DIABETIC FOOT ULCERS

Diabetic foot ulcers are extremely common—85 percent of all lower limb amputations are attributed to them. Diabetic foot ulcers affect approximately 15 percent of all diabetic patients. Of those, 15–20 percent loses a limb to amputation. Foot ulcers usually begin as small sores or cuts in the skin. Because of the loss of sensation, a small sore or a minor cut or abrasion may not be felt and may develop into a serious infection or ulcer. Walking around barefoot increases the risk of incurring a minor injury that can progress quickly to an ulceration or infection.

People who suffer from peripheral sensory neuropathy are highly susceptible to foot ulcers. Peripheral sensory neuropathy is a condition in which damage has occurred to the peripheral nervous system (the communication network that transmits information from the brain and spinal cord to all parts of the body). For example, when you have cold feet, this system informs your brain that your feet are cold. If this system is damaged, transmitters may send mixed signals, or they may not transmit at all.

Diabetic Foot Symptoms

1. resistant burning pain or numbness
2. Redness around a wound
3. Swelling of the feet or legs
4. Hair no longer growing on lower legs and feet
5. Hard, shiny skin on legs and feet
6. Localized warm sensation on foot
7. Breaks in skin
8. Wound that is draining
9. Difficulty walking
10. Fever or chills (this usually means the infection is life- or limb-threatening)

What Causes the Diabetic Foot?
Diabetes is known to cause many complications that contribute to diabetic foot problems. Diabetes disrupts our vascular system and affects many parts of the body, including the eyes, kidneys, legs, and feet. Several risk factors can increase your chances of developing a diabetic foot problem. These factors may include:

1. proper footwear, which may lead to calluses, corns, blisters, red spots, and pain
2. Foot abnormalities such as flat feet, bunions, or hammertoes
3. Nerve damage, known medically as peripheral neuropathy
4. Poor circulation
5. Trauma to the foot
6. Infections such as athlete’s foot, ingrown toenails, or fungal infections

Diabetic Foot Prevention

1. Wash feet daily with mild soap and warm (not hot) water.
2. Do not soak your feet; this leads to dry skin.
3. Keep the skin on the top and bottom of your feet smooth and moisturized.
4. Do not use lotions between your toes.
5. Do not smoke.
6. Control your blood sugar levels.
7. Inspect your feet daily for changes in your skin.
8. Use custom-molded orthotics to protect your feet.
9. Always wear properly fitting, undamaged, and supportive shoes and socks.
10. Discontinue using shoes and socks with holes in them.
11. Avoid sandals, high heels, and other forms of open-toe shoes.
12. Avoid antiseptic solutions on the feet, as they can burn or injure the skin.
13. Do not step barefoot on hot surfaces, and avoid extreme heat on your feet.
14. Do not treat sores, corns, or calluses on your own without consulting your doctor.
15. Report any damage, pain, or changes in your feet immediately.
16. Seek medical care for any wounds that develop.
17. Wear socks to bed if your feet are cold.
18. Remove obstacles around your home and workplace to reduce the chances of tripping or injuring your feet.
19. Exercise or move around often; this helps to improve circulation.
20. Avoid wearing tight clothes and shoes that may cut off circulation to your legs and feet.
21. Avoid crossing your legs for long periods.
22. Before exercising, always perform a quick warm-up routine.
23. After exercising, always perform a quick cool-down routine.
24. Proper socks to cushion your and wick away moisture

When to See Your Foot and Ankle Surgeon
If you suspect you may be developing a diabetic foot problem, it is usually best to contact your doctor at the first sign of symptoms. Early intervention can usually prevent a trip to the emergency room or a hospitalization. Write down a list of symptoms so you have them handy when talking with the doctor. This information will help the doctor to determine the relative urgency of the situation and establish a plan of action. Your doctor may wish to see you immediately, but should make an appointment to see you within 72 hours or less. Call your doctor if any of the following occurs:

1. Trauma to the legs or feet, ranging from minor to severe
2. Persistent mild-to-moderate pain in the feet
3. New blisters, wounds, or ulcers appear
4. New areas of warmth, redness, or swelling in the feet
5. Pain or soreness around the toenail
6. New or constant numbness in foot (this could be a sign of neuropathy)
7. Constant itching of the skin on foot
8. Difficulty walking

TIP: Talk with your doctor about removing calluses and corns that may develop on your feet. These should be professionally removed.

Diabetic Foot Treatment
Treatment for your diabetic foot problem will be based on the symptoms you are experiencing. If you are suffering from mild to moderate foot ulcers, simple wound-care measures are usually recommended, and oral antibiotics may be prescribed if a mild infection is present. For more serious ulcers or infections, hospital admission for IV antibiotics may be necessary. Proper wound care is essential to the healing process. For more serious cases, the doctor may prescribe a home-health nurse to help care for the wounds and dressings. If the infection cannot be cured with wound-care and antibiotic medications, surgical debridement to remove infected and damaged tissue will likely be necessary. Severe or extensive tissue damage may require amputation of the foot. During all stages of a diabetic’s life, preventive measures such as those listed above are highly recommended to avoid diabetes-related foot problems. Even if you are not suffering from ulcers, your podiatrist can help you improve other aspects of your life, such as your footwear, dietary habits, and physical fitness, which can reduce your chances of developing a diabetic foot problem.