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How To Heal A Toe Ulcer

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Keeping Your Feet Healthy

Beware of Diabetic Foot Ulcers and How to Quickly Heal Them

Patients with diabetes must be diligent about wound prevention. The first step is properly managing the diabetes itself which includes maintaining a balanced diet and exercise routine, keeping blood glucose levels in the recommended range, avoiding alcohol and tobacco, and addressing any co-occurring disorder such as cardiovascular disease or obesity.

The next step is to commit to daily skin inspections, and especially your feet when sensation is impaired, Estocado said. This inspection should be thorough, and include the sole, sides and in between the toes. Even the smallest blister or scrape can escalate for diabetic patients, so call your doctor at the first discovery of any abnormality.

How Can I Prevent Or Reduce My Risk Of Foot And Toe Ulcers

It may be possible to reduce your risk of getting ulcers, and even stop them from coming back. Try to:

  • Manage your diabetes. If you have diabetes you should wear appropriate footwear and never walk barefoot.
  • Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes. Look for any blisters, cuts, cracks, scratches or other sores. Also check for redness, increased warmth, ingrown toenails, corns and calluses. Use a mirror to view your leg or foot if necessary, or have a family member look at the area for you. See a healthcare provider immediately if you notice any problems.
  • Wear appropriate shoes and socks. Talk to your podiatrist about what you need.

Who Gets Foot And Toe Ulcers

Foot and toe ulcers can happen to many people but might be more common in Black, Native American and Hispanic people. If you have an eye, kidney or heart disease related to diabetes, youre also at a higher risk. About 15% of people with diabetes will get an ulcer, typically on the bottom of their foot. Some of those people will be hospitalized because of complications.

Youre also at a higher risk of getting foot and toe ulcers if you have any of the following conditions:

  • Blood circulation issues.

If your ulcer is black, that means cells in the tissues have died. This is called necrosis .

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What Types Of Surgeries Can Help With Diabetic Ulcers

As podiatrists, we consider future foot function along with wound healing. If surgery is right for you, we will recommend a procedure that treats your pain or infection now so you can move more easily and with less pain.

Procedures we might discuss include:

  • Debridement to remove dead or infected skin and tissue from the wound, which encourages healing.
  • Skin grafts to reconstruct weakened or missing skin, which promotes healing and helps reduce the risk of infection. Skin can be taken from another part of the patients body, such as the thigh, or come from a donor it depends on each individual.
  • Vascular surgery, which helps restore proper blood flow to the wound site, promoting healing and healthier skin.
  • Shaving or removing bone to correct deformities that put pressure on the surrounding area, such as hammertoes, bone spurs, or bunions.
  • Reconstruction of deformities such as flat or high-arched feet, which can cause areas of high pressure.
  • Realigning or fusing joints to address biomechanical defects that increase pressure
  • Lengthening tendons to release tension and take pressure off an ulcer, allowing it to heal, or prevent a new one from forming.
  • Amputation of a toe or the foot if tissue is severely damaged or an infection will not stop spreading. Our limb salvage team exhausts all other options before recommending amputation.

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Are You At Risk For A Foot Ulcer

  • Do you have a foot deformity? If so, you may have a higher than average risk of a foot ulcer.

  • Do your shoes rub the wrong way? Poorly fitting shoes are a leading cause of foot ulcers.

  • Can you feel your feet? Diabetes can cause nerve damage to the feet, making it difficult to feel cuts or scratches.

  • Do you have high blood pressure? You may not realize it, but controlling your blood pressure could actually help protect your feet as well as your heart.

  • Have you had a foot ulcer before? If so, youre at higher risk of having another one. Check your feet daily and call your doctor at the first sign of an injury.

  • Do you go barefoot? Wearing shoes both inside and outside can help protect your feet from injury.

  • Can you see your feet? People who are overweight or have diabetic eye disease should ask a family member or caretaker to examine their feet every day.

  • Do you smoke? Ask your doctor for help quitting. Your feet will thank you.

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What Is The Progression Of Foot Ulcers

Certain health conditions, such as diabetes, prevent the body from healing normally and contribute to the development of ulcers.

Foot ulcers in disabled or elderly persons are often discovered by a caregiver after the ulcers have progressed, this is because of decreased sensation in their feet due to nerve damage or because of poor vision and limited flexibility, which prevents proper inspection of the feet.

At first, a foot ulcer will involve only the skins surface and often looks like a shallow, red crater with a thickened, callused border.

As the ulcer progresses, it will involve all the layers of the skin. The crater will deepen, and the surrounding skin may begin to die and become infected.

Eventuallyafter weeks, months, or even yearsa foot ulcer may involve other structures, such as tendons and bones.

An infected ulcer can develop into:

  • Cellulitis or an abscess

In the most severe foot infections, amputation of part or all of the foot or lower leg may be necessary.

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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Vitamin E For Immunity And Recovery

Vitamin E is essential for the optimal functioning of the body. In the case of foot ulcers too, vitamin E produces amazing results. Vitamin E speeds up the healing process. It also improves the circulation of blood in the body. A proper supply of blood and oxygen to the wounded region prevents the wound from getting infected.

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Cleveland Clinic Heart Vascular & Thoracic Institute Vascular Medicine Specialists And Surgeons

Advanced Steps to Take To Heal Your Diabetic Foot Ulcer

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:

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Types Of Diabetic Ulcers

There are several types of diabetic foot ulcers

  • Neuropathic ulcers occur where there is peripheral diabetic neuropathy, but no ischemia caused by peripheral artery disease.
  • Ischemic ulcers occur where there is peripheral artery disease present without the involvement of diabetic peripheral neuropathy.
  • Neuroischemic ulcers occur where the person has both peripheral neuropathy and ischemia resulting from peripheral artery disease.

Arriving at the correct diagnosis and identifying the cause of a diabetic ulcer is critical since it affects the treatment plan.

Are Foot Ulcers Contagious

The short answer is no skin ulcers are not contagious. However, if the ulcer becomes infected, the infection could quickly spread to another family member, particularly if they have a cut or graze in their skin.

When you, or another person, cleans and dresses the wound, protective gloves should be worn, and hands should be washed thoroughly afterward. Even if the ulcer is tiny, its good to keep it bandaged at all times to prevent you from inadvertently touching the skin and spreading any infection.

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Wound Dressings For Foot Ulcers

If you have your ulcer dressed in a hospital or doctors office, theyll be able to use specialist bandages that promote wound healing.

There are three types of dressings:

  • Alginate Dressings The sodium and calcium in these bandages promote healing. These dressings have a gel-like texture that is soft on the skin, so they reduce friction. Also, they stop the surrounding skin from becoming macerated. Alginate dressings are suitable for ulcers that a weeping a lot, though it may not be suitable if there is excessive bleeding.
  • Hydrocolloid dressings These dressings keep the skin dry and promote healing. Sometimes, they are impregnated with a zinc oxide solution. Hydrocolloid dressings are compressed close to the ulcer, so they encourage dead skin to disintegrate and flake off. These dressings can be painful when first applied, but the pain subsides within a day or two.
  • Antimicrobial/Antibiotic Dressings These dressings may be used if an infection has taken hold. However, they are not suitable for everyone because they can cause further damage to certain types of wounds.
  • Most dressings also contain substances that help to manage wound odor. In most cases, the dressings will last 2-3 weeks.

    Diabetic Foot Pain And Ulcers: Causes And Treatment

    Tendon Lengthening for Neuropathic Foot Problems

    Diabetic foot pain is common amongst diabetic patients and can become severe when left untreated. Diabetic foot ulcers are the sores that are usually seen on the foot pad and it occurs in around 15% of the diabetic patients. The risk of lower-extremity amputation is increased once the ulcer develops.

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    Treatment Still Requires Regular And Ongoing Foot Self

    The best treatment for a foot ulcer, according to the American Podiatric Medical Association, ”is to prevent its development in the first place.” To prevent diabetes-related foot wounds from occurrng, you should have your feet checked at least annually, and more often if you have poor circulation or other symptoms.

    Besides seeing your endocrinologist or a podiatrist regularly, you can reduce your risk by assessing your time-in-range and making adjusting to improve your blood sugar control, quiting if you are still smoking, and taking the necessary steps to achieve good blood cholesterol levels.

    Ask your podiatrist about the best shoes to wear and how best to inspect your feet to spot problems early.

    Dr. Armstrong has no relevant disclosures. Dr. Frykberg received AOTI research funds to conduct the study and has received speaking honoraria. The study was sponsored by AOTI, Inc. which makes the device.

    More on this topic
  • American Podiatric Medical Association: Diabetic Wound Care. Available at: Accessed Oct. 21, 2019.
  • Game FL, Apelqvist J, Attinger C et al. International Working Group on the Diabetic Foot. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metabolism Research Review 2016 32 : 154-168.
  • Gottrup F, Dissemond J, Baines C, et al. Use of oxygen therapies in wound healing. J Wound Care. 2017 26:s1-S43.
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    How To Treat Diabetic Ulcers

    While prevention plays an integral part in managing physical health conditions, diabetic ulcers can occur even if diabetes is properly managed. Treatment options can vary depending on the symptoms and individual but generally consist of medicine or natural ointments.

    Diabetic ulcers are generally slow to treat. Taking pressure off the foot is crucial during the healing process. Contact casting or therapeutic boots are often recommended to reduce swelling and irritation from the ulcer. Bandages and other types of wound dressing can usually be found in local pharmacies.

    Medications are sometimes used for diabetic ulcers to normalize glucose and heal any potential infection. Hyperbaric oxygen therapy is one method of treatment that can be used as well as surgical debridement. By removing dead tissue, certain diabetic ulcers can be treated by medical professionals.

    Natural ointments are also used for certain types of diabetic ulcers. Since homeopathic treatments that reduce inflammation can help with pain reduction, this can be a beneficial treatment for healing while allowing the individual a level of comfort.

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    Q: What Causes Heel Pain

    Helping Your Diabetic Foot Ulcer Heal by Removing Pressure

    A: Typically, heel pain is not caused by one single incident or injury, and the most common cause is plantar fasciitis, which can lead to long-term pain that may one day require surgical treatment if not corrected.

    Repetitive stress/pounding of the heel can cause heel pain.

    Other common causes can include inflammation of the plantar fascia, inflammation of the back of the heel, inflammation of the heel pad, progressive degeneration of the Achilles tendon, or a stress fracture caused by repetitive stress to the heel.

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    Who Gets Diabetic Foot Ulcer

    Diabetic foot ulcer has an annual incidence of 26% and affects up to 34% of diabetic patients during their lifetime. Risk factors for developing a diabetic foot ulcer include:

    • Type 2 diabetes being more common than type 1
    • A duration of diabetes of at least 10 years
    • Poor diabetic control and high haemoglobin A1c
    • A past history of diabetic foot ulcer.

    How To Improve Scars On Feet

    If ulcers occur on the tops of the feet, they might leave scars that are difficult to disguise. The most effective treatment for scars is time. However, there are some things you can do to speed up skin-regeneration and improve the appearance of scars. Remember, you should not engage in scar treatment until your ulcer has completely healed.

    • Use a gentle exfoliating scrub in the shower you could prepare a natural formulation using honey and sugar.
    • Apply vitamin-enriched creams to the feet and ankles.
    • Apply vitamin E Oil to the scarred areas of the foot.
    • Massage shea butter into the feet to improve the texture of scars.

    Incidentally, moisturizing regularly will keep the feet supple and healthy, so may prevent sores and ulcers developing in the future. Whats more, paying regular attention to your feet means youll notice any injuries as soon as they arise.

    Read Also: How Can You Tell If You Have An Ulcer

    Diabetic Foot Ulcers Or Wounds

    If foot wounds are left untreated, they may turn into foot ulcers, which are often called diabetic foot sores. In its earliest stages, a diabetic sore may look like a blister or burn. About 20-25% of people with diabetes will get a foot ulcer at some point in their life.

    Heres what causes diabetic foot ulcers

  • The foot forms a callus.
  • The callus receives ongoing damage. Most often, this happens when a person has neuropathy and cant feel when their foot is hurt.
  • Since the damaged callus isnt treated when it should be, the skin erodes, leading to an ulcer.
  • Most foot ulcers are on the ball of your foot, often near your big toe. A foot ulcer looks like a red sore. You may have an early-stage foot ulcer if drainage from the sore is clear. If theres colored pus and the wound smells badly, it may be infected.

    If you have a foot ulcer, you should talk to your doctor about diabetic foot ulcer treatments. If its infected, you should make an appointment with your primary care doctor as soon as possible.

    Foot ulcers can take a long time to heal about three months and youll need to check in frequently with a doctor to make sure that the healing process stays on track. In some cases, you may need special shoes to reduce pressure on the wound.

    While this may all seem like a lot of work, theres a reason to stick with it. If your foot ulcer doesnt heal, it can turn into something more serious, possibly even the loss of a limb.

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