Signs And Symptoms Of Diabetic Foot Ulcers
Diabetic Foot Ulcers present with different signs and symptoms. Some of the diabetic foot ulcer symptoms are:
- Changes in skin colour
- Swelling in the foot or ankle
- Pain in the legs
- Open sores on the feet that are draining and slow to heal
- Ingrown toenails or toenails affected with fungus
- Corns or calluses
- Dry cracks in the skin, especially around the heel or other areas of the feet
- Foot odour that is unusual or that will not go away
All of these signs and symptoms may not be present all at once, depending on the severity of the condition.
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Diabetic Foot Ulcer: Treatment And Prevention
Estimates are that by 2030 there will be 550 million individuals with diabetes in the world. Because almost a quarter of all people with diabetes will develop a foot ulcer at some point, health care workers need to know the best practices for diabetic foot ulcer prevention and treatment.
Determining which diabetic foot ulcer type is important to determine an effective treatment. Here are the different types of these wounds:
- Neuropathic ulcers arise when the nerve damage from diabetic neuropathy causes the individual with diabetes to not feel pain from an injury, which often leads to the ulcer progressing substantially before the person is even aware of it. Foot and toe deformities, corns, calluses and areas repetitive stress are likely places of injury. Footwear can not only hide these issues, but can exacerbate the injury if the shoe is ill-fitting.
- Ischemic ulcers or arterial ulcers as they are sometimes called may occur due to lack of blood flow to the extremity. When an ulcer occurs as the result of an injury to the extremity, the lack of blood flow makes these ulcers difficult to heal.
- Neuroischemic ulcers occur in individuals with both neuropathy and poor arterial blood flow and are the most difficult to heal.
- Infected wounds occur in about half of patients with a diabetic foot ulcer and require particularly close care.
Advanced Therapies For Diabetic Foot Ulcers
Physicians of individuals with diabetic foot ulcers may have difficult decisions to make if wounds do not heal. Many of these patients have a significant cardiac risk and health care practitioners need to make complicated decisions about whether to perform invasive procedures like angiography. Other options can be:
- Covering the wound with cultured human cells.
- Heterogenetic dressings or grafts with recombinant growth factors.
- Hyperbaric oxygen therapy.
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How Should A Diabetic Foot Ulcer Be Treated
The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing of the wound, the less chance for an infection.
There are several key factors in the appropriate treatment of a diabetic foot ulcer:
- Prevention of infection
- Taking the pressure off the area, called off-loading
- Removing dead skin and tissue, called debridement
- Applying medication or dressings to the ulcer
- Managing blood glucose and other health problems
Not all ulcers are infected however, if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.
There are several important factors to keep an ulcer from becoming infected:
- Keep blood glucose levels under tight control
- Keep the ulcer clean and bandaged
- Cleanse the wound daily, using a wound dressing or bandage
- Do not walk barefoot
For optimum healing, ulcers, especially those on the bottom of the foot, must be off-loaded. Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.
Applying Medication and Dressings
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist may order evaluation test such as noninvasive studies and or consult a vascular surgeon.
Managing Blood Glucose
Irritated Or Wounded Feet
Ulcers can sometimes be a result of improperly fitting or even inappropriate shoes. Wearing improper footwear can cause abnormal weight-bearing, areas of concentrated pressure, and abnormal shear forces on the feet. This can then increase the likelihood of experiencing foot stress.
There are three main types of ulcers.
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This is especially important for people who have diabetic neuropathy, which is nerve damage in the body that develops from high blood sugar levels caused by diabetes. Ive had patients step on needles and hard objects, metals impregnated into their foot, and theyll never know, Dr. Masturzo points out.
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Symptoms And Treatment Of Diabetic Foot Ulcers
It is important to recognize the symptoms of a foot ulcer, so you can seek treatment immediately. Some people with diabetes have decreased feeling in their feet that can cause them to not realize that they even have a foot ulcer. Some common symptoms of diabetic foot ulcers include:
- Visible open sore on the foot
- Pain and irritation
- Discharge or leaking from the sore
- Black tissue forming around the sore
- Foul-smell coming from the area of the sore
- Thickened skin near the sore
If you have an ulcer on your foot that is not healing or is getting worse, consult with your Keller wound care specialist. Your specialist can examine and evaluate your foot ulcer and recommend necessary treatment based on the severity of the problem.
Some wound care treatment options for a foot ulcer include:
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> > > Best Diabetes Solution Available
Type 2 diabetes causes the body to become resistant to the hormone insulin. This hormone unlocks cells. There are two types of diabetes: type 1 and type 2. While both types of the disease can cause problems, you can minimize the impact by following healthy eating and being physically active. The sooner you know more about diabetes, the better prepared you will be to deal with it. Once you know more about the disease, youll be better prepared for treatment.
Type 2 diabetes is a chronic condition that causes the body to produce too much insulin. It is also known as type 2 diabetes. If you have type 1, you can control your blood glucose levels by eating a balanced diet. If you have type 2 diabetes, you can even prevent it by adopting healthy lifestyle habits and modifying your diet. Its important to seek information that can help you be your own health advocate. There are many different types of diabetes, so its important to learn as much as you can about the condition.
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Wet To Dry Dressing Or Simple Saline
This dressing has a good debriding action and helps in wound bed preparation. Wet-to-dry dressings are described in the literature as a means of mechanical debridement. It is very absorptive as well as adherent and one of the cheapest dressings used throughout the world, but requires frequent dressing change based on wound severity. Dressings should be moistened before removal to minimize any chance of bleeding. A gentle cleanser will minimize wound irritation and discomfort. When treating a granulating or epithelizing wound one should soak the dressing thoroughly with normal saline for five minutes to prevent trauma and heavy bleeding.
Zinc To Speed Up The Healing
Zinc-rich foods like eggs, nuts, and legumes can prove to be very beneficial for both your diabetes and diabetic foot ulcers. Zinc promotes the production and secretion of insulin in the body and thus helps to keep blood sugar levels in check. Zinc also hastens the healing of the wound by maintaining the structural integrity of the dermal tissue.
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What Are Foot And Toe Ulcers
An ulcer is an open wound or sore that will not heal or keeps returning. When you have ulcers on your feet and toes, it can be related to diabetes specifically, a complication called neuropathy that causes you to lose feeling in your feet. A scrape, cut or puncture in your skin can turn into an ulcer, but you might not know its there if you have neuropathy.
Ulcers can lead to infections. Sometimes, the infection wont go away and you may need to have part of your foot or toe surgically removed . About 15% of people with diabetes will get a foot or toe ulcer. Around 14% to 24% of people with diabetes in the U.S. need an amputation after they get an ulcer.
Keep Your Wound Clean And Covered With The Right Dressings
Wounds heal best when they are clean and moist. So its important to get them clean and covered right away. If you have a new scrape or cut, a basic bandage and antibiotic cream should work just fine.
But if you have wounds that are infected, slow healing or more serious, make an appointment with a doctor to learn what the best wound care is for you. Your doctor will likely recommend different types of diabetic wound care dressings to protect the injury and promote healing.
Common types of dressings for diabetic wound care
- Foam dressings Extremely soft and absorbent, foam dressings are used for wounds that leak or ooze a lot. They also offer added cushioning which can help protect the wound against physical damage.
- Alginate dressing These types of dressings are primarily made from seaweed. They can hold up to twenty times their weight in moisture, making them a great choice for deep wounds and ones with discharge. Another advantage of alginate dressings is that they prevent the growth of new bacteria.
- Hydrogel dressings Hydrogel is a water-based gel designed to keep an area moist. If your wound is dry or covered in dead skin, your doctor may recommend a hydrogel dressing to provide moisture. This can help break down dead tissue and promote cell growth. These types of dressings usually arent used for infected wounds.
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Evaluation And Treatment Of Diabetic Foot Ulcers
Ingrid Kruse, Steven Edelman Evaluation and Treatment of Diabetic Foot Ulcers. Clin Diabetes 1 April 2006 24 : 9193.
Diabetic foot problems, such as ulcerations, infections, and gangrene, are the most common cause of hospitalization among diabetic patients. Routine ulcer care, treatment of infections, amputations, and hospitalizations cost billions of dollars every year and place a tremendous burden on the health care system.
The average cost of healing a single ulcer is $8,000, that of an infected ulcer is $17,000, and that of a major amputation is $45,000. More than 80,000 amputations are performed each year on diabetic patients in the United States,and 50% of the people with amputations will develop ulcerations and infections in the contralateral limb within 18 months. An alarming 58% will have a contralateral amputation 3-5 years after the first amputation. In addition, the 3-year mortality after a first amputation has been estimated as high as 20-50%, and these numbers have not changed much in the past 30 years,despite huge advances in the medical and surgical treatment of patients with diabetes.
Signs Of A Diabetic Foot Ulcer
- Drainage from your foot that stains your socks or shoes
- Any form of swelling, irritation or redness
Seek treatment from your doctor at an early stage when you notice these symptoms to prevent the worsening of the ulcer wound.
- Skin tissue turns black
- Ulcer becomes deep
- Abscesses and multiple ulcers forming
Seek treatment immediately from a doctor when you notice skin tissue turning black, deep ulcer wounds or yellow/greenish pus oozing out from the wound. Do not neglect your ulcer wound as it will increase the risk of death or amputation of the infected limb.
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What Causes Diabetic Foot Ulcer
People with diabetes have an increased chance of developing foot ulcers because you are more likely than other people to damage the skin on your feet. This is because diabetes can cause nerve damage, so you dont notice if your foot is injured or sore. Diabetes also causes blood vessel damage so your skin cant heal easily.
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Who Can Get A Diabetic Foot Ulcer
Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.
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Cleveland Clinic Heart Vascular & Thoracic Institute Vascular Medicine Specialists And Surgeons
Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:
Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.
Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.
You may also use our MyConsult second opinion consultation using the Internet.
The Heart, Vascular & Thoracic Institute also has specialized centers and clinics to treat certain populations of patients:
Tips To Prevent Ulcers
Thereâs a lot you can do to lower your chance of having ulcers in the first place:
Keep your blood sugar in check. Good blood sugar control is the single best way to prevent small cuts and sores from becoming ulcers. If you have trouble managing your blood sugar, tell your doctor. They can work with you to make changes to your medication and lifestyle that will keep your blood sugar from getting too high. Even if your blood sugar level is fairly steady, itâs still important to see your doctor regularly. Thatâs especially key if you have neuropathy, because you may not feel damage to your skin and tissue.
Check your skin every day, and pay special attention to your feet. Look for blisters, cuts, cracks, sores, redness, white spots or areas, thick , discoloration, or other changes. Donât rely on pain even feeling more warmth or cold than usual can be a sign that you have an open wound on your skin, and itâs possible that you may feel nothing at all.
Ulcers are most likely to form on the ball of your foot or the bottom of your big toe, so be sure to check your feet every night. If you notice a problem, or you arenât sure if somethingâs normal, call your doctor.
Donât smoke.Smoking damages your blood vessels, decreases blood flow, and slows healing. Those things raise your risk of ulcers and amputation.
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Wash Your Foot With Hot Water
Make sure that the water is at a bearable temperature, otherwise, youll risk scalding the skin, and thats one more thing to worry about. As bacteria are not capable of surviving in very warm temperatures, washing your foot in hot water will surely cleanse them. Not only that, but the heat can also loosen the veins in your foot, regulating blood circulation.
Find And Treat Cuts Scrapes And Other Wounds Immediately
If you treat new wounds right away, you can start caring for them before things get bad. So as soon as you find a cut or sore:
Of course, if you dont know you have a wound, you cant treat it quickly. So if you suffer from neuropathy, keep an eye out for new wounds. Check your hands and feet daily, and dont forget to check between your toes.
Wearing white socks can help, too. If you see a red spot or a place where your sock is sticking to your skin, check your foot to see if you have a wound thats new or not healing.
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What Types Of Physicians Specialize In Treating Diabetic Foot Ulcers
The doctors that are qualified to treat diabetic foot ulcers include wound care specialists, orthopedic surgeons, vascular surgeons, and endocrinologists.
- Wound care specialists are clinicians who have received specialized training in caring for and treating all wounds, both acute and chronic. One of the most treated wounds are diabetic wounds. The percentage of these wounds that become stubborn and refuse to heal is high. This creates an issue with the patients quality of life.
- Podiatrists are foot health specialists who are specially trained in treating all injuries and illnesses pertaining to the feet, including the diagnosis and treatment of diabetic ulcers.
- Orthopedic surgeons can offer prevention measures to patients who have diabetic foot ulcers. Long-term protection of the feet is provided to patients by Orthopedists subscribing footwear that will protect them in the future. The surgeon can also correct bunions, hammertoes, and deformities in the feet to avoid the formation of an ulcer.
- A vascular surgeon does not directly treat diabetic foot ulcers. They are involved in the treatment of peripheral arterial disease, which is a critical catalyst for the impediment of blood flow to the lower legs and feet.
- Endocrinologists are specially trained physicians who address several conditions, including diabetes. An endocrinologist will be the doctor who will make referrals to the other specialists mentioned here.
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