How Are Diabetic Feet Diagnosed
To diagnose diabetic foot, a healthcare provider will:
- Ask about your symptoms and how well youre controlling blood glucose.
- Examine your toes, feet and legs.
- Touch the toes, feet and legs with various tools to check whether you have numbness.
If a diabetic ulcer or blister is present, the healthcare provider will likely:
- Examine it for any signs of infection, such as redness, swelling, warmth, discoloration or discharge.
- Order tests to take pictures deeper than the skin, such as X-ray or MRI.
- Take a sample of the skin or discharge to test for infection.
How Diabetic Foot Ulcers Start
According to the American Podiatric Medical Association, Nerve damage and numbness in your feet 3, Having to live with diabetes means adjusting to a new lifestyle, People who manage diabetes mellitus know that this metabolic disease causes high blood sugar, 2, He may check your shoes, about 15 percent of people with diabetes will develop a foot ulcer, Multiple logistic regression analysis was used to identify independent risk factors, warmth, EMUAID® First Aid Ointment contains natural ingredients, If you notice any of the following signs, or keep them from getting worse, but commonly manifests itself on the foot, The clinical diagnosis of foot infection is based on
When Should I Seek Medical Care For Diabetic Foot Pain
If you have diabetes, tell your healthcare provider right away if you experience:
- Any changes in foot shape.
- Any changes to the skin on the feet, including a wound, redness or darkness, warmth or a funny smell.
- Hair loss on your toes, feet or legs.
- Loss of feeling in the toes, feet or legs.
- Pain, tingling, burning or cramping in the feet or legs.
- Thick, yellow toenails.
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From Injury Or Blister To Ulcer
If a person with decreased sensation gets a blister or other injury, they may not notice it and it can develop into an ulcer.
Neuropathy:Neuropathy is a general term for nerve dysfunction. Peripheral neuropathy is the most common type of neuropathy in people with diabetes and typically affects the nerves of the feet, legs, and sometimes the arms and hands.
People with diabetes are at increased risk for peripheral neuropathy if they have a history of hyperglycemia and have had diabetes for a long time. Other risk factors for neuropathy include smoking and genetic predisposition.
Over time elevated blood sugar levels can affect nerve functioning and nerve signaling. Small nerve dysfunction results in the inability to feel pain, and large fiber dysfunction causes disturbances in balance, which can increase the risk of falls.
If a person has neuropathy and injures their foot without feeling it, they may not notice it until it gets much worse. Recurrent, unnoticed injuries to the foot can increase the risk of Charcot foot, in which progressive destruction of the bones and joints leads to foot deformity.
Autonomic neuropathy can cause a decrease in sweating, resulting in dry feet. Having dry feet can increase the risk of developing calluses. While calluses are healthy, if you have lost sensation, they can grow deeper cause damage to the skin surface known as breakdown, putting the foot at risk of blisters or ulcers.
Research Related To Amputations
Your doctor takes your health seriously, and research shows that working closely with your entire clinical care team will help keep you healthy and mobile. That means keeping regular appointments, following recommendations for lab tests, medications, and other treatments, and working with specialists that can help address your unique needs.
Research has shown that an aggressive, team approach is needed when caring for patients with diabetic foot ulcers due to morbidity and disability that is caused by amputations. One such study confirmed this:
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Prevention Of Diabetic Foot Ulcers
- Check your feet daily for blisters, cuts, sores, redness, cracks and swelling.
- Keep your feet clean to prevent infections by washing them in lukewarm water.
- Keep your feet dry by sprinkling little talcum powder in between your toes.
- Don’t move around barefoot.
- Wear proper shoes and wear light cotton socks
- Protect the feet from extreme hot and cold temperatures
- Control your blood sugar levels
- Avoid smoking
- Go for regular foot check-ups.
Diabetes Comprehensive Foot Exam
A comprehensive foot exam is done yearly, and includes assessment of present diabetes complications, such as neuropathy, nephropathy, retinopathy, peripheral vascular disease, and cardiovascular disease. Notes are made related to any prior amputations, history of an ulcer, or presence of a current ulcer. The examiner will assess for calf pain, changes in the feet since the last evaluation, and any problem with shoes.
The exam includes assessment of smoking status, A1C level, skin, and hair and nail condition. The examiner will look for thin, fragile, shiny and hairless skin when evaluating for circulation problems. Thickened, discolored, ingrown or infected toenails may signal a fungal infection.
The examiner will measure and draw the patients skin condition into a diagram, using a key to mark where pre-ulcers, ulcers, calluses, or bunions are, to name a few. They will note toe and foot deformities, including Charcots foot, and prominent metatarsal heads . They will also look for foot drop, and check for pulses in the feet, .
The examiner also assesses for the appropriate footwear that is fit properly. At this point, the examiner can order therapeutic shoes or foot inserts if necessary. If shoes or foot inserts are ordered, they are often covered by insurance, and it is best to get them at the podiatrist or orthoptist, as opposed to at the shoe store.
The examination can be performed by a Certified Diabetes Educator, a podiatrist, or an RN foot specialist, to name a few.
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Set Up Needed Services For After An Amputation
Seeing as this is not the best option, and getting past the denial, having the amputation is important for your health and survival. Its a hard pill to swallow, and many patients understandably have a difficult time with the decision to amputate. Counseling may be needed, and hospital social workers to assist in setting up needed orthotics, physical therapy and assistive devices when home are important for rehabilitation.
What Do Ulcers Look Like
Ulcers are wounds in your skin shaped like circles or ovals and can vary in size and color. When an ulcer starts you may notice:
- Dry skin.
- Redness.
- A rash.
As the ulcer gets worse, it can get wider, longer and deeper sometimes all the way down to the bone. In advanced stages you may see:
- A callus.
- A halo around the center that gets hard.
- Drainage in your sock, which may mean you have an infection.
- A brown discoloration.
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What Causes Foot And Toe Ulcers How Do You Get An Ulcer
There are many possible causes. The most common include:
- Neuropathy from diabetes.
- Peripheral arterial disease.
- Deformed toes.
- Walking in an odd way where you put too much pressure on one part of your foot or toe.
- Friction. Your foot or toe may rub against the toebox of your shoe.
Although they dont cause ulcers, foot and toe ulcers are often found alongside toe deformities such as hammertoe, mallet toe and clawtoe.
Clinical Pathways And Assessment Forms For Diabetic Foot
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Diabetic Foot Ulcer Symptoms
Normally a wound or sore on the skin would cause pain. But the same loss of feeling in the feet that often contributes to the development of a diabetic foot ulcer means that theres often no pain associated with the ulcer. This can make it difficult for people to realize that an ulcer is even there in the early stages, when treatment is most effective.
Aside from pain, another sign to look for is discharge or drainage from the wound in the socks. Ulcers that have been present for some time and that have become infected may also cause an unpleasant odor.
Wound Care And Dressings
Care for your wound as instructed by your provider. Other instructions may include:
- Keep your blood sugar level under good control. This helps you heal faster and helps your body fight infections.
- Keep the ulcer clean and bandaged.
- Cleanse the wound daily, using a wound dressing or bandage.
- Try to reduce pressure on the healing ulcer.
- Do not walk barefoot unless your provider tells you it is OK.
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History Of Previous Ulceration And Amputation
A diabetic patient with a history of previous ulceration or amputation is at increased risk for further ulceration, infection and subsequent amputation. Alterations in foot dynamics due to ulceration, joint deformity or amputation can cause the abnormal distribution of plantar pressures and result in the formation of new ulcers28.
Figure 3.
Structural deformity. When combined with sensory neuropathy, a structural foot deformity may predispose the diabetic patient to ulceration, infection and subsequent amputation.
Figure 3.
Structural deformity. When combined with sensory neuropathy, a structural foot deformity may predispose the diabetic patient to ulceration, infection and subsequent amputation.
Taking Pressure Off Your Foot Ulcer
Foot ulcers are partly caused by too much pressure on one part of your foot.
Your provider may ask you to wear special shoes, a brace, or a special cast. You may need to use a wheelchair or crutches until the ulcer has healed. These devices will take the pressure off of the ulcer area. This will help speed healing.
Sometimes putting pressure on the healing ulcer for even a few minutes can reverse the healing that happened the whole rest of the day.
Be sure to wear shoes that do not put a lot of pressure on only one part of your foot.
- Wear shoes made of canvas, leather, or suede. Don’t wear shoes made of plastic or other materials that don’t allow air to pass in and out of the shoe.
- Wear shoes you can adjust easily. They should have laces, Velcro, or buckles.
- Wear shoes that fit properly and are not too tight. You may need a special shoe made to fit your foot.
- Don’t wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.
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How Long Do I Have To Wear A Diabetic Boot
A diabetic boot may be removable or irremovable. For the best results, some doctors prefer a type of diabetic foot treatment called a total contact cast. This cast creates constant pressure around the foot and cant be removed. This is important for best results.
One 2003 study found that when people were given a cast that could be removed, they didnt wear it for the majority of the day. In fact, study participants only took 28 percent of their entire days steps with the protective cast boot on. As a result, their recovery time was much longer than people who wore it constantly.
Diabetic ulcers that arent accompanied by an infection should heal in six to eight weeks, according to a 2011 study . Complicating factors, such as an infection, may lengthen that recovery time.
Commitment to the treatment is important for recovery. In an older study from 2001, people who wore a total contact cast showed significantly more improvement at 12 weeks than people who wore a removable cast or a half-shoe. However, a more recent study from 2016 found no difference in healing between a cast, a removable boot, and an irremovable boot.
Diabetes And Foot Problems
For people with diabetes, having too much glucose in their blood for a long time can cause some serious complications, including foot problems. you might like Diabetes can cause two problems that can affect your feet: Diabetic neuropathy. Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain. This lack of feeling is called “sensory diabetic neuropathy.” If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly, because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that up to 10% of people with diabetes will develop foot ulcers. Foot ulcers occur because of nerve damage and peripheral vascular disease. Peripheral vascular disease. Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called “peripheral vascular disease.” Peripheral vascular disease is a circulation disorder that affects blood vessels away from the heart. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene .Continue reading > >
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How Is A Diabetic Foot Ulcer Diagnosed And Treated
Your healthcare provider will ask about your symptoms and examine your foot and the ulcer. He or she may check your shoes. He or she may also send you to a podiatrist for treatment. The goal of treatment is to start healing your foot ulcer as soon as possible. The risk for infection decreases with faster healing. Do the following to help your ulcer heal:
Tips For Diabetic Foot Care
Proper foot care can prevent these common foot problems or treat them before they cause serious complications. Here are some tips for good foot care:
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How To Treat Ulcers
If you do get an ulcer or notice a change in your skin that youâre not sure about, tell your doctor right away. Youâll likely get a procedure called debridement, which removes unhealthy tissue from the wound to spur healing.
Your doctor will also work with you to try to keep your sore or ulcer from getting infected and becoming bigger. Some of the steps they may recommend include:
Clean your ulcer daily. Use soap and water, unless your doctor recommends another cleanser. Donât use hydrogen peroxide or soak your wound in a bath or whirlpool, because this could reduce healing and may boost your odds of infection.
Keep your ulcer bandaged or covered with a wound dressing. While you may have heard that itâs important to âair outâ wounds, experts now know that not covering a wound actually increases the odds of infection and slows healing.
Keep pressure off your ulcer, especially if itâs on your foot. This may mean you need to use crutches, special footwear, a brace, or other devices. Reducing pressure and irritation helps ulcers heal faster.
Use the topical medications your doctor recommends. These may be saline, growth factors, and/or skin substitutes.
Keep your blood sugar under control. In addition to reducing your risk of ulcers, tight blood sugar control helps your body heal existing ulcers.