Foot and Wound Clinic

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complications.

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.  

Anyone who has diabetes can develop a foot ulcer. 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 plays a role in the development of foot ulcers.

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), trauma, and the duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. Nerve damage can often occur without pain, and one may not even be aware of the problem. Your general practitioner, physician, diabetologist and/or 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 of infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing. 

Trauma can cause a wound, commonly ill-fitting footwear, and blisters due to exposure of feet to warmers e.g. stoves ( jikos), electric warmers, and blankets .

Once an ulcer is noticed, seek medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons:

• To reduce the risk of infection and amputation
• To improve function and quality of life
• To reduce health care costs
• To prevent recurrence 

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing of the wound, 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 specialized dressings to the ulcer
• Managing blood glucose, infection and other health problems

Not all ulcers are infected; however, if your Podiatrist / physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

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.

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a Podiatrist and/or physician on a regular basis. He or she can determine if you are at high risk of 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, is 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 physician/ podiatrist 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 or a medical professional as soon as possible, no matter how “simple” it may seem to you. 

The key to successful wound healing is regular Physician&/or physician 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