Diabetic foot complications are the most common cause of nontraumatic lower extremity amputations. The vast majority of diabetic foot complications resulting in amputation begin with the formation of skin ulcers. Ulcers occur from pressure that causes the skin to break down and expose the tissue underneath. Early action and prevention of these ulcerations may help prevent over 80 percent of these amputations.
These ulcerations typically occur in areas that receive the most pressure and over areas of bony prominences. Most commonly in the foot they occur on the ball of the foot and your toes, but they can occur anywhere on the foot. These wounds can range from less severe, where they affect only the more superficial layers of the skin, or they can be more severe, affecting the bone. When these ulcerations start from a developed callus or blister, it is highly recommended to seek treatment from a medical professional before you consider trimming your callus yourself or trimming up your blister.
Foot ulcers are a risk for anyone with diabetes, but there are things that can increase your risk of developing wounds. These include poor hygiene, improper trimming of toenails, walking barefoot, poor fitting or poor quality of shoe, alcohol consumption, kidney disease, obesity, tobacco use, eye disease from diabetes and heart disease. There are some key things to remember when trying to prevent ulcers from occurring. Wash your feet regularly, keep your feet dry and moisturized, wear proper fitting shoes, change your socks regularly, see a podiatrist for corn or callus removal and keep your toenails adequately trimmed.
One of the first signs of a diabetic foot ulceration can be drainage that you notice on your sock or draining through your shoes. Some patients with diabetes have developed something called peripheral neuropathy. Peripheral neuropathy causes your feet to become numb and in some cases, lose sensation all together. In this case, you cannot rely on pain to alert you to something going on. Other common symptoms can include redness, irritation of the skin, unusual swelling or odor. Other systemic things that occur in the presence of diabetes include poor circulation and high blood sugar. Poor blood circulation is a form of vascular disease where blood doesn’t flow to your feet efficiently. Poor circulation also plays a role in making it more difficult for ulcers to heal. High blood sugar can slow the healing of an infected foot ulcer. High blood sugar can make it more difficult to fight off infection from ulcers. Maintaining healthy blood sugars is extremely important in reducing risk of non healing wounds.
Treatment for diabetic foot ulcers varies depending on the cause. Should the cause be due to circulatory problems and complications, then further testing and imaging is typically ordered to address level of severity. This can lead to monitoring or it can lead to a consult to vascular surgery. If the cause is due to pressure and bony prominence, in the presence of neuropathy or not, then offloading plays a large role in the healing process. Offloading comes in different varieties as well. These include diabetic shoes and inserts, surgical shoe, bracing, offloading boot, total contact casting or a knee scooter or crutches to keep you non weight bearing to the affected limb. These are things that will be decided by your wound care provider, and many factors play a role in what device is most appropriate for you.
If you or a family member are concerned about diabetic feet, reach out to a medical provider with any questions sooner than later! These things can get worse quickly and lead to amputation. Acknowledgement and prevention are key!
Kristin Raleigh, D.P.M., is a podiatrist. She also sees patients at MyMichigan's Wound Treatment Centers.
