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Diabetic Foot Ulcers

What is a diabetic foot ulcer?

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.

Foot Ulcers

What increases my risk of a diabetic foot ulcer?

Your risk increases if you have had diabetes for 10 years or longer.

  • Nerve damage may lead to numbness in your feet. You may not be able to feel when you have a cut or sore on your foot. Your feet may also become very dry and cracked. You may not notice calluses or corns (thick layers of dead, dry skin) that form on your feet.

  • Narrow or blocked blood vessels from peripheral vascular disease decreases blood flow to your feet. Decreased blood flow increases your risk of infection and slows healing.

  • Diabetes may change the shape of your feet. Your toes may become crooked or curved under and change the way you walk. Foot changes may lead to increased pressure in your forefoot (middle of your foot to your toes). Foot changes may also cause your feet to rub against your shoes, causing skin sores.

  • Diabetes may cause retinopathy, a vision problems. This may prevent you from seeing problems with your feet.

  • Shoes that are too tight or do not fit well may rub against your feet and cause sores.

  • Blisters, scratches, bites, burns, and injuries from sharp objects can all lead to foot ulcers.

  • Certain medicines, such as steroids, may affect your immune system. A decreased immune system may make it hard for your body to fight infection and heal.

  • A lack of healthy foods can decrease the blood flow to your feet.

  • Smoking increases your risk of blood vessel disease that can lead to foot ulcers. Smoking also decreases blood flow to your feet.

  • Extra body weight may increase the amount of force and pressure on your feet.

What signs and symptoms may occur with a diabetic foot ulcer?

  • Bad odor or pus coming from your foot ulcer

  • Shiny, tight skin on your foot that turns dark, cold, or pale

  • Fever and chills

  • Foot weakness or trouble moving your foot

  • Increased size or deepness of your foot ulcer

  • Muscle pain or cramps that occur when you exercise and go away with rest

  • Pain in your foot that had little or no feeling before

  • Redness and warmth, or swelling in your foot

  • Thick, yellow toenails

How is a diabetic foot ulcer diagnosed?

Your healthcare provider will ask about your symptoms and how long you have had them. Tell him how long you have had diabetes, and how you are treating it. He may ask if you have had any foot ulcers, injuries, or surgeries. He will examine your foot and the ulcer. He may also ask about your shoes. You may need the following tests to check for other problems with your foot ulcer:

  • Blood tests: Blood tests check your blood sugar level and check for an infection.

  • Biopsy: Your healthcare provider will take a sample of bone from your ulcer area to test for a bone infection. Your healthcare provider may take a sample of drainage or skin from your ulcer to check for infection. The sample helps healthcare providers find the best medicine to treat the infection.

  • Ankle brachial index: This test checks blood pressure in your ankle. It can help to test how well your blood is flowing to your feet.

  • Arterial Doppler: This test checks the blood flow through arteries that lead to your legs and feet.

  • Monofilament: Your healthcare provider will press a small wire against the bottoms of your feet until the wire bends. If you cannot feel the wire, you may have nerve damage.

  • Bone scan: A bone scan helps your healthcare provider check for a bone infection.

  • CT, MRI, or PET scan: These scans check for a bone infection or deep wound. You may get dye through an IV to help the pictures show up better. Tell the healthcare provider if you are allergic to iodine or seafood. You may also be allergic to the dye. Do not enter the MRI room with metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal implants.

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

  • X-ray: These pictures will help your healthcare provider check for infection or swelling in the joints of your foot.

How is a diabetic foot ulcer treated?

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.

  • Medicines:

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

    • Antiplatelets: This medicine prevents blood clots.

    • Growth factors: These chemicals help your body heal. 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.

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

  • Surgery: Surgery may be done to remove infected and dead tissue from your ulcer. Surgery may help improve blood flow and wound healing.

    • Achilles tendon lengthening: Achilles tendon lengthening improves 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: Angioplasty opens blocked or narrowed arteries in your leg or foot.

    • Bypass: A blocked blood vessel is replaced with another blood vessel.

    • Reconstruction: Reconstructive surgery is commonly done for ulcers that are not healing. Your healthcare provider may need to cut out your infected ulcer and the area around it. He may use a muscle or skin flap near your ulcer to cover the open area. He may also use a skin graft to cover the area. A skin graft is skin from another area of your body or from a donor.

    • Amputation: Amputation removes all or part of the foot. Part of the leg may also need to be removed. You may need an amputation if your foot ulcer is getting worse or you get an infection.

  • Dressings: Dressings are coverings used to keep the area moist and free from infection. Dressings improve healing and prevent growth of unhealthy tissue. 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 to improve healing.

  • Hyperbaric oxygen therapy: This treatment 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: This uses a machine to pull fluid out to decrease swelling, improve blood flow, and help your ulcer heal.

  • Offloading devices: These are used to decrease the amount of weight and pressure placed on your foot. Examples of offloading devices are specially made footwear, insoles (cushions), braces, canes, walkers, and wheelchairs.

How can I decrease my risk of diabetic foot ulcers?

  • Check your blood sugar level: Check your blood sugar level as often as your healthcare provider directs. You may need to check at least 3 times each day. Your healthcare provider will tell you what your blood sugar level should be. A steady blood sugar level decreases your risk of foot ulcers. Keep a record of your blood sugar levels with the date and time that you checked. Bring the record to 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: Healthy foods can help your wound heal. Choose foods low in sugar, fat, and cholesterol. A dietitian will help you create a meal plan that works for you.

  • Drink enough liquids: Liquids can help improve the oxygen in your tissues and decrease your risk of foot ulcers. Talk to your healthcare provider 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. Ask your healthcare provider or diabetes specialist to help you create a weight loss program.

  • Quit smoking: If you smoke, it is never too late to quit. Smoking decreases blood flow to your feet and may slow healing. Ask your healthcare provider for more information about how to stop smoking if you are having trouble quitting.

  • Take your medicines as directed: Your healthcare provider may give you medicine to keep your blood sugar level steady. You may also need medicine to help treat your nerve damage. Keep a written list of the medicines you take, the amounts, and why you take them. Do not stop taking your medicines unless you discuss it with your healthcare provider.

  • Wear properly 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. If your healthcare provider orders you special shoes, make sure you wear them.

How do I care for my feet?

Good foot care may help prevent ulcers, or keep them from getting worse. Follow your healthcare provider's instructions about foot care. You may also need to do the following:

  • 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. Feel your feet every day. Your feet may also be cold and pale. 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.

When should I contact my healthcare provider?

  • You see 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 feet feel weak or you have trouble moving them.

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

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

When should I seek immediate care or call 911?

  • You can see bone through your ulcer.

  • 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.

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

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

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. 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.

© 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.

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