Diabetic foot ulcer

Diabetic foot ulcer

Yes, well-managed blood sugar levels, proper foot care, and a healthy weight can prevent foot ulcers.
No, foot ulcers can be treated without surgical intervention. But if therapies fail to heal the ulcers, then surgery becomes the only option.
Healing depends on the size, location, and severity of the wound. Complete healing may take a few weeks or even months.

What are diabetic foot ulcers?

Diabetic foot ulcers are open wounds or sores found on the plantar surface of the foot. It affects almost 15% of diabetic people. Sometimes the ulcers get infected and need hospitalizations. Diabetic foot ulcer-related complications increase the risks of non-traumatic lower-limb amputations to almost 14-24% in patients. The amputation risk is higher in patients with diabetes mellitus than nondiabetic individuals.

The ulcers appear as the skin tissues break out and expose the underlying layers. Early detection and treatment, proper foot care, diet, and health regimen can prevent 85% of amputations.

Who are at risk for developing diabetic foot ulcers?

Individuals suffering from diabetes are at higher risk of developing the disease in their lifetime.

Risk factors:

  • Diabetes mellitus type 2 more than type 1.
  • Long-term diabetes for at least 10 years.
  • Being male.
  • High hemoglobin A1c.
  • Uncontrolled diabetes.
  • Previous history of ulceration.
  • Peripheral neuropathy.
  • Foot deformities.
  • Peripheral vascular disease.
  • Callus formation in the foot.
  • Lower limb ischemia (not getting enough blood).
  • Long-term cigarette smoking.
  • Insulin-dependent diabetes.
  • Old age.
  • Diabetes-related disorders like kidney diseases, eye problems, heart diseases.
  • Hyperglycemia.
  • Weight problems.
  • High blood pressure.
  • High cholesterol.
  • Poor hygiene.
  • Poor-fitted footwear.
  • Excessive alcohol consumption or tobacco use.
  • Improper toenail trimming.
  • The disease is more common in Hispanic individuals, and people of African-Caribbean or Native American descent.

There are risks of gangrene leading to amputation especially in people belonging to a lower socioeconomic class or rural areas due to poor management of the disease.

Causes for diabetic foot ulcers

Diabetic foot ulcerThere are many contributing factors:

Diabetic neuropathy

High blood sugar levels damage the sensory nerves, motor nerves, and the body’s immune system to fight diseases. A person with sensory nerve damage may not feel pain, heat, or cold in the feet. The feet become numb. Extreme sensations of cold or heat may go unnoticed. The feet develop sores that get infected over time and do not heal.

Peripheral neuropathy develops due to a lack of motor reflexes and muscle weaknesses. This changes the person’s gait. It causes foot deformities like Charcot foot, hammertoes, blisters, bunions, etc. The disturbed gait and deformities further contribute to ulcer formations.

Ill-fitting shoes further aggravate the situation and the infection sometimes spread to the bones (osteomyelitis) and requires surgery.

Peripheral artery disease

Diabetes damages the blood vessels. This causes inflammation and plaque buildups (atherosclerosis) in the artery walls. It hardens and narrows the artery walls. This is ischemia. Poor blood circulation in the feet and hands causes peripheral artery disease (PAD). It increases the risks of infections and ulcers by restricting the flow of oxygenated blood supply and essential nutrients in the arteries.

Lack of blood supply slows down the healing process of wounds and foot ulcers. PAD is one of the major causes of diabetic foot ulcers.

Foot infections

Deep diabetic foot infections can grow and spread easily to the underlying soft tissues, muscle sheaths, tendons, etc. Since the foot is numb and the patient is unable to feel the pain or discomfort, he/she continues ambulation further spreading the infection. Other health factors like ischemia, neuropathy, hyperglycemia, etc., aggravate the symptoms.

Osteomyelitis

Osteomyelitis often results in longstanding deep soft tissue infections that affect the bone marrow.

Types of diabetic foot ulcers

Diabetic foot ulcers are of different types:

Neuropathic ulcers

Peripheral diabetic neuropathy causes neuropathic ulcers. But there is no ischemia due to peripheral artery disease (PAD).

Ischemic ulcers

They occur due to peripheral artery disease without the presence of diabetic peripheral neuropathy.

Neuroischemic ulcers

These ulcers occur due to the presence of peripheral neuropathy and ischemia caused by PAD.

Diabetic foot ulcer symptoms

Diabetic foot ulcer symptomsDiabetic foot ulcer symptoms include:

  • Skin discoloration.
  • Discoloration or changes in toenails.
  • Blisters, sores, calluses, cuts, etc.
  • Pain and redness.
  • Swelling.
  • Pus or fluid discharge.
  • Foul smell from sores.

 

When to seek emergency medical help?

Apart from the noticeable symptoms, seek immediate medical help if you notice:

  • Foot shape changes.
  • Hair loss in the feet or toes.
  • Burning, tingling, cramping sensation in the feet.
  • Pain.
  • Feet numbness.
  • Yellowish thick toenails.
  • Foul smell, redness, wounds, darkness, and other changes in the feet.
  • Gangrene of some portions of the heel or forefoot.
  • Extreme gangrene of the entire foot.
  • Fever. 
  • Chills.

Diagnosis

The doctor will:

  • Ask about your symptoms.
  • See whether your blood glucose levels are in control.
  • Touch and examine the feet, toes, and legs.
  • Use tools to check numbness.
  • Take your medical history.
  • See signs for infections, discharge, skin discoloration, redness, warmth, inflammation, etc.
  • Take deep-skin x-ray and MRI.
  • Send skin samples or wound discharge samples for examination.

Treatment for diabetic foot ulcers

Wound dressing for diabetic foot ulcerCare for diabetic foot ulcer:

Debridement

Debridement is a process that removes dead skin cells and tissues. It is strictly advised not to do this on your own. Seek consultation from an authorized podiatrist, otherwise, it can worsen the injury.

Debridement process:

  • Clean and disinfect the surrounding wound area.
  • The podiatrist uses a metal probe to see how deep the wound is and whether there is any foreign object.
  • The provider separates the dead tissues and cleans the ulcer.
  • The sore may look bigger, reddish, and deeper. Black, purple, or pale wounds may not heal properly.

Other methods:

  • Therapeutic whirlpool baths to soothe the ulcer.
  • Syringe and catheter to remove dead skin tissues.
  • Use chemicals or enzymes to dissolve dead skin.
  • Maggot therapy. The maggots eat the necrotic skin tissues.
  • Hyperbaric oxygen therapy to treat swelling and infections (delivers oxygen to the ulcer).

Less pressure on the feet

Your healthcare provider may suggest you wear special shoes or braces or use crutches or a wheelchair until the wounds get healed.

Footwear should be:

  • Made of leather or canvas.
  • Avoid wearing plastic shoes that resist proper airflow.
  • Wear adjustable shoes with Velcro or buckles.
  • Avoid shoes that expose the toes like flip flops or sandals.
  • Stop wearing tight shoes or high heels.

Wound care and dressings

Clean the wound area and apply dressings daily. Avoid walking barefoot or putting too much pressure on your feet.

Some providers use wet-to-dry dressings. The wet dressings absorb the wound discharges and as it dries, some tissues come out. You can remove the dressing yourself or take help from some family member. Some dressings with medicines are also used.

Is amputation necessary?

Diabetes sometimes causes nerve damage (peripheral neuropathy) or peripheral artery disease (PAD) that reduces blood flow to the feet. This causes numbness. The person does not feel pain. Continues movement puts pressure on the foot ulcers.

With time the ulcer progresses and gets infected. PAD causes a reduction in blood flow that slows down the wound healing process and the body’s ability to fight infections. In the long run, it causes gangrene (localized body tissue decomposition) that may spread to the bone. If the infection is life-threatening and there is severe body tissue damage, amputation is the only option.

Procedure

The surgeon removes the damaged tissues and tries preserving healthy tissues as much as possible. The patient needs a hospital stay until he/she is fit to go home. It takes 4-6 weeks for complete healing. The patient will need physiotherapy until he regains limb strength. Physical therapy will also teach to use a prosthetic limb or how to be mobile in a wheelchair.

The patient must follow the diabetes treatment plan, exercise regularly, eat healthy food, and control blood sugar levels for a better life. Limb loss can be traumatic and doctors advise patients to talk to counselors or mental health providers.

How to prevent amputation?

Managing blood sugar levels and leading a healthy life are the only ways to prevent amputation.

  • Eat healthy foods like whole grains, fresh fruits, vegetables, fiber, lean meat, etc.
  • Reduce sweetened beverages, soda, etc.
  • Exercise daily for thirty minutes.
  • Reduce anxiety and stress.
  • Check blood sugar and blood pressure levels regularly.
  • Take medications and insulin as directed.
  • Daily check your feet to see if there are any blisters, discoloration, wounds, redness, or numbness.
  • Wear clean and dry socks.
  • Wear proper footwear.
  • Move your toes and feet throughout the day to improve blood circulation.

Healthy feet regime

Few helpful tips for healthy feet:

  • Clean your feet daily and keep them dry.
  • Apply petroleum jelly on skin cracks.
  • If you have plantar warts, corns, bunions, etc., seek assistance from a podiatrist.
  • Trim toenails.
  • Avoid walking barefoot.
  • Wear closed footwear.
  • Quit smoking. It causes vascular problems and affects blood circulation.
  • Avoid injuring the feet.
  • Wear cotton socks.
  • Get periodic foot exams.
  • Above all, manage blood sugar levels.

 

Facts

Diabetic individuals are 25 times more likely to get amputations than non-diabetic individuals.

Facts

Research shows 1 in every 6 diabetic people may develop diabetic foot ulcers in their lifetime. There is also a high risk of amputation.

Facts

About 85% of feet amputation due to foot ulcers are preventable. If diabetes is not well-controlled, there are 50% chances of getting another amputation.

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Yes, well-managed blood sugar levels, proper foot care, and a healthy weight can prevent foot ulcers.
No, foot ulcers can be treated without surgical intervention. But if therapies fail to heal the ulcers, then surgery becomes the only option.
Healing depends on the size, location, and severity of the wound. Complete healing may take a few weeks or even months.

 

Dos and Don'ts

Dos
  • Daily foot examination.
  • Control blood sugar levels.
  • Wear proper diabetic shoes.
Don'ts
  • Ignore numbness.
  • Treat corns, blisters, calluses, or ingrown toenails on your own.
  • Put feet in hot water. Test the water first.

 

 

 

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dance health benefits
5 unbelievable effects of dance on your overall health! You enjoy dancing, but did you know what else it does to your body? Dancing is not only…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
Surgery or home-remedy; what is the right way to treat a burn The treatment of a burn injury depends on its severity. You can save a life by offering the…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
Vitamin-D-blood-test
25-Hydroxy Vitamin D test 25-hydroxy Vitamin D test is a blood test used to measure the level of vitamin D in the…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
Plexus Slim: Is this pink slimming drink the ultimate one-stop fat burner? How effective is Plexus Slim in helping people lose weight? What are its ingredients? Can it be safely…
liver cleanse detox
14 go-to foods that are best for a complete natural liver detox Liver cleanse can be achieved by just choosing or avoiding certain types of food. Liver itself is a detoxifying…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
EEG
Electroencephalogram – EEG EEG or electroencephalogram is a diagnostic tool used to access the functioning of neurons and brain activity to…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
HSV-1_IGG
Herpes Simplex Virus I (HSV)-IgG Test Herpes simplex virus I(HSV)-IgG is an Immunoglobulin protein that acts as an antibody & stays in the blood…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
lose weight fast
12 easy and instant steps to successful weight loss Do you want to lose weight without losing your mind? Does weight loss always mean saying goodbye to…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
nutritional yeast bread
Nutritional Yeast : How can a fungi culture be good for your body? Nutritional yeast: How a simple culture of fungi can transform your skin, digestion, immunity , and much more.…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
Cottage cheese: What can you find in this healthy chunk of fresh milk cheese? Love cheese but scared of putting on extra pounds? With cottage cheese, you can get the best of…
General adaptation syndrome: Understanding stress, one step at a time The struggle of the body to produce hormones during a stressful situation is the main theme of general…
Inversion Therapy: The anti-gravity way of healing chronic back pain Inversion therapy involves suspending a person upside dow using different types of equipment. This works by taking the…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
Unbelievable health benefits of gooseberries (and a few tasty recipes) Gooseberries are antioxidant-rich tasty fruits that can be easily added in daily diet to improve overall health and…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
aspartame or sugar
Aspartame – Hidden truths about this storm in a teacup Aspartame, the artificial sweetener, has gone under the scanner on several occasions for allegedly doing more harm than…
High Fiber Diet – Fire up your fiber intake for these health benefits! Regular bowels, healthy detox, higher immunity, and guaranteed weight loss - a high fiber diet can bring all…