Diabetes mellitus is one of the most devastating diseases affecting the United States today, in terms of both patient impact and healthcare costs. Approximately 20 million Americans in the year 2005 have been diagnosed with the disease, which not only affects the daily lives and long-term health of patients, but often leads to secondary complications that can have tragic results.1 One such complication is diabetic foot ulcers.
15% of Americans with diabetes suffer from diabetic foot ulcers2
These challenging wounds affect approximately 15% of Americans with diabetes and are the primary cause of hospital admissions for all diabetics.3 The wounds are a result of poor lower extremity circulation caused by the disease. Because the reduced circulation is often accompanied by decreased sensation in the affected limbs, many foot ulcers go unnoticed by the patient until they are severe enough to require medical intervention. For many, however, the wounds progress deep into the tissue and severe bacterial infection takes over. For nearly 82,000 people each year, the result of this scenario has been amputation.14
You can learn more about your condition, why these wounds occur, diabetic foot care, and current treatment options.
Diabetic Foot Ulcers
Foot ulcers, which are casually referred to as foot sores or foot blisters, are open sores or wounds that most often occur on the bottom of the foot, and are a common problem in diabetic foot care. More than 800,000 diabetic patients experience foot ulcers each year3. If left untreated, these foot sores can often become infected and may eventually lead to amputation. But now, there is a potential solution if you see your doctor about your diabetic foot ulcer in time.
How Diabetic Foot Ulcers Form
There are a combination of factors that cause diabetic foot ulcers to form, such as a lack of feeling in the foot, poor circulation, foot deformities, foot irritation such as friction or pressure, trauma, as well as the ongoing disease of diabetes. Patients who suffer with diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage which is caused by elevated blood glucose levels over time. Often the nerve damage occurs without any pain felt by the patient. Your physician can test you for neuropathy. Foot ulcers can also be complicated by vascular disease, which reduces the body’s ability to heal, therefore increasing the risk for an infection. Diabetes can also reduce the body’s ability to fight off infections and also slow healing.2, 10
Basically, people with diabetes have poor blood flow in their hands and feet. They also tend to have a decreased sensation to pain, and often experience a gradual loss of nerve function, known as neuropathy. Foot deformities, as well as the ongoing disease of diabetes are also factors that can cause diabetic foot ulcers to form. These factors combined with an outside factor such as shoes that rub on a certain spot over time and cause the skin to break down causing friction and pressure, can lead to a wound that is difficult to heal. Patients may not report symptoms, but they may experience:
- Burning sensation, especially at night
- Unsteadiness in standing and walking
Prevention is the Best Medicine For Diabetic Foot Care2
- Control your diabetes through diet and insulin intake
- Regularly check your blood sugar levels
- Regularly check your feet for callus and breaks in the skin
- Treat any infection2
- Reduce friction and pressure by wearing good footwear2
Diabetes alters the immune systems thereby decreasing the body’s ability to fight infections. You can have foot problems, such as slow healing wounds, if blood vessels and nerves are damaged. These complications may make you less able to sense injury or pressure on the foot. A foot injury may go unnoticed until severe infection develops.
Preventive Foot Care for Diabetics4
- Inspect your feet and toes daily for changes in cuts, bruises, sores, or changes to your toenails.
- Wash feet twice daily (morning and evening), using mild soap and lukewarm water. Dry them thoroughly, especially between the toes.
- Do not put lotions between your toes, as infections can develop in moist areas.
- It’s okay to put lotion on dry areas of your feet, just not between your toes.
- Ask your doctor to show you how to care for your toenails. Always soak your feet in lukewarm water to soften toenails before trimming them.
- Cut your toenails straight across as curved nails are more likely to become ingrown.
Tips on Shoes and Socks
- Don’t walk barefoot, not even in your home. This will help protect your feet from injury, such as scratches, small cuts and bruises.
- Wear thick, soft, dry socks or non-binding panty hose every day.
- Wear socks to bed if your feet get cold.
- Don’t wear anything too tight around your legs, such as binding panty hose, girdles, knee high stockings and thigh-highs.
- Get properly measured and fit every time you buy new shoes.
- Check the inside of your shoes for rough areas that may cause irritation.
- Avoid wearing sandals, high heels, shoes with pointed toes, or panty hose with seams.
More Helpful Tips
- Exercise daily to keep good circulation in your legs and feet. Do not sit with legs crossed or stand in one position for long periods of time.
- Stop smoking as smoking can affect circulation.
- Lose weight if you are overweight.
- Don’t drink alcohol in excess.
- Visit your podiatric physician annually, or as directed.
- Never, ever try to remove calluses, corns or warts by yourself – see your podiatric physician for assistance in these cases.2
- If you are physically unable to view your feet, put a mirror on the floor to look under your feet, or ask a family member, neighbor, or a visiting nurse to perform this important monitoring.
- Avoid using antiseptic solutions on your feet.
- Avoid any temperature extremes to your feet such as heating pads or hot water bottles, or walking barefoot on hot pavement and hot sandy beaches.
- Report all foot and leg sores, changes, or signs of infection to your doctor immediately. Also report all blisters, bruises, cuts, sores or areas of redness.
- American Diabetes Association, 2005
- American Podiatric Medical Association (APMA), 2005
- American Academy of Family Physicians. Clinical Guidelines on Diabetic Foot Disorders, Volume 63, #5, March 1, 2001.
- Medline Plus, a Service of the U.S. National Library of Medicine (NLM) and the National Institutes of Health, 2005
- B. Aminian MD, M. Shams MD, M. Soveyd MD, and Gh.R. Omrani MD, Academy of Medical Sciences. Abstract titled: Topical Autologous Platelet-Derived Growth Factors in the Treatment of Chronic Diabetic Ulcers, 1997.
- James W. Brodsky, MD, Stephanie J. Crenshaw, MS, Christopher Kirksey, BS, and Fabian E. Pollo, PhD. Diabetic Foot Solutions, Orthopedic Technology Review, Volume 3, Number 2, March/April 2001.
- International Diabetes Federation. The diabetic foot: amputations are preventable, 2005
- Reuters Health Information: Diabetes, Type 2, 2001
- Smith, RJ. Saving the diabetic foot. J Natl Med Assoc. 2000; 92: 405-410. (Access restricted to online members.) Also noted on American College of Osteopathic Family Physicians website.
- American Academy of Family Physicians. Diabetic Foot Ulcers: Prevention, Diagnosis and Classification, Volume 57, #6 (March 15, 1998).
- American Academy of Family Physicians. When you have Diabetes – 10 steps to healthy feet, Volume 57, #6 (March 15, 1998)
- American Diabetes Association. All about diabetes: Foot Complications. 2005
- International Diabetes Federation. Diabetes in North America: millions of feet at risk of amputations, 2005