Top 5 Causes Of Non-healing Diabetic Foot Ulcers (and How To Prevent Them)
If you have diabetes, your blood sugar levels are higher than normal. Over time, this can cause complications with other bodily functions, especially within the feet. In fact, diabetic foot ulcers, open wounds that occur in approximately 15 percent of diabetics, are the leading cause of non-traumatic lower extremity amputations in the United States. Read on to learn the top five causes of non-healing diabetic foot ulcers, as well as important information on how to prevent complications before they occur. 1. High Blood Sugar Levels Diabetes is a metabolic disease that causes elevated levels of glucose in the blood. Elevated blood glucose levels stiffen the body’s arteries and narrow its blood vessels, restricting the delivery of the blood and oxygen needed to support the body’s natural healing abilities. 2. Poor Circulation Individuals with diabetes are at an increased risk for peripheral arterial disease (PAD), a condition that restricts blood flow to the feet and legs. PAD is especially problematic for those with chronic wounds, particularly diabetic foot ulcers, because it can seriously inhibit the body’s ability to heal. If left untreated, PAD can lead to amputation of the affected limb. 3. Nerve Damage Uncontrolled blood sugar levels can lead to nerve damage in people with diabetes. Diabetic neuropathies are a family of nerve disease that causes a loss of sensation, including the ability to feel pain. For those with nerve damage, a small cut, blister or surgical wound on the foot can go unnoticed and untreated, leading to infection and interference with diabetic foot ulcer recovery. 4. Immune System Issues One of the roles the body’s immune system is to clear away dead, damaged tissue and build new skin cells once a wound or injury has occurred. Diabetes can Continue reading >>
Diabetic Foot Ulcers
Ulceration in diabetic foot due to lack of protective sensation Epidemiology incidence approximately 12% of diabetics have foot ulcers most common medical complication causing diabetics to get medical treatment foot ulcers are responsible for ~85% of lower extremity amputations risk factors factors associated with decreased healing potential uncontrolled hyperglycemia inability to offload the affected area poor circulation infection poor nutrition factors associated with increased healing potential serum albumin > 3.0 g/dL total lymphocyte count > 1,500/mm3 Pathophysiology neuropathy has largest effect on diabetic foot pathology sensory dysfunction leads to lack of protective sensation and is primary risk factor for ulcer development autonomic dysfunction leads to drying of skin due to lack of normal glandular function net effect is increased mechanical and axial stress on skin that is more prone to injury due to drying angiopathy lesser effect than neuropathy >60% of diabetic ulcers have decreased blood flow due to peripheral vascular disease Associated conditions infection / osteomyelitis high rates of associated osteomyelitis if bone is able to be probed, or is exposed at the base of the ulcer organisms usually polymicrobial gram-positive most common pathogens are aerobic gram positive cocci (s. aureus) gram-negative increased gram-negative organisms are found in chronic wounds and wounds recently treated with antibiotics anaerobes obligate anaerobic pathogens with ischemia or gangrene deep cultures and bacterial biopsies help guide management Prognosis diabetic foot ulceration is considered the most likely predictor of eventual lower extremity amputation in patients with diabetes mellitus Classification Wagner Classification and Treatment Description Treatment Grade Continue reading >>
Diabetic Foot Ulcers: Prevention, Diagnosis And Classification
Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance. The most common risk factors for ulcer formation include diabetic neuropathy, structural foot deformity and peripheral arterial occlusive disease. A careful physical examination, buttressed by monofilament testing for neuropathy and noninvasive testing for arterial insufficiency, can identify patients at risk for foot ulcers and appropriately classify patients who already have ulcers or other diabetic foot complications. Patient education regarding foot hygiene, nail care and proper footwear is crucial to reducing the risk of an injury that can lead to ulcer formation. Adherence to a systematic regimen of diagnosis and classification can improve communication between family physicians and diabetes subspecialists and facilitate appropriate treatment of complications. This team approach may ultimately lead to a reduction in lower extremity amputations related to diabetes. Diabetic foot complications are the most common cause of nontraumatic lower extremity amputations in the industrialized world. The risk of lower extremity amputation is 15 to 46 times higher in diabetics than in persons who do not have diabetes mellitus.1,2 Furthermore, foot complications are the most frequent reason for hospitalization in patients with diabetes, accounting for up to 25 percent of all diabetic admissions in the United States and Great Britain.3–5 The vast majority of diabetic foot complications resulting in amputation begin w Continue reading >>
Diabetic Foot Ulcers
Diabetic foot ulcers can be divided into two groups: those in neuropathic feet (so called neuropathic ulcers) and those in feet with ischaemia often associated with neuropathy (so called neuroischaemic ulcers). The neuropathic foot is warm and well perfused with palpable pulses; sweating is diminished, and the skin may be dry and prone to fissuring. The neuroischaemic foot is a cool, pulseless foot; the skin is thin, shiny, and without hair. There is also atrophy of the subcutaneous tissue, and intermittent claudication and rest pain may be absent because of neuropathy. The crucial difference between the two types of feet is the absence or presence of ischaemia. The presence of ischaemia may be confirmed by a pressure index (ankle brachial pressure index < 1). As many diabetic patients have medial arterial calcification, giving an artificially raised ankle systolic pressure, it is also important to examine the Doppler arterial waveform. The normal waveform is pulsatile with a positive forward flow in systole followed by a short reverse flow and a further forward flow in diastole, but in the presence of arterial narrowing the waveform shows a reduced forward flow and is described as “damped.” Continue reading >>
Diabetes - Foot Ulcers
Debridement is the process to remove dead skin and tissue. Your health care provider will need to do this to be able to see your foot ulcer. There are many ways to do this. One way is to use a scalpel and special scissors. The skin surrounding the wound is cleaned and disinfected. The wound is probed with a metal instrument to see how deep it is and to see if there is any foreign material or object in the ulcer. The doctor cuts away the dead tissue, then washes out the ulcer. Your sore may seem bigger and deeper after the doctor or nurse debrides it. The ulcer should be red or pink in color and look like fresh meat. Other ways to remove dead or infected tissue are to: Put your foot in a whirlpool bath. Use a syringe and catheter (tube) to wash away dead tissue. Apply wet to dry dressings to the area to pull off dead tissue. Put special chemicals, called enzymes, on your ulcer. These dissolve dead tissue from the wound. Put special maggots on the ulcer. The maggots eat only the dead skin and produce chemicals that help the ulcer heal. Foot ulcers are partly caused by too much pressure on one part of your foot. Your provider may ask you to wear special shoes, or a brace or a special cast. You may need to use a wheelchair or crutches until the ulcer has healed. These devices will take the pressure off of the ulcer area. This will help speed healing. Be sure to wear shoes that DO NOT put a lot of pressure on only one part of your foot. Wear shoes made of canvas, leather, or suede. DO NOT wear shoes made of plastic or other materials that DO NOT allow air to pass in and out of the shoe. Wear shoes you can adjust easily. They should have laces, Velcro, or buckles. Wear shoes that fit properly and are not too tight. You may need a special shoe made to fit your foot. DO NOT wea Continue reading >>
Management Of Diabetic Foot Ulcers
Go to: Pathogenesis The most significant risk factors for foot ulceration are diabetic neuropathy, peripheral arterial disease, and consequent traumas of the foot. Diabetic neuropathy is the common factor in almost 90% of diabetic foot ulcers [9, 10]. Nerve damage in diabetes affects the motor, sensory, and autonomic fibers. Motor neuropathy causes muscle weakness, atrophy, and paresis. Sensory neuropathy leads to loss of the protective sensation of pain, pressure, and heat. Autonomic dysfunction causes vasodilation and decreased sweating [11], resulting in a loss of skin integrity, providing a site vulnerable to microbial infection [12]. Peripheral arterial disease is 2–8 times more common in patients with diabetes, starting at an earlier age, progressing more rapidly, and usually being more severe than in the general population. It commonly affects the segments between the knee and the ankle. It has been proven to be an independent risk factor for cardiovascular disease as well as a predictor of the outcome of foot ulceration [13]. Even minor injuries, especially when complicated by infection, increase the demand for blood in the foot, and an inadequate blood supply may result in foot ulceration, potentially leading to limb amputation [14]. The majority of foot ulcers are of mixed etiology (neuroischemic), particularly in older patients [15]. In patients with peripheral diabetic neuropathy, loss of sensation in the feet leads to repetitive minor injuries from internal (calluses, nails, foot deformities) or external causes (shoes, burns, foreign bodies) that are undetected at the time and may consequently lead to foot ulceration. This may be followed by infection of the ulcer, which may ultimately lead to foot amputation, especially in patients with peripheral arteri Continue reading >>
Diabetic Foot Pain And Ulcers: Causes And Treatment
Foot ulcers are a common complication of poorly controlled diabetes, forming as a result of skin tissue breaking down and exposing the layers underneath. They’re most common under your big toes and the balls of your feet, and they can affect your feet down to the bones. All people with diabetes can develop foot ulcers and foot pain, but good foot care can help prevent them. Treatment for diabetic foot ulcers and foot pain varies depending on their causes. Discuss any foot pain or discomfort with your doctor to ensure it’s not a serious problem, as infected ulcers can result in amputation if neglected. One of the first signs of a foot ulcer is drainage from your foot that might stain your socks or leak out in your shoe. Unusual swelling, irritation, redness, and odors from one or both feet are also common early symptoms of a foot ulcer. The most visible sign of a serious foot ulcer is black tissue (called eschar) surrounding the ulcer. This forms because of an absence of healthy blood flow to the area around the ulcer. Partial or complete gangrene, which refers to tissue death due to infections, can appear around the ulcer. In this case, odorous discharge, pain, and numbness can occur. Signs of foot ulcers are not always obvious. Sometimes, you won’t even show symptoms of ulcers until the ulcer has become infected. Talk to your doctor if you begin to see any skin discoloration, especially tissue that has turned black, or feel any pain around an area that appears callused or irritated. Your doctor will likely identify the seriousness of your ulcer on a scale of 0 to 3 using the following criteria: 0: no ulcer but foot at risk 1: ulcer present but no infection 2: ulcer deep, exposing joints and tendons 3: extensive ulcers or abscesses from infection Diabetic ulcers a Continue reading >>
Management Of Diabetic Foot Ulcers
INTRODUCTION The lifetime risk of a foot ulcer in patients with diabetes (type 1 or 2) may be as high as 25 percent [1-3]. Diabetic foot ulcers are a major cause of morbidity and mortality, accounting for approximately two-thirds of all nontraumatic amputations performed in the United States [4,5]. Infected or ischemic diabetic foot ulcers account for approximately 25 percent of all hospital stays for patients with diabetes [6]. These observations illustrate the importance of prompt and appropriate treatment of foot ulcers in patients with diabetes. The management of diabetic foot ulcers, including local wound care, use of mechanical offloading, treatment of infection, and indications for revascularization are reviewed here. The evaluation of the diabetic foot and specific management of the threatened limb are reviewed separately. (See "Evaluation of the diabetic foot" and "Treatment of chronic lower extremity critical limb ischemia".) ETIOLOGY Risk factors that can lead to foot wounds in patients with diabetes include loss of protective sensation due to neuropathy, prior ulcers or amputations, foot deformity leading to excess pressure, external trauma, infection, and the effects of chronic ischemia, typically due to peripheral artery disease [1]. Patients with diabetes also have an increased risk for nonhealing related to mechanical and cytogenic factors, as well as a high prevalence of peripheral artery disease. (See "Evaluation of the diabetic foot", section on 'Risk factors'.) ULCER CLASSIFICATION The first step in managing diabetic foot ulcers is assessing, grading, and classifying the ulcer. Classification is based upon clinical evaluation of the extent and depth of the ulcer and the presence of infection or ischemia, which determine the nature and intensity of tr Continue reading >>
How To Spot And Treat Common Diabetic Foot Ulcer Symptoms
If left untreated, diabetic foot ulcers can cause permanent damage that affects your mobility. Approximately 15% of people with diabetes suffer from foot ulcers, according to the American Podiatric Medical Association (APMA). Knowing how to recognize diabetic foot ulcer symptoms is crucial, because untreated ulcers can lead to permanent disfigurement. APMA reports that diabetic wounds are the leading cause of non-traumatic lower extremity amputations in the United States. However, proper wound care can help reduce the chances of surgical intervention, infection, and foot deformation. The following information will help you recognize wound symptoms and find an effective diabetic foot ulcer treatment. Causes Neuropathy occurs when blood vessels supplying nerves with oxygen and nutrients are damaged. The feet of a person with diabetes are particularly susceptible to neuropathy because of insufficient blood flow and unchecked blood sugar. These conditions can destroy nerve cells and cause pain, tingling, and numbness. People with diabetic neuropathy may lose enough sensation in their feet that they cannot feel the pain or the intense itching of foot injuries. Foot issues like ingrown toenails or dry skin cuts may go unnoticed unless you check your feet at least once a day for open wounds or other trauma. Diabetes also interferes with normal wound healing. Skin breaks on the feet are affected by diminished blood flow and the restriction of white blood cells that are needed to initiate the wound healing process. Symptoms Diabetic foot ulcers almost always form on the soles of the feet, where skin is subject to constant pressure. Under the weight of the body, skin deteriorates and eventually becomes an open sore. These ulcers frequently form underneath calluses and cannot be f Continue reading >>
What Are Diabetic Foot Ulcers, What Causes Them And Are They Life Threatening?
I think I may have a diabetic foot ulcer – what should I do? What are diabetic foot ulcers? Should I be concerned? If you’ve thought about any of these questions, it may be time to consider talking to your doctor. Diabetic foot ulcers are sores on the feet or anywhere below the ankle that someone with diabetes may develop. If you have diabetes and you have an open sore on your foot that just won’t heal, is red, painful, and warm, is draining pus, smells funny or just doesn’t seem to get better, then you may have a non-healing diabetic foot ulcer. If this is you, you need to see your doctor as soon as possible to discuss your options for treatment. Diabetic foot ulcers are common – in fact, 1 in 4 people with diabetes will develop at least one ulcer post-diagnosis.[i] Ulcers can be serious and life threatening; they are the leading cause of amputation due to diabetes. If you want to avoid a foot amputation due to diabetes, it’s important to have your foot ulcer evaluated by your doctor. What Are Diabetic Foot Ulcers? Diabetic foot ulcers generally begin with an injury to the foot. This injury can come from stepping on a tack, a small cut from dry skin or even just a blister from a shoe that doesn’t fit correctly. In someone without diabetes, these types of injuries would typically heal on their own. For people living with diabetes, this is not always the case. Here are some conditions that increase the likelihood of an ulcer forming in a patient with diabetes: Diabetic neuropathy – Diabetes can cause damage to nerves in parts of the body, particularly the feet. It’s one of the most common complications experienced by people living with diabetes.[i] This damage to the nerves can alter sensation in the feet, resulting in anything from increased sensitivit Continue reading >>
Evaluation And Treatment Of Diabetic Foot Ulcers
Diabetic foot problems, such as ulcerations, infections, and gangrene, are the most common cause of hospitalization among diabetic patients. Routine ulcer care, treatment of infections, amputations, and hospitalizations cost billions of dollars every year and place a tremendous burden on the health care system. The average cost of healing a single ulcer is $8,000, that of an infected ulcer is $17,000, and that of a major amputation is $45,000. More than 80,000 amputations are performed each year on diabetic patients in the United States, and ∼ 50% of the people with amputations will develop ulcerations and infections in the contralateral limb within 18 months. An alarming 58% will have a contralateral amputation 3-5 years after the first amputation. In addition, the 3-year mortality after a first amputation has been estimated as high as 20-50%, and these numbers have not changed much in the past 30 years, despite huge advances in the medical and surgical treatment of patients with diabetes. Etiology “The majority of foot ulcers appear to result from minor trauma in the presence of sensory neuropathy.” This famous but simple quote from McNeely et al.1 best describes the critical triad most commonly seen in patients with diabetic foot ulcers: peripheral sensory neuropathy, deformity, and trauma. All three of these risk factors are present in 65% of diabetic foot ulcers. Calluses, edema, and peripheral vascular disease have also been identified as etiological factors in the development of diabetic foot ulcers. Although the pathogenesis of peripheral sensory neuropathy is still poorly understood, there seem to be multiple mechanisms involved, including the formation of advanced glycosylated end products and diacylglycerol, oxidative stress, and activation of protein k Continue reading >>
Diabetic Foot Ulcer
What is a diabetic foot ulcer? Diabetic foot ulcers are sores on the feet that occur in 15% of diabetic patients some time during their lifetime. The risk of lower-extremity amputation is increased 8-fold in these patients once an ulcer develops. They occur in type 1 and in type 2 diabetes mellitus. What causes a diabetic foot ulcer? A diabetic foot ulcer is caused by neuropathic (nerve) and vascular (blood vessel) complications of diabetes. Nerve damage due to diabetes causes altered or complete loss of feeling in the foot and/or leg. This is known as peripheral neuropathy. Pressure from shoes, cuts, bruises, or any injury to the foot may go unnoticed. The loss of protective sensation stops the patient from being warned that the skin is being injured and may result in skin loss, blisters and ulcers. Vascular disease is also a major problem in diabetes and especially affects very small blood vessels feeding the skin (microangiopathy). In this situation a doctor may find normal pulses in the feet because the arteries are unaffected. However other diabetic patients may also have narrowed arteries so that no pulse can be found in the feet (ischaemia). The lack of healthy blood flow may lead to ulceration. Wound healing is also impaired. Vascular disease is aggravated by smoking. What are the signs and symptoms of diabetic foot ulcer? It is not unusual for patients to have had diabetic foot ulcers for some time before presenting to a health professional, because they are frequently painless. Depending on severity, a diabetic foot ulcer may be rated between 0 and 3. 0: at risk foot with no ulceration 1: superficial ulceration with no infection 2: deep ulceration exposing tendons and joints 3: extensive ulceration or abscesses Tissue around the ulcer may become black due to t Continue reading >>
Diabetes, Foot Care And Foot Ulcers
Some people with diabetes develop foot ulcers. A foot ulcer is prone to infection, which may become severe. This leaflet aims to explain why foot ulcers sometimes develop, what you can do to help prevent them, and typical treatments if one does occur. Why are people with diabetes prone to foot ulcers? Foot ulcers are more common if you have diabetes because one or both of the following complications develop in some people with diabetes: Reduced sensation of the skin on your feet. Narrowing of blood vessels going to the feet. Your nerves may not work as well as normal because even a slightly high blood sugar (glucose) level can, over time, damage some of your nerves (neuropathy). Read more about diabetic neuropathy. If you have diabetes you have an increased risk of developing narrowing of the blood vessels (arteries), known as peripheral arterial disease. The arteries in the legs are quite commonly affected. This can cause a reduced blood supply (poor circulation) to the feet. Skin with a poor blood supply does not heal as well as normal and is more likely to be damaged. What increases the risk of developing foot ulcers? If you have reduced sensation to your feet (see above). The risk of this occurring increases the longer you have diabetes and the older you are. If your diabetes is poorly controlled. This is one of the reasons why it is very important to keep your blood sugar (glucose) level as near normal as possible. If you have narrowed blood vessels (arteries) - see above. The risk of this occurring increases the longer you have diabetes, the older you become and also if you are male. The risk also increases if you have any other risk factors for developing furring of the arteries. For example, if you smoke, do little physical activity, have a high cholesterol leve Continue reading >>
What Does A Foot Ulcer Look Like? An Indianapolis Podiatrist Answers
As a Indianapolis podiatrist that specializes in diabetic foot care and wound care, I often get asked by patients as well as by family & friends, what does a foot ulcer look like? And why do people with diabetes develop foot ulcers? A foot ulcer is an open sore. These can be superficial such as a blister that has opened with underlying pink raw tissue exposed or an ulcer can be deep and extend down to the bone. Some ulcers are infected and drain heavily while some have very little or no drainage. An ulcer may or may not be painful. People develop foot ulcers for many different reasons and you don’t need to have diabetes to develop a foot ulcer. Pressure, trauma, and poor circulation can all lead to foot ulcers. A diabetic with a red open sore on the bottom of their foot generally surrounded by a callus has a diabetic foot ulcer. A diabetic foot ulcer, also called a neuropathic ulcer, occur most often on the bottom of the foot over a bony prominence. Ulcers can also develop on the sides of the foot or tops of the toes from friction and pressure of shoes or from poor circulation. For example, a person with diabetes develops a callus on the bottom of their foot. A callus is a build-up of skin due to increased pressure on the foot. Left untreated or, often when self-treated, the callus becomes infected or breaks down into an ulcer. The callus and the eventual ulcer many times go left untreated because a diabetic patient lacks feeling called neuropathy and is unaware that the ulcer is present. This is why you often hear that diabetics should check their feet daily and see a foot doctor routinely. Or the person may be aware of the ulcer but because it is not painful they do not seek immediate treatment. Once an ulcer is discovered it is imperative that professional treatmen Continue reading >>
Diabetic Foot Ulcer
Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot. Wound healing is an innate mechanism of action that works reliably most of the time. A key feature of wound healing is stepwise repair of lost extracellular matrix (ECM) that forms the largest component of the dermal skin layer.[1] But in some cases, certain disorders or physiological insult disturbs the wound healing process. Diabetes mellitus is one such metabolic disorder that impedes the normal steps of the wound healing process. Many studies show a prolonged inflammatory phase in diabetic wounds, which causes a delay in the formation of mature granulation tissue and a parallel reduction in wound tensile strength.[2] Treatment of diabetic foot ulcers should include: blood sugar control, removal of dead tissue from the wound, wound dressings, and removing pressure from the wound through techniques such as total contact casting.[3] Surgery in some cases may improve outcomes.[3] Hyperbaric oxygen therapy may also help but is expensive.[3] It occurs in 15% of people with diabetes,[4] and precedes 84% of all diabetes-related lower-leg amputations.[5] Classification[edit] Diabetic foot ulcer is a complication of diabetes. Diabetic foot ulcers are classified as either neuropathic, neuroischaemic or ischaemic.[6] Risk factors[edit] Risk factors implicated in the development of diabetic foot ulcers are infection, older age,[7] diabetic neuropathy, peripheral vascular disease, cigarette smoking, poor glycemic control, previous foot ulcerations or amputations,[5] and ischemia of small and large blood vessels.[8][9] Prior history of foot disease, foot deformities that produce abnormally high forces of pressure, renal failure, oedema, impaired ability to look Continue reading >>
