Foot-related complications of diabetes are among the most common reasons people with diabetes are hospitalized. Foot ulcers are one of these complications. Ulcers are holes. If you have a stomach ulcer, it is a hole in your stomach. Similarly, a foot ulcer is a hole in the skin of the foot.
Foot ulcers often become infected. The depth of the hole can be very superficial or can progress to be so deep that it erodes fat, tendon, and can infect underlying bone (osteomyelitis). Left untreated, these infections threaten the patient with potential amputation and even loss of life. Clearly, therefore, prevention and treatment of foot ulceration is a daily priority for everyone with diabetes as well as their medical team.
Diabetic foot ulcers have a number of causes. Shoe or sock friction may cause a blister that may open and become an ulcer. A burn from a hot bath can have a similar result. Over-the-counter corn or callus removers can damage healthy skin, creating an ulcer. People with diabetes may have poor circulation which may contribute to foot ulcers.
Another frequent cause of foot ulcers is diabetic neuropathy. This condition often causes a decrease in sensation, allowing repeated small trauma to the skin – causing it to break down. Discomfort from a corn or callus, for example, would normally make a person avoid pressure on that area. Those people with neuropathy do not have this protective mechanism intact, so they keep walking, pain free, on the overgrowth of hard tissue. The skin underneath breaks down and ulcerates.
Prevention of ulcers is of utmost importance and very achievable. Some logical conclusions can be made from reading the above as to what preventative measures should be followed. 1: Choose shoes and socks that fit properly and that don’t rub – rubbing causes skin irritation and destruction. 2: Avoid putting your feet in water that may be too hot, but because of neuropathy you can’t feel it – use a water thermometer first. 3: Never use over-the-counter medications on your feet without the OK from your podiatrist (foot doctor). No. 4: Examine your feet daily. If you see any changes in your feet, call your doctor immediately.
Every person with diabetes should see a podiatrist. Regularly scheduled visits will keep your feet “tuned up” for your daily activities. Your foot specialist will help you decide what type of shoes help to prevent ulcers. S/He will also make recommendations for other preventative measures. The doctor may advise surgery to remove corns or other dangerous growths permanently – reducing the risk of an ulcer.
Podiatrists often suggest special shoe inserts, called orthotics. These devices can help you walk better and redistribute pressure from the soles of your feet, in the process preventing pressure sores or callous formation. New and improved materials and techniques for making these inserts are saving the feet of many people with diabetes.
Finally, if you get an ulcer, don’t panic. See your podiatrist immediately. Adequate and aggressive early treatment can assist your body in healing most diabetic ulcers. Treatments vary and may include special dressings, debridement (removal of dead tissue from the ulcer area), special shoes, casts, physical therapy, or surgery.
Your podiatrist will work closely with the other doctors on your health care team. If your circulation is poor, your podiatrist may ask a circulation specialist (vascular surgeon) for assistance in getting more blood to the ulcer. If there is severe infection, a specialist in infectious disease may be consulted to choose the best antibiotics to kill the bacteria.
Prevention and early treatment of foot abnormalities of any kind is of vital importance to your well-being. Ask your podiatrist if you are at risk for ulcers and what you can do to prevent future problems with your feet.