Diabetic Foot Ulcer
all information

Diabetic Foot Ulcer

En Español (Spanish Version)

Definition

Diabetic foot ulcers are sores that occur on the feet of people with type 1 and type 2 diabetes . Up to 25% of people with diabetes develop foot problems. Diabetic foot ulcers usually occur on the bottom of the foot. They precede over 80% of leg amputations in the United States. However, the sooner diabetic foot ulcers are treated, the better the outcome.

Foot Ulcer

Foot Ulcers

© 2008 Nucleus Medical Art, Inc.

Causes

Diabetes can damage the nerves of the legs and feet so that you may not feel a blister or sore when it begins to appear. If undetected, the sore may become larger and infected. This may lead to an amputation of a toe , a foot, or even a leg.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing diabetic foot ulcers. If you have diabetes and any of these risk factors, tell your doctor:

Symptoms

If you experience any of these symptoms, do not assume it is due to diabetic foot ulcers. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

  • Sores, ulcers, or blisters on the foot or lower leg
  • Pain
  • Walking with difficulty
  • Discoloration in feet: black, blue, or red
  • Cold feet
  • Swollen foot or ankle
  • Fever, skin redness or swelling, or other signs of infection

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your primary doctor may refer you to a foot specialist or podiatrist.

Tests may include the following:

  • Wound culture to determine if an infection is present
  • X-rays to determine if there is evidence of infection in the bones ( osteomyelitis )
  • CT scan or MRI to evaluate a suspected pocket of pus called an abscess
  • Doppler or arteriographic studies to assess for adequate blood flow to feet, which is necessary for healing
  • Blood glucose and glycohemoglobin test called HbA1C test
  • Complete blood count to determine if there is evidence of infection—A high white blood cell count may mean that there is an infection.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Medication

Regranex gel is a medication approved by the Food and Drug Administration (FDA) for the treatment of diabetic foot ulcer. It has been shown to speed wound healing.

No Weight-bearing

Keeping pressure off the foot ulcer promotes healing. Sometimes special casts or boots are placed on the foot to “off-load” pressure from the ulcer.

Wound Care

Cleanse the wound regularly and change the dressings often to prevent infection.

Antibiotics

Antibiotics are often used—even if an infection is not clearly present—to prevent an infection. Usually the medication is administered for 4-6 weeks.

Blood Sugar Control

Infected ulcers are likely to cause high blood sugar levels. High blood sugar levels lower immune response and prevent wound healing. Therefore, improved blood sugar control—with adjustments in diet or medications—aids in fighting infections and healing wounds. Sometimes insulin shots are needed in the short-term to achieve optimal blood sugar control.

Skin Graft

Bioengineered skin graft or human skin graft can be used to treat diabetic foot ulcers which fail to heal with conventional treatments. Skin grafts have been shown to speed the healing process.

Surgery

The removal of dead tissue around the wound, or debridement , is often needed to clean the wound and promote healing. Bypass surgery to improve blood flow within the arteries of the legs may help with wound healing and spare amputations. As a last resort, amputation surgery may be needed to stop the spread of infection to the rest of the body.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy appears to help reduce major amputations. People with nonhealing wounds are placed in a chamber. Pure oxygen is pumped into the chamber, which saturates the blood with oxygen. This oxygen-rich blood helps form new blood vessels, which helps the wound heal.

Prevention

To help reduce your chances of getting diabetic foot ulcers, take the following steps:

  • Cleanse your feet daily and dry them thoroughly between the toes before putting shoes and socks on. Do not wear garters and tight stockings around the legs.
  • You may want to use petroleum jelly or an unscented lotion to moisturize dry, leathery feet. Do not put lotion between the toes, since the extra moisture may attract bacteria.
  • After cleansing your feet, inspect them daily for sores that you may not be able to feel. Use a mirror or the assistance of another person to see parts of the feet you may not usually be able to see.
  • Your primary doctor should look at your feet and test the feeling in them at least once a year at your regular visit. If you find a sore at any time, make an appointment to see your doctor immediately. You may be referred to a foot specialist or podiatrist for treatment of your foot ulcer.
  • People with diabetes may have toenails that are brittle and difficult to cut without causing ingrown toenails. You may also want to have a foot specialist or podiatrist trim your toenails regularly.
  • Buy properly fitted shoes. If you have Medicare coverage, once per calendar year Medicare (Part B) will pay 80% of the cost of a pair of properly fitted, custom-made shoes with inserts for people with diabetes. Costs may vary by state. The doctor who treats your diabetes must verify that you have a need for these shoes. Then you will need a prescription for the shoes from a podiatrist.
  • Avoid smoking.
  • Exercise daily, with the approval of your doctor, to improve blood flow and blood sugar levels.
  • Calluses can increase the pressure in the foot and lead to foot ulcers. Have your podiatrist cut any callus once you detect it. This could reduce the risk of developing a foot ulcer.

Foot Temperature Monitoring

According to two recent studies, if you are at high risk for diabetic foot ulcers, checking the temperature of your feet—using an infared skin thermometer—can reduce the number of ulcers. The TempTouch thermometer used in the study costs $150. * 1 * 2

RESOURCES:

American Diabetes Association
http://www.diabetes.org

American Podiatric Medical Association
http://www.apma.org

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca

Podiatrists in Canada
http://www.footdoctors.ca

References:

Andersen CA, Roukis TS: The diabetic foot. Surg Clin North Am. 2007;87:1149-1177.

Diabetic foot ulcer. DynaMed website. Available at:
http://www.dynamicmedical.com/dynamed.nsf?opendatabase . Accessed September 20, 2005.

Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician . 2002;66:1655-1662.

Leung PC: Diabetic foot ulcers-a comprehensive review. Surgeon . 2007;5:219-231.

Nelson EA, O’Meara S, Craig D, et al. A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers. Health Tech Assess . 2006;10.

Nelson EA, O’Meara S, Golder S, et al. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med . 2006;23:348-359.

Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA . 2005;293:217-228.

The Merck Manual of Diagnosis and Therapy . 15th ed. Rahway, NJ: Merck Sharp and Dohme Research Laboratories; 1987.

Your Medicare coverage: therapeutic shoes. Medicare website. Available at:
http://www.medicare.gov/Coverage/Home.asp . Accessed September 25, 2005.

* 1 2/7/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med. 2007;120:1042-1046.

* 2 2/7/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care. 2004;27:2642-2647.



Last reviewed January 2008 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

DiggDeliciousNewsvineRedditStumbleTechnoratiFacebook