Why Are Ulcers a Problem for Patients With Diabetes?
Patients with diabetes are not only at increased risk of developing foot ulcers, but they are less likely to heal naturally once a wound has developed. For this reason, many diabetic ulcers become seriously infected before treatment begins, and one in every five infected ulcers results in amputation.
Diabetes is a direct cause of foot ulcers due to:
- Neuropathy. Many people who develop foot ulcers have lost the ability to feel pain or sensations in their feet (diabetic neuropathy). In many cases, patients with neuropathy only realize they have an ulcer when they notice blood or drainage on their socks.
- Impaired circulation. Diabetes narrows the blood vessels in the extremities, making it harder for nutrients to reach the feet. A lack of blood flow to the feet prevents the body from healing any ulcers.
- Dry feet. Diabetes can decrease the body’s oil and sweat production, drying the skin and making it more likely to crack.
- Systemic disease. Patients with vascular disease, kidney problems, or heart disease are at increased risk of skin breakage and slow healing. Patients who use insulin are also more likely to develop a foot ulcer.
- Foot deformities. Ulcers may develop due to prolonged pressure on the same part of the foot (such as the heels or pads of the feet) or friction from shoes rubbing against bones and toes.
- Lifestyle habits. Anyone with diabetes can suffer a foot ulcer, but patients who are overweight or use alcohol and tobacco are at higher risk.
Classifications of Foot Ulcers
Diabetic foot ulcers are generally separated into four stages:
- Stage 1. You have red, irritated, or inflamed areas on your feet. This is common where the skin is thinnest, such as on the ankle bone or toe joint.
- Stage 2. You can see blisters or cracks in the skin. The skin around the wound may begin to peel or flake away.
- Stage 3. The skin is broken, and blood or pus may be draining from the wound. At this point, the layers of skin around the area will start to thin.
- Stage 4. In the final stage of a foot ulcer, the wound has affected the skin, muscles, tendons, and bone tissue. You may have dead tissue (gangrene) or bone infection (osteomyelitis) that requires amputation.
How Are Diabetic Ulcers Treated?
Even a small cut can allow harmful bacteria to enter the body, making tiny puncture wounds or burrowing toenails deadly for a patient. It would help if you got treatment as soon as you notice any redness, swelling, or potential for a break in the skin.
Treatment will depend on the severity of the wound and how far it has progressed, but common interventions include:
- Cleaning the wound thoroughly
- Draining the site if there is a noticeable infection
- Safely removing dead skin or tissue from the area
- Taking the pressure off the area (off-loading)
- Applying sterile dressings (and any necessary topical medications)
- Laser therapy to promote wound healing and increase circulation
- Prescribing antibiotics to treat system-wide infection
In extreme cases, your podiatrist might recommend surgery to remove necrotic tissue and perform skin grafting to save the limb. If the limb cannot be saved, you may need amputation to save your life.
In Our Podiatry Office, Good Wound Care Includes Prevention
Most diabetic foot wounds are preventable, and our wound care procedures always include prevention methods to improve the life and health of the patient. Once the injury is treated, we advise you on how to:
- Change your dressings and help the healing process
- Perform daily foot inspections (particularly on the bottoms of the feet)
- Manage blood glucose and other health problems
- Choose well-fitting diabetic shoes and socks