Preventing Diabetic Foot Ulcers

In the past we have written extensively about the complications that arise from diabetes.  These have included complications such as cardiovascular problems, peripheral neuropathy, atherosclerosis, foot ulcers, infection susceptibility and many others.  You quickly get the sense that diabetes is a multisystem illness with expansive impact on your body.  The focus of this article, however, is centered on preventing diabetic foot ulcers.

Why is this important?

Diabetic foot ulcers can be a major complication of diabetes.  Often an ulcer may become so deep and infected that it reaches the bone.  The infection then enters the bone and unless the infection can be resolved, will lead to amputation.  In a diabetic, amputations may begin with a toe here and a toe there, but its possible that ulcers may continue to form and the need for amputation can eventually result in a complete foot amputation or even a below the knee amputation.  In the setting of these types of amputations, additional problems arise.  While a healthy person who has undergone an amputation may do very well with a prosthesis, a diabetic with a amputation regardless of the prosthetic device, will place undue stress on the heart, and will often experience heart problems and other complications.  Often diabetics who have undergone major amputation have the same prognosis as a person with colon cancer.  With this in mind, it is easy to see why prevention of the ulcer is the name of the game, and is imperative.

How can I prevent a diabetic foot ulcer?

The most important component in preventing a diabetic foot ulcer is daily foot awareness!  Diabetics should form a solid habit of examining and caring for their feet on a regular basis. 

Things to do:

  • Daily foot inspections (have another person help if need be)

  • Daily shoe inspections (remove any debris or irritants, check for shoe breakdown)

  • Proper Hygiene (gentle cleansing, topical moisturizers, nail clipping, etc.)

  • Proper shoe gear (fully supportive, fully cushioned, proper fitting with adequate space)

  • Thick absorbent socks

  • Regular visits to your podiatrist: evaluate extent of neuropathy, evaluate biomechanical concerns, evaluate for musculoskeletal deformities, etc.

 

Things to avoid:

  • Home remedies

  • Hot soaks

  • Heating pads

  • Harsh substances (hydrogen peroxide, betadine, etc.)

  • Anything that would exacerbate the wound or impede it’s healing

 

Keep in mind, the smallest of wounds or skin abrasions can become the largest of ulcers. Because of diabetic peripheral neuropathy, often an individual cannot feel the wound or ulcer and is unaware of what is causing it.  Any minor skin abrasion or wound on the foot should be treated with gentle cleansing, applying a topical antibiotic, and appropriate dressing and padding of the wound to prevent it from progressing.  It is always good practice to follow up with your podiatrist for proper management of any wound you may have received especially if you already have a history of ulcers or amputations. Additional conservative care may include custom orthotics.  These function to help correct any biomechanical causes of inappropriate pressures, which may be contributing to ulcer formation.

In the event that conservative care fails, there are often surgical options to reduce ulcer formation and promote healing.  The goal of these surgeries are to reduce the tightness or tension in the calf and Achilles tendon, which will in turn diminish the pressure placed on the forefoot.  This is often done in the setting of an ulcer that will not heal or recurring ulcers.

Conclusion

As in all cases education, foot awareness, prevention, and conservative care are the mainstays of treatment. Occasionally progressive treatment such as surgery may be warranted.  Regular visits to your podiatrist are imperative to management of any ulcers or wounds and to avoid amputation.  If you have or know of anyone who has diabetic foot complications, don’t hesitate to schedule an appointment with Dr. Gary N. Friedlander of Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona.

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