The formation of foot ulcers is typically associated with poorly controlled diabetes. This complication occurs when skin tissue breaks down and exposes lower layers, which tends to happen beneath your big toes and on the balls of your feet.
Dr. med. Dipl. oec. med., FESC Michael LichtenbergArnsberg, Westfalen
Overview of diabetic foot problems
Though anyone with diabetes can experience foot pain and develop foot ulcers, thorough foot care is an important preventive measure. Any treatment recommended for diabetic foot conditions will depend on the cause of the complaint. It’s always important to seek medical advice, because if an infection is allowed to set in, there is a chance that a lower limb amputation may be necessary.
Symptoms of diabetic foot problems
The symptoms of foot ulcers are not always easy to notice, at least until an ulcer becomes infected. Some early signs to look out for include:
- redness, irritation and swelling around a wound
- leaking pus
- foot odours
In more serious cases, there is a lack of healthy blood flow to the ulcerated area, which can be associated with some of the following symptoms:
- discoloured white, blue or black tissue around the wound
- increased firmness in the wound area
- odorous discharge
- pain and numbness
Causes of diabetic foot problems
Factors that can cause or contribute to diabetic ulcers commonly include:
- poor circulation
- hyperglycemia (high blood sugar levels)
- damaged nerves
- irritated or wounded feet
Vascular disease may cause inefficient blood flow to your feet, and will make it harder for ulcers to heal properly.
High levels of glucose may impair the process of healing any infected foot ulcers. Those with type 2 diabetes may find it more difficult to combat infected ulcers, so effective blood sugar management is critical.
With damaged nerves, you may first experience pain and a tingling sensation. This will reduce the sensitivity in your feet, and that can then lead to painless wounds, which may become ulcerated.
Ulcers typically cause seepage from the wound area, sometimes accompanied by a lump, which may not always be painful. You may have dry skin that cracks and causes calluses, corns and wounds that bleed.
Diagnosis of diabetic foot problems
After a thorough physical examination, your doctor will assess the severity of any foot ulcers, perhaps using similar criteria to the following 0 to 3 scale:
- 0: no ulcer present, though foot is at risk
- 1: ulcer present but without infection
- 2: deep ulcer, which exposes tendons and joints
- 3: extensive, infected ulcers and/or abscesses
Your doctor may also use some of the following tests and procedures to check for nerve damage:
- a monofilament test checks for touch sensitivity
- a series of nerve conduction studies can check how your nerves process electrical signals
- electromyography can assess the electrical discharge in your muscles
- quantitative sensory testing measures nerve responses to vibration and temperature changes
Treatment of diabetic foot problems
Prevention of foot pain and diabetic foot ulcers usually involves staying off your feet. Walking creates pressure, causing ulcers to expand and thus making infection worse.
Certain foot protection may be recommended, such as:
- diabetic shoes
- casts or foot braces
- compression wraps or shoe inserts, which can prevent corns and calluses
A debridement (the removal of dead skin, debris, or infections that may be causing ulcers) may be undertaken to help with healing.
An infected diabetic foot ulcer is a serious complication that needs immediate treatment. Preventive measures may include:
- foot baths and disinfection of the wound area
- frequent dressing changes to keep the ulcer dry
- enzyme treatments
- special dressings, which inhibit bacterial growth
You may be prescribed antibiotics or anti-clotting medications if an infection continues to progress. There are also some over-the-counter medications that may help, such as special dressings, iodine or medical-grade honey.
Most ulceration will not require surgery. However, some surgical procedures may be recommended to reduce the pressure on your ulcer, or perhaps to remove bunion growths. Such surgery can prevent your ulcer deteriorating to the extent that an amputation becomes necessary.
Chances of recovery from diabetic foot problems
Diabetic foot ulcers are treatable, especially if you seek help early and follow foot care advice. Where an infection becomes untreatable, amputation may be required. However, thorough and consistent care will help to avoid the development of any further ulcers.
Prevention of diabetic foot problems
The American Podiatric Medical Association report that between 14 and 24% of Americans with diabetic foot ulcers require amputations. Preventive foot care is a crucial factor, and close management of your blood glucose can ensure your likelihood of developing diabetic foot problems remains low.