Living with diabetes brings about a unique set of challenges. Yes, you need to keep track of your blood glucose levels throughout the day, but that’s not all. Diabetes, especially when managed poorly, can lead to complications. To make sure you’re taking preventative action and monitoring your overall health, you first need to understand the risks. One of said risks is the formation of diabetic foot ulcers. In this article, we’ll cover everything you need to know about diabetic foot ulcers, how to prevent them, and if needed, how to treat them.
What are Diabetic Foot Ulcers?
Diabetic foot ulcers are open sores or wounds that commonly occur in people with diabetes.1 They’re considered a complication for people who are not managing and controlling their diabetes regularly. About 15% of people with diabetes will experience foot ulcers during their lifetime and of those 15%, about 14-24% will require amputation and 6% will need to be hospitalized due to further ulcer-related complications.1 While the numbers might seem small, diabetes is the leading cause of non-traumatic lower extremity amputation in the United States.1
Diabetic foot ulcers are serious complications and should be diagnosed and treated as soon as you notice any changes. For this reason, people with diabetes need to regularly inspect their feet and body as well as regularly visit a podiatrist for check-ups.
Most ulcers occur on the underside of your foot, under your big toe or on the ball of your foot, but they can present themselves anywhere.2 If left untreated, foot ulcers can affect every layer of your skin all the way down to the bone. Luckily, foot ulcers are preventable and can be treated without amputation when caught early.
Risk Factors
The primary risk factor for developing foot ulcers is diabetes. Anyone currently living with diabetes is at risk for developing foot ulcers. For some, the risk of developing foot ulcers increases. Here are a few things that could increase your chances of developing foot ulcers:2
- Diabetes related illnesses
- Eye disease
- Heart disease
- Kidney disease
- Age and gender – diabetic foot ulcers are most prevalent in older men2
- Poorly fitted shoes
- Poor quality shoes
- Poor hygiene
- Increased alcohol consumption
- Tobacco use
- Obesity
- Improper toenail trimming
- Ethnicity – Native Americans, African Americans, and Hispanics are more likely to develop ulcers1
Causes of Diabetic Foot Ulcers
In addition to the risk factors listed above, most diabetic ulcers develop due to poor circulation.2 Poor circulation increases the chances of developing ulcers that don’t heal, since blood flow isn’t reaching the area as prevalently. High blood glucose levels also contribute to reduced healing efficiency, which is why managing your diabetes is so important.2 Here are some other common causes of diabetic foot ulcers and how to prevent them.
Are Diabetic Foot Ulcers Serious?
After looking at the numbers, it’s clear that diabetic foot ulcers are very serious. In all of the diabetes-related amputations done, 85% of them started with foot ulceration.1 To avoid serious complications or amputations, you need to take any signs of symptoms of foot ulcers seriously and contact your podiatrist or doctor immediately.
Symptoms of Diabetic Foot Ulcers
In diabetic people, nerve damage can develop unknowingly.1 This nerve damage drastically reduces your ability to feel anything that could indicate cause for concern. Essentially, this means that you’ll lack feeling in your feet and have poor circulation, which makes it more difficult to notice any minor changes such as a cut, scratch, or beginning of an ulcer. Instead, you’ll need to keep an eye out for other changes and check your extremities regularly.
That’s why, to avoid complications, it’s important to recognize the symptoms of diabetic foot ulcers early on. Because of nerve damage, most people who experience foot ulcers don’t feel any pain.1 Instead, one of the first signs or symptoms that you have an ulcer is drainage.2 Drainage occurs from the ulcer and stains clothing, such as socks or shoes, which is how most people notice something’s wrong. Some people also experience redness or swelling if the ulcer has just began to form.1
When doing physical at-home examinations, people who develop ulcers frequently have contrasting black tissue that surrounds the developing ulcer.2 This is called eschar and develops due to the lack of blood flow to the ulcerated area.2 When left untreated, this will eventually lead to gangrene and you’ll experience odorous discharge, increased pain, and a numbness over the infected area.2
When to See Your Podiatrist
If you notice any discoloration of your skin, see a doctor. If you feel any pain or sensitivity in your feet, see a doctor. Foot ulcers often don’t present noticeable symptoms until infection has occurred and at that point, more drastic measures are needed to treat the problem. To stay on the safe side, it’s always better to talk to your doctor or podiatrist as soon as you notice any changes or get regular checkups.
Doctors and podiatrists use a scale to determine how serious the ulcer is. The following criteria help determine the best course of action to treat diabetic foot ulcers:2
- 0: currently showing no signs of an ulcer, but the foot is at risk
- 1: ulcer is currently present, but has not become infected
- 2: ulcer is deep and exposes joints and/or tendons
- 3: ulcer is excessive, multiple ulcers present, or abscesses are present from infection
Diagnosing and Treating Diabetic Foot Ulcers
Once you’ve seen your podiatrist, and determined where your ulcer falls on the criteria, you can move forward with diagnoses and treatment plans. The main recommendation is called off-loading, which essentially means stay off of your feet as much as possible.2 Added pressure on your extremities contribute to infection and expansion of the ulcerated site.2 This is one reason why obesity is a huge risk factor for ulcer development—added weight means added pressure.
Depending on the severity of your ulcer, your doctor will either recommend over-the-counter medications along with feet protecting accessories, prescriptions, or surgery. There are diabetic shoes available to help prevent and diminish ulcers along with casts, foot braces, compression wraps, and shoe inserts.2
OTC Options
There is a range of topical over-the-counter medications that you can use to help treat and manage diabetic foot ulcers. Iodine is recommended to help keep the area clean alongside dressings with silver or silver sulphadiazine cream or polyhexamethylene biguanide (PHMB) gel.2 Some people have seen results using medical grade honey in an ointment form, but talk to your doctor to find the treatment plan that will work best for you.
Prescription Medications
In certain situations, you may need prescription strength medications to help treat your ulcers. Depending on your situation, you may be prescribed antibiotics, antiplatelets, or even anti-clotting medications.2
Surgery
If your ulcer has progressed, you may need surgery to remove deformities or shave down infected bone.2 Surgery on ulcers is rare, but in certain circumstances, necessary. If things progress too far, amputation will be required.
Remember, all infections are different and require a different course of action to be treated. Your podiatrist may send in tissue samples to get a better idea of what is going on or order additional screening tests to make sure infection hasn’t spread.
Preventative Measures to Reduce the Risk of Diabetic Foot Ulcers
Luckily, diabetic foot ulcers are preventable. Manage your blood glucose levels regularly throughout the day and take the following precautions to reduce your chances of developing ulcers:2
- Wash, dry, and moisturize your feet daily
- Change your socks frequently
- Keep your toenails trimmed
- Wear the right shoes
- See a podiatrist regularly
If you do get a foot ulcer, there are steps you can take to ensure that it doesn’t get infected. Some of them include:2
- Frequently disinfecting the skin that surrounds the ulcer
- Foot baths
- Keeping the ulcer dry (when not in foot baths)
- Changing dressings frequently
- Undergoing enzyme treatments
- Using dressings with calcium alginates
Conclusion
Living with diabetes means that you need to adjust your lifestyle to stay healthy. While this might be difficult at first, it’s the only way to ensure you don’t develop any serious complications, like foot ulcers. As long as you manage your diabetes, you can live a normal, healthy life. Take any and all preventative measures needed and never skip a doctor’s visit. If you’re looking for extra support, sign up for Byram Healthcare’s Caring Touch At Home™ Program. Our program focuses on exceptional customer service and top-of-the line brand name products to make sure that your needs are covered while reducing out of pocket expenses. The Caring Touch At Home™ Program combines convenience, affordability, and choice to deliver extensive service and support to everyone living with diabetes.
If you need a little extra support, reach out to Byram’s Diabetes Center of Excellence. We offer a one source, total solution for diabetes care to help you better manage your condition and live a long, healthy life. Our COE pairs high quality products with clinical and educational resources to help support all of your needs. Browse our products, find resources, and learn more about our Caring Touch At Home™ Program today.
Sources:
1https://www.apma.org/diabeticwoundcare
2https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments
