What is a diabetic foot ulcer?
A diabetic foot ulcer is an open sore or wound in approximately 15 percent of people with diabetes. Foot ulcers are a significant complication of diabetes and often lead to severe infections, which can, in turn, lead to amputation of the affected foot or leg.
Diabetic foot ulcers most commonly occur on the bottom of the foot, where they can cause considerable pain and make walking very difficult. They can also appear on the top of the foot or toes. In people with diabetes, foot ulcers are usually caused by a combination of factors, including neuropathy (nerve damage), poor circulation, and mechanical stress on the foot.
A diabetic foot ulcer is an open wound that is commonly found on the foot. Let’s discuss details about the Diabetic Foot Ulcer Treatment.
Individuals with diabetes and poor circulation of blood mostly develop diabetic foot ulcers. People with diabetes have a slow healing process and this cause wounds not to heal or slow to heal.
A mild foot ulcer can deteriorate into a severe foot ulcer if it does not heal on time. This could cause the ulcer to be infected, leading to more serious health problems and major cases of amputations.
Symptoms of Diabetic Foot Ulcer
A diabetic foot ulcer normally starts in the form of sore and deteriorates into a severe open wound.
A person with foot ulcer may not feel pain and may not know at an early stage if he/she has a foot ulcer. This is because the nerves transmitting pains to the brain have been damaged. This condition is known as diabetic neuropathy.
Symptoms of diabetic foot ulcer include:
- Discoloration, swelling, and warmth around the wound site.
- A feeling of pain when the wound is touched.
- Hardened skin around the wound.
- Discharges coming out of the wound.
- Foul odors emitting from the wound.
- Fever.
- Feeling of cold.
Causes of Diabetic Foot Ulcer
Diabetic foot ulcer mostly affects individuals with diabetes. A condition known as diabetic neuropathy occurs when the blood vessels that supply nerves with oxygen and nutrients get damaged.
Individuals with diabetes have insufficient blood flow and high level of blood sugar. These conditions lead to damage of nerve cells which causes numbness, tingling, and pain.
Sensations may be lost in the feet due to diabetic neuropathy and they won’t be able to feel pains. The body may not recognize the presence of the wound, hence the white blood cells responsible for wound healing is restricted. This leads to a low healing process.
Diagnosis of Diabetic Foot Ulcer
Your doctor will most likely know if you have diabetic foot ulcer by examining or looking at your foot. He or she will inspect your feet, toes, and toenails for cuts, scratches, blisters, or ingrown toenails.
Your doctor will ask you some health-related questions such as the type of shoes you normally wear, the ways with which you keep your feet clean and healthy.
You may be asked to stand and walk so that the weight of your body and the pressure on your feet can be assessed. If you limp, this may indicate structural damage. Your doctor will also examine your blood sugar level and blood circulation.
Your doctor will check the wound for infection and how deep the wound is. He/she will check if there are any infections such as cellulitis or osteomyelitis.
Ulcer may develop and affect the bones that are closed by. Your doctor will also check if you have circulatory problems, foot abnormalities or diabetic neuropathy. Any of these conditions can affect or hinder the healing process.
To check for neuropathy, your doctor will most likely check your reflexes, examine the sensation around your feet or examine your feet to know if you feel vibrations.
Your doctor may check blood circulation in your feet and legs by feeling your pulses. He/she will also check if your feet are warm and pinkish. Doppler ultrasound may be used to test blood circulation in cases of weak pulses.
Your doctor may examine the severity of the ulcer by using a cotton swab or other instruments to check how deep the ulcer is. He/she will also check if the ulcer has eaten deep into the bones and tendons.
Tests
You may have to undergo different kinds of tests so that your doctor will know the extent or severity of the ulcer. Your doctor will also be able to know if the ulcer is infected and also if bones and tendons are affected.
The tests that you may undergo include:
-
Blood tests
A blood test is done so that your doctor can screen for any form of infections. If the ulcer is reddish, swollen or you feel the warmth around the area, a blood test may also be conducted.
-
MRI Scans
MRI scans are done so that your doctor can know the extent of damage caused by the ulcer. It shows the bones and reveals any inflammations that may have occurred.
-
X-rays
You may undergo an X-ray so that your doctor can examine the internal bones and tendons for any infection or damages. Changes in the alignment of bones, loss of bone mass, weakened bones and fractures may occur. Early detections of any of these conditions help to prevent a worse case of amputations.
-
CT Scan
You may also undergo a CT scan to check and examine internal organs and bones.
-
Bacterial cultures
Your doctor may take a sample of the ulcer with a cotton bud or any other thin medical instruments to check for bacteria.
Diabetic Foot Ulcer Treatment
Early stages of ulcer without infection can be treated by removing dead tissues known as debridement. The dead tissues are removed and the ulcer will be cleaned. After cleaning the ulcer, your doctor will apply the necessary medications and bandage the wound.
You will most likely be prescribed special footwear to help relieve pressure on the wound area. The special footwear will also make walking easier and you will feel more comfortable. You may also be given antibiotics if there is a possibility of an infection.
You may need to undergo periodic check-ups and examinations. The bandage needs to be changed periodically and the wound re-cleaned.
If you have poor circulation of blood, it will be much difficult for the wound to heal. In cases like this, you may be required to undergo surgery.
The Diabetic Foot Ulcer Treatment surgery is done to open up one or two arteries in your legs that may have been blocked. The arteries are opened to allow for better blood flow so that the white blood cells responsible for wound healing can flow to the wound area.
It is important that you keep your blood sugar under control and always wear comfortable footwear.
Prevention
To prevent foot ulcers:
- Always check your blood sugar level
- Examine your feet daily for signs of reddish coloration, thickened skin, or cracks.
- Practice good feet hygiene
- Trim your toenails and maintain them.
- Wear comfortable footwear’s that fits well.
Early Stage Diabetic Foot Ulcer Symptoms
Symptoms of early stage diabetic foot ulcer include:
- Changes to the skin or toenails
- Skin discoloration
- Swelling of the foot
- A burning pain
- Blisters and calluses
- Frequent bleeding
- Discharge of fluid or pus.
- Foul smell
Foot Ulcers That Won’t Heal
Foot ulcers that won’t heal are usually present in diabetic patients. Foot ulcers that won’t heal in diabetic patients are usually due to poor circulation, high blood sugar, and nerve damage.
Diabetes can lead to poor circulation of blood to the feet. This limits oxygen and nutrients to the ulcer, thereby making it difficult for the ulcer to heal.
High glucose levels can slow the healing process of a foot ulcer. People with diabetes usually have high blood sugar which slows down the healing of their ulcers.
Nerve damage can lead to a loss of feeling in the feet and affect the healing of foot ulcers. Nerve damage can prevent you from feeling pain and this can cause you not to seek appropriate treatments for your wound, thereby preventing your wound from healing.
Diabetic Foot Pain Symptoms
Symptoms of diabetic foot pain will vary for each individual depending on the severity of the pain. Patients with diabetic foot pain may find it difficult to stand or walk. Some patients may find it difficult to sleep and get a good night’s rest.
Common symptoms of diabetic foot pain include:
- Sharp or burning pain
- Numbness
- Pins and needles pain
- Tingling sensation
- Pain that feels like sores
- Sensitivity to touch
Diabetic Foot Ulcer Stages Pictures
Grade 0 – No open lesions or ulcers
Grade 1 – Superficial ulcers that include the skin and subcutaneous tissue.
Grade 2 – Deep ulcers that include the ligaments, muscles, tendons, etc.
Grade 3 – Ulcer with bone involvement.
Grade 4 – Partial gangrene.
Grade 5 – Full-foot gangrene
Types of Diabetic Foot Ulcers
There are three types of diabetic foot ulcers. These include neuropathic, neuroischemic, and ischemic ulcers.
Neuropathic Foot Ulcers
Neuropathic foot ulcers are caused by loss of sensation in the feet. They are a common complication in patients with nerve damage.
Neuropathic foot ulcers can develop when you lose sensation in your feet. As a result, you may be unaware of injuries in your foot.
Ischemic Foot Ulcers
Ischemic foot ulcers occur when there is inadequate blood flow in your legs. This can result in cell death and tissue damage in your legs.
Ischemic foot ulcers can initially manifest as blue discoloration or necrosis due to lack of blood flow to the area and degenerate into gangrene. It affected foot can get amputated if left untreated.
Neuroischemic Foot Ulcers
These ulcers are caused by the combination of nerve damage and peripheral artery disease (PAD). Neuroischemic foot ulcers occur in individuals who have both peripheral neuropathy and ischemia resulting from PAD. Neuroischemic foot ulcers are least likely to heal without treatment and intervention. The risk of amputation is high if the ulcer gets infected.
Diabetic Foot Ulcer Location
Diabetic foot ulcer is commonly located on the bottom of the foot. It can sometimes be located on the side of the big toe or on top of the toes.
How to Manage Diabetic Foot Ulcer
Managing diabetic foot ulcer follows specific steps which include:
Debridement
Debridement is the removal of foreign objects, including dead or dry tissue and dirt from the surface of the wound. It allows the wound to be properly cleaned. If your ulcer is covered with dead or dry tissue, debridement will be done to remove the dead or dry tissue from the surface.
Cleaning and applying medications
The ulcer will be properly cleaned under running water and gently pat dry. A topical gel or antibiotic ointment may be applied to the wound .
Dressing
Dressing the wound closes it and prevents dirt and bacteria from getting into it. Dressing allows the wound to drain out fluids and helps the wound heal faster. Dressing needs to be changed periodically as the foot heals.
Oral or intravenous antibiotics
Oral or intravenous antibiotics may be given to you to prevent and treat infections. Your doctor will let you know the appropriate antibiotics to use.
Other treatment options include:
Wearing foot cushions
Wearing foot cushions and padding such as a brace, castings, shoe inserts, and shoes designed for people with diabetes can help protect the affected foot and aid healing.
Negative Pressure Wound Therapy
Negative pressure wound therapy devices may be useful in treating diabetic foot ulcers. These devices are used to remove exudates and bacteria from the wound to help the wound heal. They also help to draw the edges of a wound together to promote closure of the wound.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy (HBOT) is a therapy used to aid the healing of non-healing wounds like diabetic foot ulcers. You will be placed in an oxygen chamber or room where you breathe pure oxygen. The pure oxygen that you breathe in helps your tissue to heal faster. HBOT can help increase the healing of foot ulcers.
Surgery
When other treatments don’t heal the ulcer, surgery may be the last resort. Surgery may help alleviate pressure around your wound, shave down the bone, or remove foot abnormalities that may be worsening the condition of the ulcer or preventing it from healing.
Bacteria Causing Diabetic Foot Infection
Staphylococcus aureus, Streptococci, Enterococcus spp, and Escherichia coli are the most common bacteria that cause diabetic foot infection.
FAQ
What does a diabetic ulcer on foot look like?
Diabetic ulcers on foot are usually red, swollen, and painful. The ulcer may be small or large and can occur on the heel, toe, or ball of the foot.
The most common cause of diabetic foot ulcers is neuropathy—a condition that causes progressive damage to nerves in your feet. As an outcome of this damage, you might not notice any pain until an injury becomes infected or infected tissue dies off, causing an open sore (also called a wound).
What does the start of a diabetic ulcer look like?
A person with diabetes may experience the following:
- A burning sensation in the foot
- Instability in the color of the skin on foot, such as redness, dark spots, or discoloration (a brownish color)
- Instability in the texture of the skin on foot, such as dryness, cracking, and peeling
Can diabetic foot ulcers cause death?
The mortality rate for people with diabetic foot ulcers is high. The death rate for people with diabetic foot ulcers is even higher. The mortality rate for people with a diabetic foot ulcer who do not get treatment can be as high as 67%.
What helps diabetic wounds heal faster?
- Good blood flow to the wound.
- Good blood sugar levels in your body.
- Your body has good blood pressure, cholesterol, protein, and oxygen levels.
How long does a diabetic foot ulcer take to heal?
The healing time for a diabetic foot ulcer varies depending on the size and location of the wound. A small ulcer on an area of healthy skin might take only six weeks to heal, while a large ulcer that has been neglected for several years may take up to 6 months or more to heal.
As you can see, many factors influence how long it takes for your foot ulcers to heal. The key is getting your wounds cleaned and bandaged regularly and taking care of them in between visits with your doctor so they don’t become infected or worsen over time.
What are the complications of diabetic foot ulcers?
Infection.
If the ulcer isn’t treated and heals on its own, the wound can become infected.
Gangrene.
This occurs when tissue dies due to a lack of blood supply because of infection or other causes.
Loss of limb (foot amputation).
Your doctor may suggest that you surgically remove your foot if gangrene is seen in more than one area on an infected foot ulcer or if you’ve had repeated infections despite being treated with antibiotics and other medicines in recent months.
Death.
People with diabetes are at increased risk for death from all causes compared with people without diabetes, so it’s essential to get treatment right away if you notice any signs of infection or another complication related to diabetic foot ulcers
Who Can Get a Diabetic Foot Ulcer?
You can get a diabetic foot ulcer if you have diabetes, peripheral arterial disease (PAD), neuropathy, or poor circulation.
If you already have a one-foot ulcer or have had one in the past, then it’s more likely that another will form on that same foot.
The risk of getting an ulcer increases if:
- You’re older than 50 years old
- You’ve had problems with previous ulcers
- Your blood sugar control isn’t good enough
What Is the Value of Treating a Diabetic Foot Ulcer?
In addition to the above, treating a diabetic foot ulcer has the following benefits:
It can save your life. If you don’t treat an ulcer and it’s left to grow larger and deeper, it will increase your risk of infection and become life-threatening. Untreated infections can spread to other parts of your body, including the bones or heart.
It can prevent amputation. If left untreated, an ulcer that is too large or deep could result in an amputation later on down the road — an unfortunate outcome for many people with diabetes.
It prevents further damage and additional problems down the line like foot deformities or loss of sensation in feet due to nerve damage caused by lack of circulation.
What percentage of diabetic foot ulcers heal?
After approximately 20 weeks of good wound care, 31% of diabetic neuropathic ulcers heal. Similarly, after approximately 12 weeks of reasonable care, 24% of neuropathic ulcers attain complete healing.
How Should a Diabetic Foot Ulcer Be Treated?
This type of ulcer is a severe complication in people with diabetes. A diabetic foot ulcer can lead to serious infections, amputation, and even death if not adequately treated.
This way to treat a diabetic foot ulcer is to catch it early and start treatment immediately. The goal of treatment is to elevate the ulcer’s healing and prevent further complications.
Treatment may include cleansing the wound, removing dead tissue, applying bandages or dressings, and giving antibiotics to prevent infection. In some cases, surgery may be important to remove dead tissue or to repair damaged blood vessels.
How much does it cost to treat a diabetic foot ulcer?
The average cost of treating a diabetic foot ulcer is between $600 and $2,000. This cost can differ depending on the severity of the ulcer and the necessary treatment. Treatment for a diabetic foot ulcer may include antibiotics, debridement, and offloading. In some cases, surgery may be required.
Best clinic to get diabetic foot ulcer treatment in Lubbock, TX
South West Woundcare is the best diabetic foot ulcer treatment clinic in Lubbock, TX. They have a team of experienced and trained professionals who can provide you with the best care possible. They also have a wide range of services you can choose from, so you can get the most out of your treatment.
