Diabetic Foot Ulcers – A step in the wrong direction

In 2018, statistics showed there were 425 million people worldwide with diabetes. According to the International Diabetes Federation (IDF), this number is forecasted to increase to 642 million by 2040, proving that diabetes remains one of the fastest-growing diseases.

Research has shown that of patients with diabetes, 15 percent will develop a diabetic foot ulcer at some point in the life of their diagnosis. Half of these patients will develop an infection or other ulcer-related complication. Alarming statistics also report that diabetes is the leading cause of non-traumatic, lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer ultimately have an amputation. While these facts are cause for concern, research has also shown that foot ulcers are preventable with proactive measures.

Diabetic foot ulcers – defined as an open sore or wound commonly located on the bottom of the foot – 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, which is defined as 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. The nerve damage often can occur without pain and one may not even be aware of the problem.

Among diabetics, anyone can develop a foot ulcer; however, Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People with Type 1 diabetes and 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 have been shown play a role in the development of foot ulcers.

Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present. Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated promptly to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.

Appropriate wound management includes the use of dressings and topical medications. Products can range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers. For a foot wound to heal, there must be adequate circulation to the ulcerated area, and carefully controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Both will enhance healing and reduce the risk of complications.

According to the American Podiatric Medical Association (APMA), 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 to determine if you are at high risk for developing a foot ulcer and implement strategies for prevention. The following are some of the common risk factors for developing a diabetic foo ulcer:

• Neuropathy
• Poor circulation
• A foot deformity (e.g., bunion, hammer toe)
• Wear inappropriate shoes
• Uncontrolled blood sugar
• A history of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, and high cholesterol, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks.

In addition, learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day – especially the sole and between the toes – for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a healthcare 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 they may seem to you.

The key to successful wound healing is regular podiatric and vascular care to ensure the following:

• Lowering blood sugar
• Appropriate debridement of wounds
• Treating any infection
• Reducing friction and pressure
• Restoring adequate blood flow

Diabetic foot ulcers are serious because the soft tissue of the foot can allow an infection access to muscle and bone very quickly, with the infection and poor blood flow leading to more serious complications. As such, there are several reasons foot ulcers should be treated as soon as possible including reducing the risk of amputation, as well as lowering medical costs. However, the most important reason may just be an improvement in the quality of life for diabetics.