Diabetic foot ulcers are wounds on the feet that are non-healing for more than six weeks. Foot ulcers will affect 15% of diabetic patients some time during their lifetime. The risk of lower-extremity amputation is significantly increased in patients who have had ulcers. Diabetes is still the leading cause of no traumatic lower extremity amputations totalling (85%).
Diabetic foot ulcers are caused by neuropathic (nerve), vascular (blood vessel) complications and bony deformity. Ulcer may take weeks to months to heal and are generally painless due to sensation loss in the feet.
Nerve damage due to diabetes causes altered or complete loss of feeling in the foot and/or leg, which is known as peripheral neuropathy. Trauma and injury to the foot may go unnoticed and due to the delay in treatment can become infected or ulcerate.
Vascular disease is also a common problem in diabetes mainly affecting the small blood vessels. This reduction and abnormality in blood flow may lead to ulceration, where wound healing is impaired, this can be further aggravated by smoking.
Causes of Diabetic Foot Ulcers:
- Peripheral Neuropathy.
- Arterial disease or atherosclerosis.
- Long term complication of diabetes.
- Biomechanical abnormalities and/ or bony deformities.
- Inappropriate footwear.
- Foreign bodies.
- Barefoot walking.
- Sheer force, friction and blisters.
Symptoms of Diabetic Foot Ulcers:
- Skin discolouration (red, purple, brown).
- Skin break.
- Blood, fluid or discharge.
- Hard thickened skin.
- Signs of infection with or without the sensation of pain (redness, heat, swelling, pus, odour).
Treatment for Diabetes Foot Ulcers:
- Regular debridement of hard skin and non-viable tissue by a podiatrist.
- Regular wound dressings to maintain an optimum environment for wound healing.
- Revascularisation by a vascular surgeon if required to allow healing.
- Antibiotics for any infections.
- Offloading footwear or air cast walkers to reduce pressure and callus.
- Orthopaedic reconstruction of any bony prominence if required.
- Amputation if bone infection present and IV antibiotics fail.
- Endocrinologist input to regulate and control blood sugar levels and diabetes.
Prevention of Diabetes Foot Ulcers:
- Education on daily diabetes foot care by a podiatrist.
- General foot care such as nails and hard skin to be regularly treated by a podiatrist.
- 3-12 monthly diabetes neurovascular foot risk assessment undertaken by a podiatrist.
- Fitted for appropriate supportive footwear.
- Long term offloading foot orthotics if require to evenly distribute pressure on the soles of the feet.
- Regular 6-12 monthly visits to a diabetes educator on how to manage your diabetes.
- GP management of diabetes and 3 monthly HbA1c blood test.
- Good diet and exercise regime to manage your diabetes.