Foot Conditions
Diabetic Wound Care
Description
A diabetic
foot ulcer is an open sore or wound that most com- monly occurs on
the bottom of the foot in approximately 15 percent of patients with
diabetes. Of those who develop a foot ulcer, six percent will be hospitalized
due to infection or other ulcer-related complication.
Diabetes
is the leading cause of nontraumatic lower extremity amputations in
the United States, and approximately 14 to 24 percent of patients
with diabetes who develop a foot ulcer have an amputation. Research,
however, has shown that the development of a foot ulcer is preventable.
Who Can
Get a Diabetic Foot Ulcer?
Anyone
who has diabetes can develop a foot ulcer. Native Americans, African
Americans, Hispanics and older men are more likely to develop ulcers.
People who use insulin are at a higher risk of developing a foot ulcer,
as are patients with diabetes-related kidney, eye, and heart disease.
Being overweight and using alcohol and tobacco also play a role in
the development of foot ulcers.
How do Diabetic Foot Ulcers
Form?
Ulcers
form due to a combination of factors, such as lack of feeling in the
foot, poor circulation, foot deformities, irritation (such as friction
or pressure), and trauma, as well as duration of diabetes. Patients
who have diabetes for many years can develop neuropathy, a reduced
or complete lack of feeling in the feet due to nerve damage caused
by elevated blood glucose levels over time. The nerve damage often
can occur without pain and one may not even be aware of the problem.
Your podiatric physician can test feet for neuropathy with a simple
and painless tool called 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 retard healing.
What is the Value of
Treating a Diabetic Foot Ulcer?
Once
an ulcer is noticed, seek podi- atric medical care immediately. Foot
ulcers in patients with diabetes should be treated for several reasons
such as, reducing the risk of infection and amputation, improving
function and quality of life, and reducing health care costs.
How Should a Diabetic Foot
Ulcer be Treated?
The
primary goal in the treatment of foot ulcers is to obtain healing
as soon as possible. The faster the healing,
the less chance for an infection.
There
are several key factors in the appropriate treatment of a diabetic
foot ulcer:
- Prevention
of infection.
- Taking the
pressure off the area, called “off-loading.”
- Removing
dead skin and tissue, called “debridement.”
- Applying
medication or dressings to the ulcer.
- Managing
blood glucose and other health problems.
Not
all ulcers are infected; however if your podiatric physician diagnoses
an infection, a treatment program of antibiotics, wound care, and
possibly hospitalization will be necessary.
There
are several important factors to keep an ulcer from becoming infected:
- Keep blood
glucose levels under tight control.
- Keep the
ulcer clean and bandaged.
- Cleanse
the wound daily, using a wound dressing or bandage.
- Do not walk
barefoot.
For
optimum healing, ulcers, especially those on the bottom of the foot,
must be “off-loaded.” Patients may be asked to wear special
footgear, or a brace, specialized castings, or use a wheelchair or
crutches. These devices will reduce the pressure and irritation to
the ulcer area and help to speed the healing process.
The
science of wound care has advanced significantly over the past ten
years. The old thought of “let the air get at it” is now
known to be harmful to healing. We know that wounds and ulcers heal
faster, with a lower risk of infection, if they are kept covered and
moist. The use of full strength betadine, peroxide, whirlpools and
soaking are not recommended, as this could lead to further complications.
Appropriate
wound management includes the use of dressings and topically-applied
medications. These range from normal saline to advanced products,
such as growth factors, ulcer dressings, and skin substitutes that
have been shown to be highly effective in healing foot ulcers.
For
a wound to heal there must be adequate circulation to the ulcerated
area. Your podiatrist can determine circulation levels with noninvasive
tests.
Controlling Blood Glucose
Tightly
controlling blood glucose is of the utmost importance during the
treatment of a diabetic foot ulcer. Working closely with a medical
doctor or endocrinologist to accomplish this will enhance healing
and reduce the risk of complications.
Surgical Options
A
majority of noninfected foot ulcers are treated without surgery; however,
when this fails, surgical management may be appropriate. Examples
of surgical care to remove pressure on the affected area include shaving
or excision of bone(s) and the correction of various deformities,
such as hammertoes, bunions, or bony “bumps.”
Healing Factors
Healing
time depends on a variety of factors, such as wound size and location,
pressure on the wound from walking or standing, swelling, circulation,
blood glucose levels, wound care, and what is being applied to the
wound. Healing may occur within weeks or require several months.
How Can a Foot Ulcer be Prevented?
The
best way to treat a diabetic foot ulcer is to prevent its development
in the first place. Recommended guidelines include seeing a podiatrist
on a regular basis. He or she can determine if you are at high risk
for developing a foot ulcer and implement strategies for prevention.
You
are at high risk if you:
- have neuropathy,
- have poor
circulation,
- have a foot
deformity (i.e. bunion, hammer toe),
- wear inappropriate
shoes,
- have uncontrolled
blood sugar.
Reducing
additional risk factors, such as smoking, drinking alcohol, high cholesterol,
and elevated blood glucose are important in the prevention and treatment
of a diabetic foot ulcer. Wearing the appropriate shoes and socks
will go a long way in reducing risks. Your podiatric physician can
provide guidance in selecting the proper shoes.
Learning
how to check your feet is crucial in noticing a potential problem
as early as possible. Inspect your feet every day—especially
between the toes and the sole—for cuts, bruises, cracks, blisters,
redness, ulcers, and any sign of abnormality. Each time you visit
a health care provider, remove your shoes and socks so your feet can
be examined. Any problems that are discovered should be reported to
your podiatrist as soon as possible, no matter how “simple”
it may seem to you.
The
key to successful wound healing is regular podiatric medical care
to ensure the following “gold standard” of care:
- lowering
blood sugar
- appropriate
debridement of wounds
- treating
any infection
- reducing
friction and pressure
- restoring
adequate blood flow
The
old saying, “an ounce of prevention is worth a pound of cure”
was never as true as it is when preventing a diabetic foot ulcer.
Information provided by the American Podiatric
Medical Association
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