The Centers for Disease Control and Prevention reports that there are 30.3 million people living with diabetes in the United States. Diabetes comes with many serious complications, including chronic wounds, nerve damage and foot ulcers.
The American Podiatric Medical Association reports that 15 percent of diabetic patients will develop a foot ulcer. Further, diabetes is the leading cause of nontraumatic, lower-extremity amputations in the U.S. — caused by infected wounds and foot ulcers that cannot heal. While difficult to treat, foot ulcers often can be prevented.
“Controlling risk factors and monitoring the skin daily is key to minimizing the negative effects of diabetes,” said Nancy Estocado, Advanced Wound Care Clinical Coordinator at Sunrise Hospital and Medical Center. For anyone with diabetes, understanding how to prevent and properly address wounds — especially foot ulcers — is integral to living a healthy life.
What is a diabetic foot ulcer?
A diabetic foot ulcer is an open wound or sore, commonly located on the bottom of the foot, in a patient with diabetes. However, not all ulcers on the foot are diabetic.
Distinguishing between a diabetic foot ulcer and a foot ulcer caused by other reasons is important because it will inform treatment options. “A good history, the primary cause of the wound and the wound location are all important to know when diagnosing a diabetic foot ulcer,” Estocado said.
Why are diabetics prone to foot ulcers and other chronic wounds?
Diabetic patients are more prone to developing chronic wounds for a few reasons. Two of the most influencing factors are nerve damage and blood circulation issues that are common among diabetic patients.
Nerve damage, or neuropathy, tends to occur in patients who have a longer history with diabetes because elevated blood glucose levels damage nerves over time. Neuropathy causes patients to experience reduced, or lack of, sensation in the areas affected.
Many patients can sustain trauma or develop an infection without realizing it because they’re unable to feel pain in the area. Further, neuropathy commonly affects the feet, so a wound on the bottom of the foot can escalate quickly because the patient cannot feel or see the wound easily.
Blood circulation issues also can increase the risk for developing chronic wounds, as well as making the wounds more prone to infection. “High blood glucose levels cause the narrowing of blood vessels, which constricts blood supply,” Estocado said. “Adequate blood supply is essential to normal wound healing. The secondary effect of impaired blood supply is a decrease in white blood cells, which are responsible for fighting infection and maintaining a strong immune system.”
Wound treatment for diabetic patients is a unique and complicated task. Hyperbaric oxygen therapy — wherein the patient is exposed to high levels of concentrated oxygen — can be hugely beneficial by improving blood supply and delivering oxygen to the wound.
Estocado also notes that moist wound healing, proper wound dressing application and offloading pressure in the area can all aid in healing.
If the wound becomes infected, high doses of antibiotics and aggressive treatment is required, as amputations often occur as result of infection reaching the bone.
Keeping your feet healthy
Patients with diabetes must be diligent about wound prevention. The first step is properly managing the diabetes itself — which includes maintaining a balanced diet and exercise routine, keeping blood glucose levels in the recommended range, avoiding alcohol and tobacco, and addressing any co-occurring disorder such as cardiovascular disease or obesity.
The next step is to commit to daily skin inspections, and “especially your feet when sensation is impaired,” Estocado said. This inspection should be thorough, and include the sole, sides and in between the toes. Even the smallest blister or scrape can escalate for diabetic patients, so call your doctor at the first discovery of any abnormality.
Tips for wound care
1. Protect the wound from bacteria immediately. “Never leave a wound open to the air because bacteria can easily multiply and cause harm,” Estocado said.
2. Wash the wound well with saline or clean tap water.
3. Apply antibiotic ointment after washing to keep the wound moist.
4. Cover the wound with a bandage to control drainage and protect it. Change the bandage and repeat this process every 1-2 days.
5. Keep the pressure off the wound as much as possible and, if recommended, use special shoes/socks.