannot see under the foot. Tissue around the ulcer may become black due to the lack of healthy blood flow to the foot. In severe cases partial or complete gangrene may occur.
If you do notice any cuts, corns or callus (callus can cover an ulcer making it harder to detect) on your feet have them checked out by a podiatrist. A medical pedicure is the best and safest way to have your feet assessed and treated to prevent any further problems.
What do Diabetic Foot Ulcers look like?
In the most serious of cases, if left the ulcers are untreated the ulcer will become infected and the surrounding skin will die causing gangrene from lack of circulation. This can lead to amputation.
How are Diabetic Foot Ulcers Treated?
The primary goal in the treatment of Diabetic foot ulcers, is to get the wounds healing as soon as possible. The faster the healing takes place the less chance there is of infection. There are several key factors in the appropriate treatment of a diabetic foot ulcer:
- Prevention of infection
- Taking pressure off the sore areas, called “off-loading”.
- Removing dead skin and tissue, called “debridgement”.
- Applying medication or dressings to the ulcer.
- Managing blood glucose and other health problems.
Not all ulcers are infected; however if you are diagnosed with an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
When something does go wrong, see a Podiatrist immediately. Waiting a “few days to see what happens” before seeing someone may be the difference between a good and poor outcome. The sooner treatment is started the faster the healing can begin. Please avoid home treatments as these often make conditions worse.
At Podiatry HQ we have qualified Podiatrists that are able to provide you with the appropriate treatment and work with you on the prevention of further complications.