Dealing with diabetic foot ulcers
A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of persons with diabetes. It is most commonly located on the bottom of the foot and takes a long time or never heals. Of those who develop a foot ulcer, six to 10 percent will be hospitalized due to infection or other ulcer-related complications. Twenty-eight percent to 38 percent of diabetics with a previous ulcer will re-ulcerate within 12 months.
Worldwide, diabetes is the leading cause of non-traumatic lower extremity amputations, and approximately 15 to 24 percent of patients with diabetes who develop a foot ulcer will have an amputation. Almost all (85 percent) of all amputations are performed on persons who had a foot ulcer/wound that did not heal. Somewhere in the world someone gets an amputation due to diabetes every 30 seconds. However, numerous research studies have shown that the development of a foot ulcer and the subsequent amputation is largely preventable.
Who can get a diabetic foot ulcer?
Anyone who has diabetes is at risk and can develop a foot ulcer. Diabetics have a 15 percent chance of getting a foot ulcer in their lifetime.
The factors that put you at high risk for foot ulcers are neuropathy, poor circulation, foot deformity (i.e. bunion, hammer toe), wearing inappropriate shoes, and uncontrolled blood sugar. Research has shown that Native Americans, persons of African descent, Hispanics and older men are more likely to develop foot ulcers. People who use insulin, or who have diabetes-related kidney, eye, and heart disease are at higher risk of developing foot ulcers. Being overweight, having high cholesterol, drinking alcohol and smoking tobacco also play a role in the development of foot ulcers.
How do diabetic foot ulcers form?
Ulcers develop because of a combination of several factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation from poorly fitting shoes, and trauma. If left untreated, these injuries can turn into diabetic foot ulcers. Persons who have had uncontrolled diabetes with elevated blood glucose levels for many years can develop neuropathy (loss of the ability to feel pain in the feet due to nerve damage). Vascular disease can complicate foot ulcers, reducing the body’s ability to heal and increasing the risk of infections and amputations.
Elevations in blood glucose levels can also reduce the body’s ability to fight off a potential infection and delaying healing.
Preventing diabetic foot ulcers
If you have diabetes, it is important to check your feet for injuries you might not feel. See your podiatrist regularly to have your feet professionally examined at least once per year, just like your eyes and your kidneys. Here are some steps that can help you keep your feet healthier and in better shape.
Take control of your diabetes
• Know your A1C level, what it means, and what your doctor wants your number to be.
• Take your diabetes medications as prescribed by your doctor and maintain a healthy lifestyle.
• Keep all appointments with your healthcare team for regular check-ups.
Make a daily feet check part of your routine
• Look at your feet for cuts, sores, red spots, swelling, and injuries you may not feel.
• If you cannot see the bottom of your feet, use a mirror so you can see all the parts of your feet.
• Be sure to have your feet checked every time you visit a healthcare provider by taking off your shoes to remind them to look at your feet.
Follow the “3-Ws” foot care plan
• Wash your feet daily in warm (not hot) water. Always dry them well especially between the toes and keep your feet moisturized by using lotion, cream, or petroleum jelly on the tops and bottoms, but not between the toes.
• Wear socks and shoes that are breathable, provide cushioning, and fit well. Never walk bare feet, always take care to protect your feet and avoid injuries. If you have neuropathy and foot deformities you may need special diabetic shoes.
• Wiggle your toes and ankles several times per day to improve blood flow. Put your feet up while sitting, but don’t cross your legs or wear tight hoses or clothes around your feet.
If you develop or suspect an ulcer, you should see a podiatrist immediately. It Is important to treat diabetic foot ulcers as soon as possible to reduce the risk of infections and amputations, improve function and quality of life and reduce healthcare costs.
How a diabetic foot ulcer should be treated
The primary goal in treating diabetic foot ulcers is to heal it as soon as possible. The faster the ulcer heals the better, to decrease the chance for infection and amputation. Ulcers are treated in a number of ways to increase healing. Your podiatrist is professionally trained in treating ulcers and can help the ulcer heal quickly by taking the pressure off the ulcer, treating any infection and putting the right medication on the ulcer after checking blood glucose control and adequate blood supply dressing the ulcer.
It is vital for diabetics to keep their blood sugar under control because high blood sugar will delay healing. There are several things you can do to keep an ulcer from becoming infected and promote healing, including keeping your blood sugar under control, keeping the ulcer clean and bandaged, and limiting the amount of walking and standing on the foot or ulcer. The old saying, “an ounce of prevention is worth a pound of cure” is the best advice when referring to a diabetic foot ulcer.
For more information or to see a podiatrist visit Bahamas Foot Centre, Rosetta Street or telephone 325-2996; Bahamas Surgical Associates, Albury Lane or telephone 394-5820 or the Foot & Ankle Institute, Dean’s Lane 326-5402 or email us at [email protected] or www.apma.org or heal2gether.org.