Understanding and Managing Diabetic Foot Ulcers: A Comprehensive Guide
Diabetic foot ulcers are a prevalent, serious, and costly complication of diabetes. Alarmingly, about one in three people with diabetes will develop a foot ulcer at some point in their lives. The statistics are daunting: the chance of dying within five years after developing a diabetic foot ulcer is 30%, which rises to 70% for those who undergo an above-foot amputation. In Canada, hospital admissions for diabetic foot ulcers are 25% more costly than admissions for conditions like heart failure and pneumonia. This is before considering the additional expenses for outpatient antibiotics, rehabilitation, prosthetics, therapeutic footwear, and ongoing care. edmonton podiatrist edmonton podiatrist edmonton podiatrist
What Causes Diabetic Foot Ulcers?
Diabetic neuropathy affects motor, sensory, and autonomic nerves, creating a perfect storm for ulcer development. Motor neuropathy leads to deformities and biomechanical abnormalities, sensory neuropathy reduces protective sensation, and autonomic neuropathy alters skin moisture levels. This combination promotes callus formation which, if untreated and subjected to chronic impact, can result in ulcers.
Additionally, age, body habitus, and financial challenges commonly faced by people with diabetes can impair foot care. Reduced flexibility or increased abdominal obesity may prevent proper foot inspection, while vision problems from age-related vision loss or retinopathy make it harder to spot issues. Trimming toenails can also lead to self-inflicted injuries. Financial constraints may prevent patients from buying properly-fitted footwear or accessing professional foot care.
What Should You Do If You Discover a Diabetic Foot Ulcer?
Initial treatment of a diabetic foot ulcer involves five key areas: off-loading, wound debridement, wound dressings, infection treatment, and ensuring adequate blood flow. If you discover an ulcer on the bottom of your foot, offload the foot as much as possible using devices like knee walkers, crutches, walkers, or wheelchairs. For wounds on the side or top of the foot, ill-fitting footwear is often the culprit, so inspect your shoes and get new ones if necessary. If you notice you have a diabetic foot ulcer, do what you can to take pressure off the affected foot and see your medical practitioner right away.
How Can You Prevent Diabetic Foot Ulcers?
Due to the high risk of recurrence, patients with a history of diabetic foot ulcers are considered in "remission" rather than healed. The recurrence rate is 42% at one year and 65% at five years. Here are three key practices to reduce the risk of developing or recurring ulcers:
Daily Foot Inspections: Look at your feet every day, or have someone else do it if you can't. Early detection of pre-ulcerative lesions, like calluses, can prevent them from becoming wounds, and open wounds can be treated sooner.
Professional Foot Care: If you discover corns, calluses, ingrown toenails, splinters, or other wounds, see a foot care specialist instead of treating them yourself. Lifelong ulcer prevention from a foot care professional is crucial for those with a history of ulcers.
Therapeutic Footwear: Wearing custom shoes, insoles, or both can reduce the risk of getting a diabetic foot ulcer by half. Patients with loss of protective sensation should wear footwear whenever their feet touch the ground, indoors or outdoors.
What Are the Emerging Technologies and Innovations in Treating Diabetic Foot Ulcers?
New technologies are promising in reducing the incidence of diabetic foot ulcers and helping them heal faster. Intelligent insoles with temperature and pressure sensors, monitored remotely, are now available. Extracorporeal shockwave therapy, initially used for kidney stones and musculoskeletal issues, has been approved by the FDA for treating neuropathic diabetic foot ulcers. Other treatments like topical oxygen therapy, placenta-derived products, topical fibrin and leucocyte platelet patches, sucrose octasulfate dressings, and hyperbaric oxygen have modest evidence supporting their use and may be considered as additional treatments for non-healing ulcers, though they are not widely used.
Conclusion
Diabetic foot ulcers pose a significant threat to the quality of life for people with diabetes. Prompt referral to a specialized care team is essential for those with ulcers, and lifelong preventative foot care and therapeutic footwear are crucial to reducing the high risk of recurrence. The mainstays of treating diabetic foot ulcers include offloading and debridement of the wound, treating infections, and ensuring adequate blood flow.
Concerned about your feet? Book a medical pedicure with one of our High Risk Foot Care Nurses today. edmonton podiatrist edmonton podiatrist edmonton podiatrist
References
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