Diabetic Ulcer

 

A diabetic foot ulcer is a sore or open wound, which most commonly occur on the button of the foot over bony prominences.  Approximately 15 % of diabetics develop foot ulcers, and 6% of those are hospitalized for infection or other ulcer related problems.  Diabetic foot ulcers are the number one cause of non-traumatic amputations in the United States.  Diabetic ulcers are preventable.

 

Cause

 

Ulcers can form from a variety of factors.  These causes include poor circulation, loss of sensation to the feet, deformities, trauma, and pressure.  Diabetes can cause damage to small nerves that affect sensation to the hands and feet, and damage small blood vessels, causing kidney disease and eye complications.  Loss of sensation causes normal pains and irritations to go unnoticed, causing more rubbing or pressure that develops into a wound.  Poor circulation causes small nicks, cuts, and blisters to not heal quickly.  This allows those areas to become infected, or to become traumatized further.

 

Treatment

 

The goal in treating ulcers is to get the ulcer to heal as soon as possible.  Generally there are 4 things that stop ulcers from healing.  Poor blood flow, infection, pressure, and swelling can all delay ulcer healing.  Blood flow tests are usually performed, and if poor blood flow is found, the patient is usually referred to a vascular Dr.  Infection is treated with antibiotics and ulcer debridement.  Pressure can be off-loaded with padding, bracing, and good shoe selection.  Swelling can be controlled by compression stockings, or ace wraps.

 

Prevention

 

Prevention is related to reducing risk factors.  Diabetics should see a podiatrist on a regular basis for diabetic foot care.  Diabetics should also perform daily foot checks.  They are looking for areas of skin that are open and bleeding, skin that is red, cuts, cracks, blisters, or increased warmth to their feet.  Diabetics should also check their shoes daily to make sure there are no objects (rocks, nails, etc) in their shoes that can cause ulcers.  Well fitting shoes can prevent rubbing and irritation.  Controlling other health factors such as high blood glucose, smoking, alcohol, and high cholesterol can help prevent ulcers.  Regular exercise can help increase blood flow to the feet.  Diabetics should have their feet examined every time they see a health care provider.