Approximately 15 percent of individuals with diabetes develop a diabetic foot ulcer, which is an open sore or wound typically found on the underside of the foot. Among those who have a foot ulcer, around 6 percent may require hospitalization due to infection or other complications associated with the ulcer.
Diabetes is the primary reason for non-traumatic lower extremity amputations in the United States, with around 14-24 percent of diabetic patients developing a foot ulcer that will necessitate amputation. A foot ulcer occurs before 85 percent of diabetes-related amputations. Studies indicate that the occurrence of a foot ulcer can be avoided.
Causes of Diabetic Ulceration
Foot ulcers can develop in individuals with diabetes. Native Americans, African Americans, Hispanics, and older men have a higher likelihood of developing ulcers. Those who use insulin, as well as patients with diabetes-related kidney, eye, and heart conditions, are at an increased risk of foot ulcer development. Being overweight and consuming alcohol and tobacco also contribute to the formation of foot ulcers.
Ulcers are a result of various factors, including reduced sensation in the foot, poor blood circulation, foot deformities, irritation (such as friction or pressure), and trauma, along with the duration of diabetes. Over time, individuals with diabetes may develop neuropathy, which is a diminished or complete loss of sensation in the feet due to nerve damage caused by prolonged high blood glucose levels. Nerve damage can occur silently without pain, leading to an unawareness of the issue. A podiatrist can assess neuropathy in the feet using a straightforward and painless device known as a monofilament.
Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body's ability to fight off a potential infection and also slow healing.
Symptoms
Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.
When to Visit a Podiatrist
Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.
Diagnosis and Treatment
The main objective when treating foot ulcers is to achieve healing as quickly as possible to minimize the risk of infection. Key factors in the proper treatment of diabetic foot ulcers include preventing infection, off-loading pressure from the area, debriding dead skin and tissue, applying medication or dressings, and managing blood glucose levels and other health issues.
Not all ulcers are infected, but if an infection is diagnosed by a podiatrist, a treatment plan involving antibiotics, wound care, and potential hospitalization will be required. To prevent infection, it is crucial to maintain tight control of blood glucose levels, keep the ulcer clean and bandaged, cleanse the wound daily, and avoid walking barefoot.
For optimal healing, especially for ulcers on the bottom of the foot, off-loading is essential. Special footgear, braces, castings, wheelchairs, or crutches may be recommended to reduce pressure and irritation on the ulcer, expediting the healing process.
Recent advancements in wound care have shown that keeping wounds covered and moist accelerates healing and reduces infection risks, contrary to the outdated belief of exposing wounds to air. Avoiding practices like using full-strength betadine, hydrogen peroxide, whirlpools, or soaking is advised to prevent complications.
Effective wound management involves using dressings and topically-applied medications, ranging from normal saline to growth factors, ulcer dressings, and skin substitutes proven to be highly successful in healing foot ulcers. Adequate circulation to the ulcerated area is crucial for wound healing, which can be determined through noninvasive tests by a podiatrist.
Maintaining tight control of blood glucose levels is paramount throughout the treatment of diabetic foot ulcers. Collaborating closely with a medical doctor or endocrinologist to manage blood glucose levels will enhance the healing process and reduce the likelihood of complications.
Treatment Options: Most non-infected foot ulcers are initially managed without surgical intervention; nonetheless, if conservative treatment proves ineffective, surgical intervention may be necessary. Surgical procedures aimed at alleviating pressure on the affected area may involve bone shaving or excision, as well as the correction of deformities like hammertoes, bunions, or bony protrusions.
The healing process duration is influenced by various factors, including wound size and location, pressure on the wound during weight-bearing activities, swelling, circulation, blood glucose levels, wound care practices, and the type of dressing used. Healing may range from a few weeks to several months.
Prevention
To effectively manage a diabetic foot ulcer, it is essential to focus on prevention before it occurs. Following recommended guidelines, regular visits to a podiatrist are crucial. By consulting with your podiatrist, you can assess your risk level for developing a foot ulcer and establish preventive measures.
High-risk factors include neuropathy, poor circulation, foot deformities (e.g., bunions, hammer toes), wearing improper footwear, uncontrolled blood sugar, and a history of previous foot ulcers. Mitigating additional risks like smoking, alcohol consumption, high cholesterol, and elevated blood glucose is vital for diabetic foot ulcer prevention and treatment. Choosing suitable shoes and socks significantly reduces risks, and your podiatrist can offer advice on selecting the right footwear.
Learning how to conduct regular foot checks is imperative to detect any issues early. Daily inspections, particularly of the sole and between the toes, for cuts, bruises, cracks, blisters, redness, ulcers, or any abnormalities are essential. During healthcare visits, make sure to remove your shoes and socks for a thorough foot examination. Promptly report any identified problems to your podiatrist, regardless of their perceived severity.
The cornerstone of successful wound healing lies in consistent podiatric care that adheres to the "gold standard" of treatment, which includes managing blood sugar levels, proper wound debridement, addressing infections, minimizing friction and pressure, and restoring adequate blood circulation.
Ensuring the health of your feet is crucial for your overall well-being. If you are experiencing foot problems associated with diabetes such as diabetic ulcers, corns, calluses, blisters, fungal/thick toenails, or other issues, contact us for professional guidance and treatment. Your feet will thank you!
Dr. Johnston's schedule at our Perrysburg office:
Tuesday 8am - 5pm
Wednesday 8am - 12pm
Friday: 8am - 1pm
Heel and Toe Podiatry
1021 Sandusky St. Suite A
Perrysburg, OH
419-474-7700
A foot Doctor Near Me in Perrysburg
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