Do you have diabetes? Have you ever developed a foot ulcer? This can be not only painful but cause very poor outcomes if not treated.
Every year, two to five percent of diabetic patients develop a diabetic foot ulcer (DFU). The Journal of Clinical Medicine goes on to state that 15% to 20% of diabetics are at risk for developing a DFU in their lifetime. Also, the risk of having an amputation within the first year after your first DFU is 34.1%.
Consistent monitoring of your feet and early foot wound care provides the best outcomes. Keep reading to learn more about preventing and treating DFUs.
Causes of Diabetic Foot Wounds
If you have diabetes you are at increased risk for developing a foot wound. Many people with diabetes develop peripheral neuropathy in their feet. This is caused by changes in the small blood vessels that feed the nerves in your legs.
You may feel burning pain or numbness and decreased pain sensation in your feet. This describes the peripheral neuropathy. This may not allow you to feel pain meant to signal that something is wrong.
It may begin with something very simple. For example, you get a new pair of shoes or take a longer walk than usual. Your shoe rubs on your foot causing a small callus or a blister.
If you walk outside on a hot day, you may burn your foot without notice. Stepping on hard or sharp items or getting a splinter can start the process. Ingrown toenails may also occur with no painful symptoms.
If you do not carefully check your feet and toes, small sores can get worse. Without warning, you may develop a deep, serious wound, and infection.
The most effective treatment is prevention. Keeping your blood sugar within a set range decreases the damage on all blood vessels in your body.
When blood sugars often stay above the normal range, the inside of blood vessels begin to crack like a dry riverbed. Fats from the blood sticks in the cracks and build up causing blockages. Decreased blood flow to parts of the body lowers the amount of oxygen and tissue damage can occur.
Body tissues that don’t have enough oxygen have a harder time healing. The reduced amount of blood flow also means fewer healing factors going to a damaged area. This increases the risk of injury, infection, and decreases the ability to heal.
There are several general prevention measures to take. First, keep your feet clean, dry, and moisturized to prevent cracking which can let in bacteria. Wear shoes that fit properly and don’t slide on your feet.
Don’t walk around barefoot. Never place feet into water unless you or someone else has checked to make sure it is not hot. Don’t smoke because this decreases the amount of oxygen in your blood.
See a foot doctor if you have any foot problems. Have your healthcare provider check your feet at least every year. Most important, check your feet every day for any changes or injuries.
Proper Diabetic Foot Check
If you can’t check your own feet, ask a family member or caregiver. Always be sure you have plenty of light to see all parts of your foot.
Start by looking at the tops of your feet, between toes, around toenails, and the back of your heel. Then look at the bottom of your foot. You can place a mirror on the floor or hold it to see the bottom of your foot.
Look for the following:
- Open wounds
- Cuts or splinters
- Ingrown toenails
- Cellulitis: red, warm, swollen area signaling an infection
- Any wound with pus
If you have any of these findings, contact your practitioner immediately.
Advanced Signs of Diabetic Foot Wounds
DFUs often occur on parts of the feet that bear a lot of pressure. This includes the sole, back of the heel, and ball of your foot.
Other findings indicating high risk include large calluses, brittle or broken nails, and deep cracks in the skin. The skin may appear more thin with loss of hair on the legs and feet. Blue or dark-colored toes and toenails and pale feet indicate decreased blood flow.
Deep, large ulcers with pus, pale color, or blackened areas can mean that the tissue is dying or has died. This is a medical emergency. Severe infections and those that get into the bone can result in amputations.
Diabetic Foot Wound Care
Once a diabetic wound develops, treatment must begin immediately. Practitioners will watch your blood glucose to keep it within the normal range. This will help with wound healing.
The first step is debridement. This involves removing all damaged tissue and any foreign matter from the wound.
Debridement not only removes dead and infectious tissue but also reveals wound depth. Some wounds go to and into the bone and bone marrow. The healthy, bleeding tissue can now “breathe” and begin healing.
Wound care is individualized for each patient according to their needs. Care may include daily saline or other dressings, like a hydrocolloid dressing, to keep the wound moist. Antibiotic therapy is used for the treatment of infection.
Additional wound coverage options include cultured human cells or heterogeneic dressings/grafts. Some practitioners may apply recombinant growth factors and use hyperbaric oxygen treatments.
To help the wound heal, there must be no pressure on the tissue as this will decrease the blood supply. Yet, it is best for the individual to be out of bed. This increases circulation and prevents other health problems.
Contact casts or removable cast boots are sometimes used to relieve pressure when walking. Your practitioner may also order therapeutic shoes.
If the ulcer does not improve with ongoing wound care, surgery may be needed. Surgery may involve adding tissue supplements or fixing deformities that are causing pressure. If a bone infection is not responsive to treatment, then amputation may be recommended.
Are You at Risk for Foot Wounds?
Do you have a medical condition that puts you at risk for foot wounds? Prompt, effective foot wound care decreases healing time and increases outcomes. Finding the proper supplies may be a challenge for some.
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