What’s the number one reason people with diabetes are hospitalized? Diabetic foot ulcers: Chronic open wounds on the bottom of the feet.
They’re a common occurrence for people with type 2 diabetes. They’re difficult to treat and can become on ongoing, expensive, debilitating problem—but they don’t have to, with the right prevention and care.
Andrew Bruyn, DPM, a podiatrist on the medical staff at Baylor Scott & White Medical Center – Buda, discusses diabetic foot ulcers, how to treat them and how to avoid them.
What is a diabetic foot ulcer?
“An ulcer is a chronic wound,” Dr. Bruyn said. “If you wore a new pair of pumps and went out dancing and got a blister on your heel, that’s not an ulcer. An ulcer is a chronic wound that stays open.”
The goal of treatment is closing your wound as quickly as possible, since prolonged healing time increases your risk of infection, hospitalization, amputation and death.
What causes diabetic foot ulcers?
Corns and calluses
Typically, with diabetics, ulcerations develop in areas where calluses or corns form., including places of bony prominence where you’re bearing excess weight due to:
- Mechanical imbalance
- Loss of fat padding on your foot
- Areas where your shoe rubs your foot
“Diabetic patients often have neuropathy—loss of sensation in the foot,” Dr. Bruyn said. “With neuropathy, the callus becomes thick, the patient doesn’t feel it and it causes an underlying ulceration.”
Neuropathy is a potentially dangerous condition because the nerves in your feet that should send you pain signals aren’t functioning properly.
“I’ve had patients say that they couldn’t feel a tack or an insulin needle stuck in their foot,” he said. “Sometimes they don’t feel their feet at all.”
Very often, diabetic patients will have poor circulation in their extremities. With poor blood flow, wounds have difficulty healing.
Diabetes affects vision; consequently, many diabetic patients cannot see their feet well enough to make accurate assessments of the condition of their feet.
What is the treatment for diabetic foot ulcers?
Treatment for your foot ulcer depends on these factors:
- Assessment of skin changes around the ulcer
- Length, width and depth of ulceration
- Probe-to-bone test
- Condition of wound edges
- Whether the wound exudes pus
- Presence of dead flesh (necrosis)
- Presence of pain
Once your physician assesses your ulceration, he or she may recommend one or more of the following treatments:
- Debridement: your physician will cut away dead tissue and clean out your wound
- Oral or intravenous (IV) antibiotics
- Calcium alginates
- Growth hormones
- Skin substitutes
- Offloading: readjusting your weight to take the pressure off the bony part of your foot
- Hyperbaric oxygen therapy: a special chamber where you breathe condensed oxygen, helping your wounds heal more quickly
- Glycemic control
How do I prevent diabetic foot ulcers?
“The best approach to managing foot ulcers is prevention,” Dr. Bruyn said. “Prevention doesn’t hurt, it often doesn’t require a shot and it often doesn’t require surgery.”
Good prevention practices include:
- Perform a nightly self-assessment of your feet
- Have a professional trim your toenails and remove corns and calluses monthly
- Wear the correct shoes that properly offload your weight
- Have your feet examined annually by a podiatrist (foot doctor) or more frequently, if recommended
- Notify your physician or podiatrist immediately when you suspect you have a foot problem
How do I do a self-assessment of my feet?
Checking your feet every night is vital in finding the problems leading to foot ulcerations. The American Podiatric Medical Association (APMA) offers a guide for how to do a foot self-assessment.
Those steps can include examining your feet, preferably at the end of each day, for:
- Open wounds
- Foreign material
If you can’t lift your leg up to get a good view, place a mirror on the floor and sit on the edge of your bed. Store the mirror under the bed and slide it out with your foot when you need it.
If you have poor vision, have your spouse, partner, child, grandchild or friend check your feet for you.
“Be aggressive in checking your feet,” Dr. Bruyn said. “We don’t want you to wait until you have a disastrous complication.”
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About the author
Andrew Bruyn, DPM, AACFAS, is a podiatrist on the medical staff at Baylor Scott & White Clinic – Buda Medical Center. As the son of a podiatrist, Dr. Bruyn has been exposed to foot and ankle treatment from an early age. He quickly began to appreciate the importance of lower extremity care as he became a runner and triathlete and ultimately decided to follow in his father’s “footsteps.” After residency, Dr. Bruyn joined his father in practice for two enriching years before his love of the Hill Country brought him and his family back to the Austin area. Dr. Bruyn welcomes patients from all walks of life, including pediatrics, geriatrics and athletes. Schedule an appointment with Dr. Bruyn today.