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Diabetic Foot Ulcer

Diabetic Foot Ulcer

Definition

Ulcers are slow-healing wounds on the skin. Diabetic foot ulcers occur on the feet of people with type 1 and type 2 diabetes. Diabetic foot ulcers usually occur on the bottom of the foot.

Foot Ulcer
Foot Ulcers
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Causes

Diabetes can damage the nerves of the legs and feet. This may make it difficult to feel a blister or sore. If you don’t care for a sore it may become larger and infected.

Diabetes also can cause problems with blood flow. Poor blood flow can make it difficult to heal.

The ulcer itself is usually caused by:

  • Repetitive trauma or pressure on the foot
  • Puncture wound on the foot
  • Objects in the shoe that can damage the skin, such as a small rock

Risk Factors

Factors that may increase your chance of diabetic foot ulcers include:

  • Neuropathy—numbness, tingling, or burning sensation in your feet
  • Peripheral artery disease (PAD)—poor circulation in your legs
  • Improperly fitted shoes
  • A foot deformity, such a bunion
  • Diabetes for more than 10 years
  • Poor diabetes control (HbA1c > 9%)
  • Not wearing shoes
  • A history of smoking

Symptoms

Symptoms may include:

  • Sores, ulcers, or blisters on the foot or lower leg
  • Pain
  • Difficulty walking
  • Discoloration in feet: black, blue, or red
  • Fever, skin redness, swelling, or other signs of infection

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your primary doctor may refer you to a foot specialist.

Your bodily fluids and tissues may be tested. This can be done with:

  • Blood tests
  • Wound culture
  • Ankle-brachial pressure

Images may be taken of your bodily structures. This can be done with:

  • Doppler or arteriographic ultrasound to assess blood flow
  • X-ray to look for infection
  • MRI scan or CT scan to look for bone infection

Treatment

The sooner a diabetic foot ulcer is treated, the better the outcome. Treatment options include the following:

Prevention

To help reduce your chance of diabetic foot ulcers:

  • Clean your feet daily. Dry them thoroughly, especially 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. The extra moisture may attract bacteria.
  • Inspect your feet daily. Look for sores that you may not be able to feel. Use a mirror or the assistance of another person to see all parts of your feet.
  • Your doctor should look at your feet and test the feeling, flexibility, and circulation in them at least once a year. If you find a sore at any time, make an appointment to see your doctor right away.
  • People with diabetes may have toenails that are brittle and difficult to cut. You may also want to have a foot specialist trim your toenails regularly.
  • Buy properly fitted shoes. Some insurance companies will pay for custom-made shoes with inserts. A doctor can give you a prescription for the shoes.
  • Avoid smoking.
  • Talk to your doctor about exercise. Daily exercise will help to improve blood flow and blood glucose levels.
  • Calluses can increase the pressure on the foot and lead to foot ulcers. Have your foot doctor remove any calluses. This could reduce the risk of developing a foot ulcer.
  • Ask your doctor if you should use a special infrared thermometer. It can check the temperature of your feet.
  • Improved control of your diabetes may reduce the risk of ulcers.
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