Diabetic Foot Ulcers

WHAT YOU SHOULD KNOW:

Diabetic Foot Ulcers (Inpatient Care) Care Guide

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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Medicines used to treat you diabetic foot ulcer may cause an allergic reaction. Offloading devices may make it hard for you to walk or do other activities. A cast may increase your risk of infection or tissue damage. Hyperbaric oxygen treatment may cause blurry vision, ear pain, and seizures. If you have surgery, you may bleed more than expected and need a blood transfusion. You may also get an infection or get blood clots. You may need more than one surgery to treat your foot ulcer. Even with treatment, your ulcer may not heal, your infection may spread, and you may die.

  • If your diabetic foot ulcer is not treated, it may not heal. Your ulcer may become infected, and the infection may spread to your blood and other body parts. Your foot and leg may turn black from tissue death. Your risk of a foot or leg amputation will increase. A diabetic foot ulcer can be life-threatening if it is not treated.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Blood tests:

You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Nutrition:

A dietitian will work with you to choose the best foods to control your blood sugar. You may need to eat foods high in protein, vitamins, and minerals to improve your healing.

Medicines:

You may need different medicines to help your ulcer heal, fight infection, and control your diabetes. You may also need medicines to treat other health problems that occur with diabetes.

  • Antibiotics: This medicine prevents or fights an infection caused by bacteria.

  • Antiplatelets: This medicine prevents blood clots.

  • Cholesterol medicine: This medicine decreases the amount of cholesterol in your blood. Cholesterol may weaken or block your arteries.

  • Growth factors: Growth factors are chemicals that help your body heal itself. They improve the action of the cells in your body used for healing. Growth factor may be put directly on your ulcer as a gel.

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

  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

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

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

Treatment:

The goal of treatment is to heal your ulcer. Treatment is done to prevent worsening of your wound and treat infection.

  • Surgery: Surgery removes infected and dead tissue from your ulcer. Surgery may help improve blood flow and wound healing.

    • Achilles tendon lengthening: This is done to improve the movement of your ankle. Your Achilles tendon connects your heel to your lower leg muscle. With better movement, your ulcer may heal faster, and your risk of another ulcer may decrease.

    • Angioplasty: A blocked or narrowed artery in your leg or foot is opened.

    • Bypass: A blocked blood vessel is replaced with another blood vessel. The new blood vessel may be taken from another area in your body.

    • Reconstruction: An infected ulcer and the area around it is cut out. If your ulcer is large, muscle or a skin flap near your ulcer is used to cover the open area. A skin graft may be used instead. A skin graft is skin from another area of your body or from a donor.

    • Amputation: Amputation removes all or part of your foot. A part of your leg may also need to be removed. Amputation may be needed if you have an ulcer that is getting worse. You may also need an amputation if you get an infection in your skin or bone that does not go away.

  • Dressings: Dressings are ulcer coverings used to keep the area moist and free from infection. The dressings may contain medicines to help your ulcer heal and prevent infection.

  • Electrical stimulation: Electrical stimulation uses a low-level electrical current on your ulcer. The currents may improve the healing of your foot ulcer.

  • Hyperbaric oxygen therapy: You are placed in a room filled with pure oxygen. The oxygen you will breathe is at a higher pressure than normal air. The high-pressure air increases the oxygen supply to the area of your ulcer. The increased oxygen may decrease swelling, and help your ulcer to heal faster.

  • Negative pressure therapy: A machine pulls infection and fluid out of your ulcer. Negative pressure therapy may decrease swelling, improve blood flow, and help your ulcer heal.

  • Offloading devices: Offloading devices are used to decrease the amount of weight and pressure placed on your foot. You may need to use offloading devices with or without surgery. Examples of offloading devices are specially made footwear, insoles (cushions), braces, canes, walkers, and wheelchairs.

Tests:

  • Ankle brachial index: Ankle brachial index is a test to check how well your blood is flowing to your feet. Your caregiver will measure the blood pressure in your ankles. An ABI may be done after some treatments to check for improved blood flow.

  • Arterial Doppler: An arterial Doppler is done to check the blood flow through your arteries. A Doppler test may be done after some treatments to check for improved blood flow.

  • Bone biopsy: Caregivers take a sample of bone from your ulcer area. The sample is checked for infection.

  • Wound culture: A sample of drainage is taken from your ulcer to check for infection.

  • Imaging tests: You may be given dye to help the pictures show up better. Tell the caregiver if you are allergic to iodine or seafood. You may also be allergic to the dye.

    • Bone scan: A bone scan is done to look at the bones in your foot and leg. You are given a small amount of dye through an IV. Pictures are then taken of your bones. Your caregiver may use this test to look for a bone infection.

    • CT or MRI scan: Your caregiver uses these pictures of your foot to check for a bone infection or deep abscess (wound).

    • PET scan: Pictures are taken of your foot to check for a bone infection.

    • Ultrasound: An ultrasound uses sound waves to show pictures of your foot on a monitor. This test may be done to check for a bone infection.

    • X-ray: Pictures of the bones in your foot are taken. The pictures will help your caregiver check for infection that may have spread to bone.

© 2013 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.

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