Diabetic foot ulcers are sores that occur on the feet of people with type 1 and type 2 diabetes . Up to 25% of people with diabetes develop foot problems. Diabetic foot ulcers usually occur on the bottom of the foot. They precede over 80% of leg amputations in the US. However, the sooner diabetic foot ulcers are treated, the better the outcome.
Diabetes can damage the nerves of the legs and feet so that you may not feel a blister or sore when it begins to appear. If undetected, the sore may become larger and infected. This may lead to an amputation of a toe , a foot, or even a leg.
The following factors increase your chance of developing diabetic foot ulcers. If you have diabetes and any of these risk factors, tell your doctor:
These factors increase your chance of developing a foot ulcer. Tell your doctor if you have any of these risk factors:
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your primary doctor may refer you to a foot specialist or podiatrist.
Tests may include the following:
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Regranex gel is a medication approved by the Food and Drug Administration (FDA) for the treatment of diabetic foot ulcer. It has been shown to speed wound healing.
Keeping pressure off the foot ulcer promotes healing. Sometimes special casts or boots are placed on the foot to “off-load” pressure from the ulcer.
Cleanse the wound regularly and change the dressings often to prevent infection.
Antibiotics may be used to prevent an infection. You may need to take the medicine for 4-6 weeks.
Infected ulcers are likely to cause high blood sugar levels. High blood sugar levels lower immune response and prevent wound healing. Therefore, improved blood sugar control—with adjustments in diet or medications—aids in fighting infections and healing wounds. Sometimes insulin shots are needed in the short-term to achieve optimal blood sugar control.
Bioengineered skin graft or human skin graft can be used to treat diabetic foot ulcers which fail to heal with conventional treatments. Skin grafts have been shown to speed the healing process.
The removal of dead tissue around the wound, or debridement , is often needed to clean the wound and promote healing. Bypass surgery to improve blood flow within the arteries of the legs may help with wound healing and spare amputations. As a last resort, amputation surgery may be needed to stop the spread of infection to the rest of the body.
Hyperbaric oxygen therapy appears to help reduce major amputations. People with nonhealing wounds are placed in a chamber. Pure oxygen is pumped into the chamber, which saturates the blood with oxygen. This oxygen-rich blood helps form new blood vessels, which helps the wound heal.
If you are diagnosed with a diabetic foot ulcer, follow your doctor's instructions .
To help reduce your chances of getting diabetic foot ulcers, take the following steps:
According to studies, if you are at high risk for diabetic foot ulcers, checking the temperature of your feet—using an infared skin thermometer—can reduce the number of ulcers. The TempTouch thermometer used in the study costs $150. Ask your doctor if you should check the temperature of your feet.
RESOURCES:
American Diabetes Association
http://www.diabetes.org/
American Podiatric Medical Association
http://www.apma.org/
CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca/
Podiatrists in Canada
http://www.podiatrycanada.org/fin_pod.html
References:
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Nelson EA, O’Meara S, Craig D, et al. A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers. Health Tech Assess . 2006;10.
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Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA . 2005;293:217-228.
Your Medicare coverage: therapeutic shoes. Medicare website. Available at:
http://www.medicare.gov/Coverage/Home.asp
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2/7/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Armstrong DG, Holtz-Neiderer K, Wendel C, Mohler MJ, Kimbriel HR, Lavery LA. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. Am J Med. 2007;120:1042-1046.
2/7/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care. 2004;27:2642-2647.
Last reviewed September 2009 by Bridget Sinnott, MD, FACE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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