A diabetic foot ulcer is an open sore or wound that is commonly located on the bottom of the foot and may take a long time to, or never, heal. Diabetic foot ulcers are notoriously difficult to heal, often resulting in lower-limb amputations. An estimated 34 percent of diabetes patients will develop foot ulcers during their lifetime. More than 90 percent of people with diabetic peripheral neuropathy are unaware they have it, but it puts them at higher risk for developing foot ulcers and injury to the feet. More than half of all foot ulcers (wounds) will become infected and require hospitalization and 20 percent of those infected will result in an amputation. Eighty-five percent of all amputations are done on people who had a foot ulcer/wound that did not heal. The good news is that there is hope, and the majority of these amputations can be prevented.
Anyone who has diabetes is at risk and can develop a foot ulcer, but the longer you have had diabetes and if it is not under control, you are at higher risk. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers. Ulcers can develop because of a number of other factors, such as lack of feeling in the foot (neuropathy), poor circulation, foot deformities and trauma/injury to the foot.
Once a diabetic foot ulcer is noticed, persons with diabetes are asked to seek medical attention right away and to see the podiatrist as soon as possible. Often, persons with diabetes delay coming to the doctor because of fear, or because they have no pain or because they think there is nothing that can be done to treat the ulcer and prevent amputations. It is exciting that there is new hope in the treatment of diabetic foot ulcers. The goals of treatment is to reduce risk of infection and amputation, improving function and quality of life, reducing health care costs and of course prevent early death.
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible and prevent the ulcer from returning. The faster the healing, the less chance of 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 (“off-loading”) with padding, special shoes and braces, and “debridement” – cutting away hard callus skin and tissue that increase pressure.
• Applying medication or dressings to the ulcer to help it heal.
• Managing blood glucose to help with healing.
For a wound to heal, there must be adequate blood flow to the foot or leg. The doctor or podiatrist will check your blood flow.
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 and prevention
New surgical techniques have developed over the past decade. Minimal incision surgery or surgery done through a very small cut in the skin is one of the best ways to prevent diabetic foot infections. It allows the podiatrist to remove boney areas on the foot and toes that lead to high pressure and ulcers. The doctor can also fix deformities in the tendons and bones to balance the pressures in the foot that are causing the foot ulcers. This technique is very effective because of the small incision. It encourages rapid healing without risk of infection or great concerns about circulation.
The best way to treat a diabetic foot ulcer is to prevent its development in the first place. We recommend you see a podiatrist on a regular basis for routine care and checkups on your feet to determine your risk of foot ulcer implement prevention strategies. Make sure blood sugar is under control and reduce risk factors, such as smoking. Wearing the correct shoes and socks will go a long way in reducing risks.
Learning how to check your feet is crucial in noticing any problems as early as possible and get to the podiatrist as soon as possible. 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. If you do develop a foot ulcer, know there is new hope for treatment and cure.
• For more information email us at foothealth242@gmail.com, or to see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Hilltop Medical Centre, East Terrace Centreville or telephone 394-5820; or Lucayan Medical Centre, East Sunrise Highway, Freeport, Grand Bahama, every first and third Thursday, telephone 373-7400.
