Foot ulcers: keep an eye on your feet

If you have diabetes, you should be on the lookout for sores or scratches on your feet. If not cared for, a sore may grow deeper and become infected. Finally, amputation may be needed.

Foot ulcers are the most common cause of diabetes-related hospitalizations. In people with diabetes, uncontrolled blood glucose (sugar) levels often lead to damaged nerves and blood vessels. As a result, in the legs and feet there will be a loss of feeling and poor blood circulation. These conditions can lead to the development of a foot ulcer from relatively mild trauma. Healing may be slowed because the wound isn’t getting enough oxygen-rich blood to repair the damaged tissue.

If nerve damage has caused you to lose sensation in your foot, you may not notice a cut or other injury there, particularly if it’s on a part of the foot that’s difficult to see. If you can’t feel a foot ulcer and you don’t see it, it will go untreated. Infection may set in, and it’s often infection that leads to amputation.

Keeping watch

One of the best ways to prevent foot ulcers from developing is simply to inspect your feet daily. A member of your diabetes care team should examine them during your office checkups. But keeping an eye on your feet may be your best bet for discovering a problem. In one study of 1,666 people with diabetes in the U.S., nearly all of the foot infections seen developed after a cut or some other type of wound. But visual signs, rather than pain, were the most frequent complaint.

Whenever you notice a troublesome break in the skin, contact a healthcare provider right away to check it for infection. If the wound is infected, the doctor will clean it, removing dead or unhealthy tissue, and take a specimen to find the cause, extent, and severity of the infection. X-rays or an MRI (magnetic resonance imaging) scan of the foot can provide even more details and show whether the infection has reached the bone.

A variety of treatments

If your foot wound is infected, you may need to take oral antibiotics, or the doctor may apply a special antibiotic dressing directly to the wound. Mild infections may require a week or so of antibiotic treatment; more severe cases, up to three weeks. The ulcer needs to be protected from pressure and rubbing while it heals. Dressings and shoe inserts that isolate and protect the wound may do the trick, or you may need to stay off the foot completely.

One promising method for treating diabetes-related foot infection involves the use of fly larvae—otherwise known as maggots. The larvae eat the dead cells and leave the wound very clean. While this idea may take some getting used to, it’s hard to argue with its success: Fly larvae therapy has reduced the need for antibiotics and amputations.

In some cases, surgery may be necessary to restore circulation to the foot. Bypass surgery in the lower leg can now improve blood flow to the foot in many people with diabetes.

Not again!

Most people develop a second foot ulcer within three years of the first one. Wearing comfortable, well-designed shoes can help keep these injuries at bay. You can also ward off foot ulcers by improving circulation in your legs and feet and reducing the risk of nerve damage. It’s important to control your blood glucose levels, keep your cholesterol and blood pressure levels low, and not smoke.

If you keep getting foot ulcers in the same place—for example, on your toes—then you might need surgery that will change their shape to avoid rubbing.

From The Lancet and Diabetes Care