What Are Diabetic Leg Ulcers

Check And Wash Your Feet Daily

In addition to wearing the right shoes, be sure to check your feet, or ask a spouse or friend to check your feet, every single day. Diabetic nerve damage makes it much harder for you to feel any pain caused by wounds, so only a visual inspection will reveal signs of injury. Look carefully for cuts, cracks, and blisters. Check closely around the nails since this area is especially vulnerable to infection.

Also make sure to wash your feet at least once a day with warm water and dry them afterwards. Its important to dry between each individual toe so that moisture doesnt accumulate and breed bacteria. Take this time to gently trim your toenails in a way that prevents ingrown nails. Moisturize your feet after washing to minimize cracking and chafing as well.

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Diabetic Lower Extremity Wounds

There is one diabetic related amputation performed every 20 seconds with over 2,500 limbs being lost per day due to infection and a poorly controlled disease process.1 25% of those with diabetes will have a lifetime risk of developing a lower extremity wound with more than 50% of those becoming infected requiring hospitalization.2 Once an individual has had a lower extremity wound they carry a 68% risk of reamputation over 5 years unless one changes their habits and life styles.3 All of this can be prevented with a team approach towards care and a focus on prevention.4

A diabetic foot ulcer is an open sore or wound that is commonly located on the bottom of the foot. Diabetes is currently the leading cause of all non-traumatic lower extremity amputations in the United States.

Do You Have A Diabetic Foot Ulcer

Since nerve damage may prevent you from feeling the pain of your diabetic foot ulcer, its important to visually inspect your feet every day. If you notice any of the following signs, seek medical care immediately:

• Drainage from your foot is staining your socks or leaking from your shoe
• Unusual swelling
• Strong, irregular odor from one or both feet
• Black tissue surrounding a wound on the foot

Many diabetic foot ulcers develop under the big toe and along the balls of the feet. The earlier you can identify your diabetic foot ulcer and receive treatment, the better your chances of preventing severe complications.

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Treatment Options For Foot Ulcers

A DFW wound care doctor can examine your feet, check for signs of infection, and recommend treatment options for your diabetic foot ulcer based on your specific condition and needs. For foot ulcers that are severely infected or spreading to other areas, hospitalization may be needed.

According to our DFW wound care doctor, some of the most common treatments for a foot ulcer are:

• Off-loading.Off-loading is recommended to take pressure off the ulcer. This can be done by using padding over the ulcer, crutches while walking, a brace or cast on the foot, or a compression wrap.
• Medication. If there are signs of an infection, an antibiotic ointment can be put on the ulcer then covered with a dressing or bandage. An oral antibiotic may also be prescribed to help with infection.
• Cleaning. The ulcer should be kept clean and dry. This can be done by washing the ulcer daily with a mild soap and warm water and changing any dressings or bandages used to cover the ulcer.
• Debridement. Removing any dead skin or tissue by debridement is often done to speed up the healing process. Debridement is done by a podiatrist using a sharp tool to remove the skin and tissue.
• Surgery. If more conservative foot ulcer treatments have not been successful, surgery may be recommended. Surgery can be done to correct a foot deformity such as a hammertoe or bunion that is causing the foot ulcer. Also, shaving or removing bones is an alternative option.

Ways To Treat Foot Ulcers

If you are currently experiencing a foot ulcer or think you have a foot wound while diabetic, then its important to seek professional care as soon as possible. This is not a normal wound you can treat at home as foot ulcers go past skin level where you need a professional Podiatrist to treat the wound and see if there are any complications such as infection. The faster you get professional help, the more chances you have in treating your wound. Regular family doctors will usually refer patients with foot ulcers to a professional wound care center where they specialize in foot wounds such as a foot ulcer. A diabetic wound care specialist in California, such as the Wound Institute of America, can provide the most advanced diabetic wound treatment with the latest wound care technology. Your primary doctor can provide a referral for your treatment to be continued at a professional center.

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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.

Healing Of Diabetic Foot Ulcers In Patients Treated At The Copenhagen Wound Healing Center In 1999/2000 And In 2011/2012

1Department of Endocrinology I, Copenhagen Diabetes Foot Center, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark

2Department of Endocrinology I, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark

3Department of Endocrinology, Nordsjællands Hospital, DK-3400 Hillerød, Denmark

4Copenhagen Diabetes Foot Center, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark

Abstract

1. Introduction

Diabetic foot ulcers are severe complications to diabetes mellitus and are associated with a higher mortality , a lower quality of life , and ultimately life-threatening amputations . With a life incidence of up to 25% in patients with diabetes, the foot ulcers are frequent and dangerous complications to diabetes . Due to the large burden of diabetic ulcers for the individual as well as society, it is relevant to find predictors of the healing time in the context of prophylaxis and treatment.

2. Materials and Methods

2.3. Description of the Copenhagen Wound Healing Center

2.4. Data Collection and Definitions

Diabetes mellitus was defined as diagnosis with ICD-10 code DE10X-DE14X or if the diagnosis was mentioned in the patient records. Age was registered at the debut of the foot ulcer in 1999, 2000, 2011, or 2012, alternatively at the first mention of the ulcer if debut time was unknown. Debut of the ulcer was noted as the date when the diabetic foot ulcer was discovered by the patient.

2.5. Statistical Analysis

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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.

Treatment For Vascular Ulcers

Its important to note that not all skin ulcers are caused by diabetes, and that even people who dont have diabetes can suffer from chronic wounds. Even people without diabetes can be susceptible to vascular ulcers. Vascular ulcers are caused by problems with the vascular system .

These types of ulcers can happen to people who suffer from veins or arteries that dont function properly, causing blood flow in the legs to be limited. This can lead to an increased risk of wounds that may not heal normally and can become infected.

The Wound Care Center at Harrington also provides full service care for these types of wounds, including on-site X-rays, MRI and lab work.

To make an appointment at the Harrington Wound Care Center, call 248-8105. You can also learn more on our website here.

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What Type Of Healthcare Provider Helps With Ulcers How Do They Diagnose An Ulcer

Your healthcare provider can tell what type of ulcer you have based on four observations:

• Appearance of the ulcer.
• Appearance of the borders.
• Appearance of the surrounding skin.

Your primary healthcare provider can diagnose an ulcer, but they may send you to a specialist for treatment. You may see a podiatrist, a provider who works with feet, or a wound specialist. To find out how deep the ulcer goes, and to see if it caused an infection in a nearby bone, they may order an X-ray, MRI or CT scan.

For more complicated cases that require surgery, you may also see a plastic surgeon, anesthesiologist, orthopedic surgeon and/or vascular surgeon.

Leg Sores: Symptoms & Signs

Leg sores can arise from trauma, infection, tumors, or chronic medical conditions. Any process of inflammation or tissue damage can manifest as a sore on the leg. Leg sores may affect primarily the skin or can extend into the subcutaneous tissues, muscles, bone, and deeper structures of the leg. Depending upon the exact cause, they may be associated with redness, swelling, oozing, crusting, ulceration, and Common causes of leg sores include insect bites and stings, cuts and abrasions, and skin infections. REFERENCE: Kasper, D.L., et al., eds. Harrison’s Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015. Pictures, Images, Illustrations & Quizzes Causes of Leg SoresContinue reading > >

• Symptoms of diabetes: Seven signs YOU could have the condition

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Treatment Of The Foot Ulcer Depends On The Severity Of The Wound

What Is A Diabetic Foot Ulcer

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.

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Preventing Diabetic Foot Ulcers

One of the most common injuries in people with diabetesa condition in which the body has trouble regulating blood sugar levelsis an open sore, or ulcer, that forms on the foot. If you have diabetes, NYU Langone doctors advise taking steps to prevent foot ulcers, or prevent them from worsening.

Without treatment, even a small blister on the foot can become an open sore in a matter of days. Because people with diabetes often have nerve damage called peripheral neuropathy, which prevents them from feeling foot pain, any type of blister, cut, or scrape may go unnoticed.

Diabetes is also associated with reduced blood flow in the legs and feet, called lower extremity arterial disease. This can slow the rate of healing, so that once an ulcer develops, it may take weeks or months to fully heal.

Because an ulcer is an open sore, the risk of infection is high. An infection that starts in an ulcer can travel through the bloodstream to a bone in the foot. An infection in the bone can pose a serious health risk and, in severe instances, may require amputation of the affected foot.

Diabetic foot ulcers can be preventable. Doctors at NYU Langone recommend daily foot inspections so any injury can be addressed right away, before it becomes an open sore. Managing your blood sugar levels and maintaining a healthy weight can help your body remain healthy, which can speed healing.

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.

Preventing Infection

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

Off-Loading

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

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What Causes Diabetic Foot Ulcers

• Blood glucose levels
• And the length of time you have had diabetes

If youve been struggling with diabetes for many years, you are more likely to develop neuropathy, which is reduced feeling in the feet due to nerve damage. This nerve damage can occur slowly over time due to high blood glucose levels, and because it is often painless, you might not even be aware of the problem.

Unfortunately, you might also not be aware of foot ulcers.

If you cant feel DFUs, then you probably arent doing anything to help them heal. And, diabetic wound healing can be very complicated and slow if you dont help it along.

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.

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Where Does An Ulcer Appear

There are many different kinds of ulcers. While peptic ulcers form in the stomach or upper intestine lining, ulcers can also occur almost anywhere on the body.

Ulcers that are found outside the body can include leg and foot ulcers. These ulcers are generally swollen or tender and can cause itchiness or pain. Skin discoloration and changes in texture are also common in ulcers found outside the body.

Whether they are found inside or on the skin’s surface, ulcers are sores that are often slow to heal. Once they have disappeared, ulcers can return if not treated properly. Depending on the cause of the ulcers, they can require different treatment options.

When You Need More Treatment

If your wound doesnât heal in about a month or becomes an infection that spreads to the bone, you may need other treatments. These can include surgery and hyperbolic oxygen therapy, which involves breathing pure oxygen in a special room in order to help your body heal.

If your ulcer develops gangrene and your tissue dies, your doctor may have to amputate that area of your body.

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When To See Your Doctor

If you begin to see blackened flesh around an area of numbness, see your doctor right away to seek treatment for an infected foot ulcer. If untreated, ulcers can cause abscesses and spread to other areas on your feet and legs.

At this point, ulcers can often only be treated by surgery, amputation, or replacement of lost skin by synthetic skin substitutes.

How To Prevent Diabetic Ulcers

For those who are diabetic or who have experienced ulcers in the past, there are some ways to prevent foot ulcers. If a foot wound has occurred due to a diabetic ulcer, there is a risk that it may return.

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