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Why Do Diabetics Get Foot Ulcers


Why Are Diabetics Prone To Foot Ulcers And Other Chronic Wounds

Why Do Diabetics Get More Foot Infections?

Diabetic patients are more prone to developing chronic wounds for a few reasons. Two of the most influencing factors are nerve damage and blood circulation issues that are common among diabetic patients.

Nerve damage, or neuropathy, tends to occur in patients who have a longer history with diabetes because elevated blood glucose levels damage nerves over time. Neuropathy causes patients to experience reduced, or lack of, sensation in the areas affected.

Many patients can sustain trauma or develop an infection without realizing it because theyre unable to feel pain in the area. Further, neuropathy commonly affects the feet, so a wound on the bottom of the foot can escalate quickly because the patient cannot feel or see the wound easily.

Blood circulation issues also can increase the risk for developing chronic wounds, as well as making the wounds more prone to infection. High blood glucose levels cause the narrowing of blood vessels, which constricts blood supply, Estocado said. Adequate blood supply is essential to normal wound healing. The secondary effect of impaired blood supply is a decrease in white blood cells, which are responsible for fighting infection and maintaining a strong immune system.


Evaluation And Treatment Of Diabetic Foot Ulcers

  • Ingrid Kruse, DPM and
    • Diabetic foot problems, such as ulcerations, infections, andgangrene, are the most common cause of hospitalization among diabeticpatients. Routine ulcer care, treatment of infections, amputations, andhospitalizations cost billions of dollars every year and place a tremendousburden on the health care system.

      The average cost of healing a single ulcer is $8,000, that of an infectedulcer is $17,000, and that of a major amputation is $45,000. More than 80,000amputations are performed each year on diabetic patients in the United States,and 50% of the people with amputations will develop ulcerations andinfections in the contralateral limb within 18 months. An alarming 58% willhave a contralateral amputation 3-5 years after the first amputation. Inaddition, the 3-year mortality after a first amputation has been estimated ashigh 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 withdiabetes.

      Quit Smoking To Improve Circulation In Your Feet

      The dangers of smoking run from your head to your feet. The chemicals in cigarette smoke damage and constrict your blood vessels, which means that if you smoke, youre depriving your feet of the nutrient- and oxygen-rich blood that fights infection and keeps them healthy. Diabetic patients already have risk factors that compromise their blood vessels. Its never too late to stop smoking, says Tillett.

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      When Should I See My Health Care Provider About Foot Problems

      • a cut, blister, or bruise on your foot that does not start to heal after a few days
      • skin on your foot that becomes red, warm, or painfulsigns of a possible infection
      • a callus with dried blood inside of it,which often can be the first sign of a wound under the callus
      • a foot infection that becomes black and smellysigns you might have gangrene

      Ask your provider to refer you to a foot doctor, or podiatrist, if needed.


      The Diabetic Foot Care You Need

      Why Diabetic Foot Ulcers Are So Dangerous

      Diabetics can experience a wide range of foot related issues, and its critical that they follow these important preventative measures.

      If you or someone you love is experiencing a foot ulcer dont wait. Infection can progress quickly and in severe cases, lead to amputation.

      Our team prides ourselves on our ability to get patients in for same-day appointments for emergencies. Make a quick appointment or give us a call at 239.936.5400, right away.

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      How Is A Diabetic Foot Ulcer Diagnosed And Treated

      Your healthcare provider will ask about your symptoms and examine your foot and the ulcer. He or she may check your shoes. He or she may also send you to a podiatrist for treatment. The goal of treatment is to start healing your foot ulcer as soon as possible. The risk for infection decreases with faster healing. Do the following to help your ulcer heal:


      What Should I Watch For

      Take a moment each day to look at your feet. Find a well-lit area, perhaps under a lamp or in the bathroom, and look closely at your entire foot especially the tips of your toes and the bottoms of your feet. If you aren’t able to see your feet, ask a family member or caretaker to check them for you.

      If you notice a callous, blister, drainage on your sock, an area of redness or a patch of skin that remains warmer than the surrounding areas long after you’ve removed your shoes, contact your doctor. Your doctor may clean the wound, remove any dead tissue, apply a clean bandage, treat any infection and advise you to stay off of your foot as long as possible. Left untreated, foot ulcers are a leading cause of foot amputations in people with diabetes.

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      How Long Does It Take For A Diabetic Foot Ulcer To Heal

      The nature of the diabetic ulcer of the foot will determine how much time it will need to heal. If it is mild, it may heal on its own in as little as three weeks. More severe ulcers will take months to heal.

      Additionally, blood sugar plays a part in healing wounds. People living with diabetes may have a more challenging time healing, in general, due to their fluctuating blood sugar levels. Therefore, healing diabetic ulcers of the foot may have more success healing when treated by a wound care specialist.


      Is It Time To See The Foot Doctor

      Why do diabetics get foot ulcers? / Dr. Kristine Orion, MD

      If your daily foot checks have revealed a concerning problem, or it has simply been too long since your last comprehensive diabetic foot exam, please give us a call to schedule your appointment as soon as possible.

      Regarding the annual exam, it really is important that you form this habiteven if you have no previous history of foot problems. The unfortunate reality is that diabetes-related nerve and circulatory system damage can happen slowly over many yearsslow enough that you dont realize a problem until your risk for ulceration has increased significantly. Regular exams can help us spot brewing problems long before you can, and then help you counteract them.

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      Why Do Diabetics Get Foot Ulcers

      Not all people living with diabetes get foot ulcers. However, if diabetes goes untreated or is managed poorly, issues like diabetic ulcers of the foot tend to be more common. Diabetic ulcers of the foot happen when the foot does not get proper circulation, and a combination of high blood sugar, irritated skin or tissue in the feet, and damaged tissue all combine to create the perfect conditions for foot ulcers.

      Often, diabetic ulcers of the foot go unnoticed due to poor circulation and are only noticed after drainage, discoloration, and lumps form on the feet.


      Keeping Your Feet Healthy

      Patients with diabetes must be diligent about wound prevention. The first step is properly managing the diabetes itself which includes maintaining a balanced diet and exercise routine, keeping blood glucose levels in the recommended range, avoiding alcohol and tobacco, and addressing any co-occurring disorder such as cardiovascular disease or obesity.

      The next step is to commit to daily skin inspections, and especially your feet when sensation is impaired, Estocado said. This inspection should be thorough, and include the sole, sides and in between the toes. Even the smallest blister or scrape can escalate for diabetic patients, so call your doctor at the first discovery of any abnormality.

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      Why Are Foot Ulcers So Dangerous

      Unfortunately, when you have diabetes, even seemingly minor foot wounds can quickly get infected and spiral out of control if you dont notice and deal with them promptly. The longer ulcers remain open, the greater your risk of infection. Thats because the same circulatory issues that slow healing also reduce your bodys ability to fight off germs.

      If the infection continues to worsen and spread, you may arrive at a point where amputation is the only way to stop the progression and save your life.


      Just how common is this outcome? Consider that diabetes is a factor in the vast majority of preventable, non-traumatic amputations performed each year. Its estimated that around 100,000 Americans with diabetes undergo an amputation each year, and around 85% of these incidents began with a foot ulcer.

      In other words: very common, and very dangerous.

      When To See A Dermatologist

      WCW: Applying Altrazeal to a Post Surgical Diabetic Foot ...

      Diabetes can cause many other skin problems. Most skin problems are harmless, but even a minor one can become serious in people who have diabetes. A board-certified dermatologist can recognize skin problems due to diabetes and help you manage them.

      Are all dermatologists board certified?

      No. See what it takes to become board certified.

      ImagesImage 1: Image Courtesy of Clark C. Otley, MD. All Rights Reserved


      Images 3, 7, 8, 9: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

      Image 2 from DermNetNZ

      Some images used with permission of Journal of the American Academy of Dermatology

      ReferencesCohen Sabban, EN. Cutaneous manifestations of diabetes mellitus from A to Z. Focus session presented at: 74th Annual Meeting of the American Academy of Dermatology March 4-8, 2016 Washington D.C.

      Duff M, Demidova O, et al. Cutaneous manifestations of diabetes mellitus. Clinical Diabetes. 2015 33:40-8.


      Kalus AA, Chien AJ, et al. Diabetes mellitus and other endocrine disorders. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008:1461-70.

      McKinley-Grant L, Warnick M, et al. Cutaneous manifestations of systemic disease. In: Kelly AP and Taylor S. Dermatology for Skin of Color. . The McGraw-Hill Companies, Inc. China, 2009:481-4.

      Morgan AJ and Schwartz RA. Diabetic dermopathy: A subtle sign with grave implications. J Am Acad Dermatol. 2008 58:447-51.

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      Smooth Corns And Calluses Gently

      Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, talk with your foot doctor about the best way to care for these foot problems. If you have nerve damage, these patches can become ulcers.


      If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.

      Do NOT

      • use corn plasters, which are medicated pads
      • use liquid corn and callus removers

      Cutting and over-the counter corn removal products can damage your skin and cause an infection.

      To keep your skin smooth and soft, rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because moistness might cause an infection.

      Diabetic Foot Ulcer Risk Factors

      Anyone with diabetes is at risk of a foot ulcer. People with neuropathy, poor glycemic control, and vascular disease are considered high-risk for ulcers and associated complications.


      • insulin use
      • obesity

      To be fully informed of your risk, speak with a podiatrist to test for neuropathy. As nerve damage can occur without pain, your podiatrist can test your feet with a simple, painless tool called a monofilament. Patients who are unable to feel the monofilament are insensate and are 10 times more likely to develop a foot ulcer than their sensate counterparts.

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      Foot Ulcer Treatment Using A Hyperbaric Oxygen Chamber

      A highly successful way of treating diabetic ulcers of the foot has been through hyperbaric oxygen chambers. Hyperbaric oxygen chambers increase circulation, blood oxygen levels and promote angiogenesis among foot ulcer patients healing processes that are often stunted due to diabetes.

      Foot ulcer treatment using hyperbaric oxygen chambers is relatively simple but has been shown to decrease the time that patients suffering from diabetic ulcers of the foot take to heal.

      Typically, patients receive at least ten hyperbaric oxygen therapy treatments, and they may receive HBOT treatments up to five times per week.


      Diabetic Foot Ulcer Symptoms

      How To Cure A Diabetic Foot Ulcer

      While ulcers can form in many areas, those with diabetes often suffer from wounds on the bottom/soles of their feet, as this is where the skin is subject to the most pressure from body weight.

      Because neuropathy is common and diabetics often dont feel pain around the ulcer, sensitivity is often not a symptom. Instead, here are a few things to look out for:

      • Drainage from pussing or oozing
      • Redness or swelling around the wound
      • A foul-smell, from discharge
      • Fevering or chills

      Many of these symptoms indicate infection, and if you experience any of these signs, seek treatment immediately.

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      Why Are Diabetics More Prone To Developing Foot Ulcers

      Approximately 15% of those with diabetes suffer from foot ulcers, according to Advancing Foot & Ankle Medicine and Surgery . To make matters worse, 6% of those patients will require hospitalization due to an infection or other complication.


      It begs the question, What puts diabetics at higher risk of getting foot ulcers?

      Elevated blood glucose levels over time can cause nerve damage to the extremities, or a condition called neuropathy.

      This nerve damage can make it difficult for diabetics to feel pain in their legs, ankles and feet. Wearing ill-fitting shoes can cause rubbing that produces a wound, walking barefoot can cause a lesion or tight footwear can cause circulation issues. Without the ability to sense pain, these issues often go unnoticed and worsen with time.

      This is especially true for older patients, who may lose the ability to reach and care for their feet and neglect to maintain hygiene and routine care.

      In addition, elevations in blood glucose can reduce the bodys ability to fight off a potential infection as well as slow healing time. Because of this, diabetics typically have more trouble resisting and recovering from foot ulcer-related issues.

      How Can I Prevent Diabetic Foot Ulcers

      Diabetic foot ulcers are the most common reason for hospital stays among people with diabetes.

      Whats the reason? People with diabetes, not only do they not heal non-diabetics, but in addition to that, they develop a disease called diabetic neuropathy, where they lose feeling in their feet, says Arti Masturzo MD, medical director at the Bethesda North Wound Care Center.

      However, with the proper precautions, Dr. Masturzo says diabetic foot ulcers can be avoided.

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      What Do Diabetic Foot Ulcers Look Like

      Diabetic ulcers of the foot may vary in appearance. However, it may bear the following symptoms:

      • Crater-like appearance
      • Positioned on top or side of the foot

      If the person with diabetes has diminished nerve function in the foot, they might unexpectedly ignore an ulcer. If this is the case, caregivers might be able to tell they have a diabetic ulcer of the foot if they experience a foul odor, swollen foot, or notice a difference in the size of their feet.

      What Are Foot Ulcers

      Advances in healing of diabetic foot ulcers

      Foot ulcers are sores that fester and develop across the foot, usually as a complication of uncontrolled diabetes.

      Maybe your ulcer started as a cut or a popped blister that never healed. Or perhaps the skin slowly broke down due to excessive, repeated friction and pressure. Structural foot defects, poorly fitting footwear, or athletic overuse can all play a role, too.

      But whatever the cause, most ulcers will continue to worsen if they dont receive treatment. Thats because diabetes reduces blood flow to the feet, which in turn limits the supply of oxygen and nutrients and impairs swift healing.

      Even worse, if you arent paying attention, it may take hours or even days for you to notice there is even a problem. Thats because diabetes is also linked with peripheral nerve damage that can blunt your ability to feel your own feet.

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      Risk Factors For Lower Extremity Amputation

      Risk Factors for Lower Extremity Amputation in the Diabetic Foot

      Absence of protective sensation due to peripheral neuropathy

      Arterial insufficiency

      Foot deformity and callus formation resulting in focal areas of high pressure

      Autonomic neuropathy causing decreased sweating and dry, fissured skin

      Limited joint mobility

      Impaired vision

      Poor glucose control leading to impaired wound healing

      Poor footwear that causes skin breakdown or inadequately protects the skin from high pressure and shear forces

      History of foot ulcer or lower extremity amputation

      Risk Factors for Lower Extremity Amputation in the Diabetic Foot

      Absence of protective sensation due to peripheral neuropathy

      Arterial insufficiency

      Foot deformity and callus formation resulting in focal areas of high pressure

      Autonomic neuropathy causing decreased sweating and dry, fissured skin

      Limited joint mobility

      Impaired vision

      Poor glucose control leading to impaired wound healing

      Poor footwear that causes skin breakdown or inadequately protects the skin from high pressure and shear forces

      History of foot ulcer or lower extremity amputation

      How Can I Avoid Diabetes Foot Ulcers

      Avoiding diabetes foot ulcers is a matter of taking good care of the feet .

      Furthermore, people with diabetes should have their feet checked at least once a year by a doctor or healthcare professional. Recognising symptoms such as reduced feeling and acting on them immediately should help to avoid diabetes foot ulcers.

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      What Increases The Risk Of Developing Foot Ulcers

      • If you have reduced sensation to your feet . 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 level as near normal as possible.
      • If you have narrowed blood vessels – 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 level, high blood pressure or are overweight.
      • If you have had a foot ulcer in the past.
      • If you have other complications of diabetes, such as kidney or eye problems.
      • If your feet are more prone to minor cuts, grazes, corns or calluses which can occur:
        • If you have foot problems such as bunions which put pressure on points on the feet.
        • If your shoes do not fit properly, which can put pressure on your feet.
        • If you have leg problems which affect the way that you walk, or prevent you from bending to care for your feet.

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