Diabetic Foot Wound Diabetic Foot Ulcer

A diabetic foot ulcer is an open sore or wound on the foot of a person withdiabetes. Because of loss of pain sensation, it is usually notpainful.

What is going on in the body?

A person with diabetes often has peripheralvascular disease, or decreased circulation to the legs and feet. Anydamage to the feet may heal slowly because of the poor circulation. The personmay also have diabetic neuropathy,acondition in which nerve damage from diabetes causes decreased sensation in thelegs and feet. The person can develop an open area from pressure or from a cutand not even feel the sore. Untreated, the damaged area can develop a diabeticfoot ulcer.

What are the causes and risks of the condition?

A diabetic foot ulcer is caused by direct damage to the skin, such as a cut, orby pressure, such as that from poorly fitting shoes. The following factors increase aperson’s chance of developing a foot ulcer:

diabetic neuropathy, withdamageto the nerves supplying the feet

peripheral vascular disease,withdecreased blood flow to the feet

a history of 10 years or more of diabetes

smoking

male gender

blood sugar levels that arenotunder control

diabetic retinopathy, or damage tothe retina of the eye from diabetes

cardiovascular problems caused by diabetes

kidney problems caused by diabetes, including chronic renal failure

a history of skin ulcers or amputation ofa limb

conditions caused by increased pressure on the feet, such as corns andcalluses

foot bones that are deformed or have limited movement, such as bunions

thick toenails

What are the signs and symptoms of the condition?

Early symptoms of a diabetic foot ulcer include redness of the skin,blistering, and other signs of irritation. In later stages, the person may havean open wound that drains fluid onto socks or bedding. The open wound can thenbecome infected and develop swelling, redness, and drainage of pus. The personmay have a fever, and blood sugar levels may be higher thanusual.

How is the condition diagnosed?

Diabetic foot ulcers are usually first recognized by the affected individual.The advice of a healthcare provider should be sought immediately. The providercan diagnose the ulcer by looking at it. If the ulcer is draining fluid, a cultureof the fluid may be sent to the laboratory to check for infection.

What can be done to prevent the condition?

Prevention consists of following guidelines for foot care for people with diabetes. These guidelines includeregularly inspecting the feet and wearing shoes and inlays that fit properly.

What are the long-term effects of the condition?

If a diabetic foot ulcer isn’t treated early and effectively, a person mayexperience:

an infection in the ulcer itself

septicemia, an infection of thebloodstream, which can be caused by bacteria from the ulcer

loss of function and ability to perform activities of daily living

amputation of the involvedfootor leg

death

In the United States, people with diabetes account for 50% of nontraumatic amputations. Mostof these amputations are below the knee. After a limb has been amputated, theopposite limb is often lost within a few years. This happens not only because of ongoingproblems and vascular disease, but also because the opposite leg must bearincreased pressure and workload.

What are the risks to others?

A diabetic foot ulcer is not contagious and poses no risk to others.

What are the treatments for the condition?

There are 10 major areas of treatment:

monitoring of peripheral vascular disease, which causesdecreased blood flow to the feet. Monitoring includes regular measurement ofoxygen levels in the skin, blood flow in the veins of the legs, and pulses inthe legs and feet. In some cases, imaging with special dyes and X-rays will beused.

monitoring of diabeticneuropathy,or nerve damage from diabetes, in the feet

correcting risk factors. A person who smokes should quit smoking. A diet for diabetes should be carefully followed for bloodsugar control. Blood pressure and cholesterol levels can be controlled with medication.

doing regular exercise for a personwithdiabetes, to improve circulation to the feet. The healthcare providermay also prescribe special support hose to improve blood flow from the legsto the heart.

aggressively treating any sign of skin damage. The treatment may consistsimply of local wound care and antibiotics. Infections, especially boneinfections, must be treated surgically. It is very important toavoid pressure on the ulcer during healing because new tissue is delicate.Prescription inlays, or shoe inserts, can be used to relieve pressure on thearea.

treating any fungal infections of the foot, such as fungal nail infections, with prescription medicationsfromthe healthcare provider

wearing well-cushioned walking shoes, athletic shoes, or specialprescription shoes as recommended by the healthcare provider

following a team approach to care. The team may include the person withdiabetes, the primary care physician, the physician’s assistant, the diabetes educator,the nutritionist, the surgical specialist and, if needed, a physician specializing indiabetes.

performing daily foot care for apersonwith diabetes. In addition, the healthcare provider should examine theperson’s feet at each visit.

learning about diabetes on anongoing basis. The individual must assume responsibility for self-care andlearn how to prevent ulcers.

What are the side effects of the treatments?

All medications have side effects. For example, some of the medications used totreat diabetes may cause low blood sugar, known as hypoglycemia, which is potentially fatal. Surgery can causebleeding, infection, and allergicreaction to anesthesia.

What happens after treatment for the condition?

After a person gets a diabetic foot ulcer, he or she will be at risk for furtherskin breakdown and infection for the rest of his or her life. Informedself-care and monitoring are the best tools available to prevent skinlesions from becoming life- and limb-threatening infections. A neglected blister or callous is the most common reason for amputations in people with diabetes.

How is the condition monitored?

A person with diabetes needs tofollowfoot care guidelines and monitor blood sugar levels for the restofhis or her life. Foot inspection and monitoring of diabetes, as well as any highblood pressure or highcholesterol, is also done by the healthcare provider.