Diabetic Foot Ulcers

WHAT YOU SHOULD KNOW:

A diabetic foot ulcer is a wound that develops when high blood sugar levels damage blood vessels and nerves. The damage leads to skin and tissue breakdown. Even a small cut or scratch can become a diabetic foot ulcer. Diabetic foot ulcers do not heal well and are hard to treat. An injury is more likely to become an ulcer if it is not treated right away.

INSTRUCTIONS:

Medicines:

You may need any of the following:

  • Antibiotics: These prevent or fight an infection caused by bacteria.

  • Antiplatelets: These prevent blood clots.

  • Insulin: This medicine decreases your blood sugar level by moving the sugar into cells so it can be used for energy.

  • Pain medicine: You may need medicine to take away or decrease pain.

    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.

    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.

  • Vasodilators: These widen your blood vessels and improve blood flow.

  • Take your medicine as directed. Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your healthcare provider or specialist as directed:

Bring any special devices or footwear to your follow-up visits so your healthcare provider or specialist can check them. You may need many follow-up visits to check how your wound is healing. Your healthcare provider may measure your wound area to see if it is getting smaller. Tell your healthcare provider or specialist about any new symptoms you are having. He may order blood tests to check your blood sugar level. He may also do an ultrasound or Doppler test to check the blood flow to your foot. He may remove dead tissue around your ulcer. Write down your questions so you remember to ask them during your visits.

Care for your diabetic foot ulcer:

Follow your healthcare provider's instructions about how to care for your wound.

  • Elevate your wound: You may need to keep your foot raised to decrease swelling and improve healing. Your healthcare provider may also have you dangle your foot if you have poor blood flow.

  • Keep your wound clean: Baths and showers may cause your wound covering to become soiled and increase your risk of infection. Ask your healthcare provider for instructions on bathing until your foot heals.

  • Cover your wound correctly: Do not put dressings or bandages on your foot that will stick to your wound.

Physical therapy:

When you are able, your healthcare provider may have you to start physical therapy. A physical therapist will help you with exercises to help make your bones and muscles stronger. If your foot or leg was amputated, therapy may help you return to your daily activities.

Prevent another diabetic foot ulcer:

Good foot care may prevent ulcers, or keep them from getting worse. Follow your healthcare provider's instructions about foot care.

  • Check your feet: Check each day for wounds, corns, and calluses (thick areas of dead, dry skin). Look at your whole foot, including the bottom, and between and under your toes. The skin on your feet may be shiny, tight, or darker than normal. Your feet may also be cold and pale. Feel your feet by running your hands over the tops, bottoms, sides, and between your toes. Redness, swelling, and warmth are signs of blood flow problems that can lead to a foot ulcer. Do not try to remove corns or calluses yourself.



  • Wash and dry your feet carefully: Wash your feet each day with soap and warm water. Do not use hot water, because this can injure your feet. Dry your feet gently with a towel after you wash them. Dry between and under your toes.

  • Moisturize your feet: Use lotion or a moisturizer after you wash and dry your feet. Do not put lotion or moisturizer between your toes. Ask your healthcare provider what to use.

  • Cut your toenails correctly: File or cut your toenails straight across. Use a soft brush to clean around your toenails. If your toenails are very thick, you may need to have a healthcare provider or specialist cut them.

  • Protect your feet: Do not walk barefoot or wear your shoes without socks. Check your shoes for rocks or other objects that can hurt your feet. Wear cotton socks to help keep your feet dry. Wear socks without toe seams, or wear them with the seams inside out. Change your socks each day. Do not wear socks that are dirty or damp.

Self-care:

  • Check your blood sugar: Check your blood sugar level as often as directed. You may need to check at least 3 times each day. Your healthcare provider or diabetes specialist will tell you what your blood sugar level should be. A stable blood sugar level decreases your risk of foot ulcers. Keep a diary of your blood sugar levels with the date and time that you checked them. Bring the record to your follow-up visits. Your healthcare provider may use the record to make changes to your medicine, food, or exercise schedules.



  • Manage your blood pressure: Have your blood pressure checked regularly. Keep your blood pressure at the level your healthcare provider suggests to prevent damage to your blood vessels.

  • Eat healthy foods: Choose foods that are low in sugar and fat. Your dietitian can help you create a meal plan that works for you.

  • Drink enough liquid: Liquids may help improve the oxygen in your tissues and decrease your risk of foot ulcers. Drink unsweetened drinks and water. Talk to your healthcare provider or dietitian about how much liquid you should drink each day, and which liquids to drink.

  • Ask about your weight: A healthy weight decreases the amount of force and pressure you put on your feet. Ask your healthcare provider if you need to lose weight, and how much to lose. Even a 10 to 15 pound weight loss can help decrease the pressure on your feet. Weight loss can also help you manage your blood sugar levels. Healthcare providers will help you create a weight loss program.

  • Quit smoking: Smoking can worsen the problems that can occur with diabetes, such as poor blood flow to your feet. Ask your healthcare provider for information if you need help quitting.

  • Wear proper fitting shoes: Wear shoes that do not rub against any area of your feet. Ask your healthcare provider for help in choosing shoes that fit you best. He may order special shoes for you.

Contact your healthcare provider or specialist if:

  • You see any new blisters, cuts, scratches, or sores on your foot.

  • You see hard areas of skin on your foot.

  • Your toenails become thick, curled, or yellow.

  • You have new numbness in your feet or legs.

  • Your blood sugar is higher or lower than healthcare providers told you it should be.

  • You have questions or concerns about your condition or care.

Return to the emergency department if:

  • You have a fever or chills.

  • You feel pain in a foot that used to have little or no feeling.

  • Your foot ulcer has a bad smell or is draining pus.

  • Your foot becomes red, warm, and swollen.

  • Your foot is cold and pale.

  • You see any black or dead tissue in or around your ulcer.

  • Your ulcer becomes bigger, deeper, or does not heal.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Diabetic Foot Ulcers (Aftercare Instructions)

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