Diabetic Foot UlcerDiabetic Foot Ulcer

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Diabetic Foot Ulcer is one of the common complications associated with the diabetes. About 15% of diabetics are contacted with diabetic foot ulcers. 20% of those who develop foot ulcer will lose the limb to amputation. Within 3-5 years, 50% of this group will lose a second limb to amputation.

Signs and Symptoms
Early sign include:

  • redness of the skin,

  • blistering and

  • other signs of irritation.

In the later stages:

  • the person may encounter an open wound that drains fluid onto socks or bedding,

  • infection on open wound,

  • infected open wound develop swelling, redness, and drainage of pus,

  • fever and blood sugar levels may be higher than usual.

Causes
A diabetic foot ulcer is an open sore or wound on the foot of a person with diabetes. It is caused by combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma, as well as duration of diabetes. Diabetics can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time.  Because of loss of pain sensation,  diabetics might be unaware of any trauma to their feet caused by ill-fitting footwear or an object in their shoes. Continued walking on an injured foot will damage it further and minor lesions can become more serious. Peripheral vascular disease can further complicate a foot ulcer, It reduces the body’s ability to heal and increases the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also retard healing.

Risk Factors
 Anyone who has diabetes can develop a foot ulcer. The following factors increase a person's chance of developing a foot ulcer:

  • Neuropathy - damage to the nerves supplying the feet

  • Peripheral vascular disease - decreased blood flow to the feet

  • Nephropathy - kidney problems, including chronic renal failure. Damage to the small blood vessels that filter and clean the blood

  • Retinopathy - Poor vision due to damage at the retina of the eye from diabetes

  • Foot deformity or have limited movement, such as bunions

  • Poor glycaemic control - blood sugar levels that are not under control

  • History of diabetes for a period of 10 years or more

  • Smoking

  • Male gender

  • Callus (hard skin), thick toenails

  • Cardiovascular problems caused by diabetes

  • A history of skin ulcers or amputation of a limb

  • Overweight / Obese

  • Alcoholic

  • Age - older people and/or those who live alone

Prevention
For diabetics, meticulous attention to foot care and proper management of minor foot injuries are key to preventing ulcer formation.
Foot care for diabetics. The do's and don'ts

  1. Foot hygiene - Gently wash your feet daily with mild soap and lukewarm water. Dry it up carefully, especially between the toes. Followed by the application of topical moisturizers,  helps to maintain healthy skin that can better resist breakdown and injury. Avoid hot soaks, heating pads and harsh topical agents such as hydrogen peroxide, iodine (e.g., Betadine) and astringents (e.g., witch hazel).

  2.  Foot care - Look after your feet:
    - Inspect your foot daily, check sores, cuts, bruises, changes to the toenails.
    - cut toenails straight across and never cut into the corners; use an emery board or file on sharp corners.
    - do not try to remove corns and callus yourself - see a Podiatrist for this; Do Not use commercial corn cures - this is so important in those with diabetes as it is so easy to damage the skin.
    - avoid going barefoot.

  3. Adopt a healthy lifestyle - proper diet, no smoking, frequent exercises, reduced alcohol consumption.

  4. Proper Fitting Footwear - Poorly fitted shoes and sock are a common cause of problems in the foot of those with diabetes. Go for specially designed diabetic shoes and diabetic sock.

  5. See a Podiatrist, at least annually.  Regular foot care from a Podiatrist is a key way to prevent problems from developing in those who are at risk.
     

 The above approach may ultimately lead to a reduction in lower extremity amputations related to diabetes.

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