Diabetic Foot Ulcers

People with poorly controlled diabetes usually experience decreased foot sensation and impaired wound healing. As a result, they may develop foot ulcerations that are painless and heal poorly. The lifetime incidence of diabetic foot ulcers in people with diabetes is 19%–34%.[1]

Because individuals with diabetes may have reduced sensation in their feet, they may not notice these ulcers forming, leading to delayed treatment and complications. If left untreated, diabetic foot ulcers can become infected, penetrate deeper layers of tissue, and even lead to severe complications such as gangrene or amputation.

Proper foot care, including regular inspection, keeping feet clean and moisturized, wearing appropriate footwear, and managing blood sugar levels, is crucial in preventing the development of diabetic foot ulcers. Prompt medical attention and specialized wound care are necessary for effective treatment and to prevent further complications.

Ulcerations typically develop on the weight-bearing areas of the foot, such as the heel or metatarsal head (also known as the ball of the foot).[2] These ulcerations look round and crater-like. In severe cases, they may ooze and bleed.

What are the complications of diabetic foot ulcers?

thisdiagnosed through a combination of:

Physical Examination: Checking for signs of ulcers, infection, and nerve damage.
Neurological Assessment: Testing sensation in the feet.
Vascular Examination: Assessing blood flow to the feet.
Ulcer Assessment: Evaluating size, depth, and signs of infection.
Imaging and Laboratory Tests: X-rays, MRI, ultrasounds, and blood tests may be used if needed.
Based on these assessments, a treatment plan is developed to promote healing and prevent complications.

The main treatments include wound debridement (removing dead skin and tissue), moist wound dressings, reducing weight on the ulcer (via orthotics or shoe changes), antibiotics to combat infections, and controlling blood sugar levels (poorly controlled blood sugar can impair wound healing).[4]

How can diabetic foot ulcers be prevented?

Medical treatments for diabetic foot ulcers encompass a range of approaches, including wound debridement to remove dead tissue, specialized dressings to promote a moist healing environment, offloading techniques to relieve pressure on the ulcerated area, and topical medications to prevent infection and stimulate healing. Additionally, systemic antibiotics may be prescribed for infected ulcers, and advanced therapies like hyperbaric oxygen therapy or biological treatments may be considered for non-healing ulcers. Revascularization procedures may also be performed to improve blood flow to the affected foot.

In conjunction with these treatments, comprehensive diabetic foot care involves regular monitoring, patient education on proper foot care techniques, optimization of blood sugar levels, and addressing other factors such as nutrition and smoking cessation that can impact wound healing. A multidisciplinary approach is often necessary, with collaboration among podiatrists, wound care specialists, vascular surgeons, and other healthcare professionals to tailor treatment plans to individual patient needs and optimize outcomes.

In some cases, adjunctive therapies like electrical stimulation, ultrasound therapy, or negative pressure wound therapy may be utilized to further enhance wound healing. Patient compliance with treatment recommendations and ongoing follow-up care are crucial aspects of managing diabetic foot ulcers effectively. Moreover, addressing underlying risk factors such as neuropathy, peripheral arterial disease, or foot deformities through targeted interventions can help prevent recurrence of ulcers and minimize the risk of complications. By combining medical treatments with comprehensive care strategies, healthcare providers can strive to achieve optimal outcomes for individuals with diabetic foot ulcers, promoting wound healing, preserving limb function, and improving overall quality of life.

Ulcerations typically develop on the weight-bearing areas of the foot, such as the heel or metatarsal head (also known as the ball of the foot).[2] These ulcerations look round and crater-like. In severe cases, they may ooze and bleed.

What are the complications of diabetic foot ulcers?

If not treated early enough, diabetic foot ulcers can lead to complications such as osteomyelitis (infection of the bone), gangrene (tissue death), and foot abnormalities. An amputation may be the only option if there is significant tissue loss or a life-threatening infection.[2]