Diabetes, Foot Care and Foot Ulcers

diabetic foot ulcer

A skin ulcer is where an area of skin has broken down and you can see the underlying tissue. Most skin ulcers occur on the lower legs or feet. The skin normally heals quickly if it is cut. However, in some people with diabetes the skin on the feet does not heal so well and is prone to developing an ulcer.

Why are people with diabetes prone to foot ulcers?

Reduced sensation of the skin on your feet:Your nerves may not work as well as normal because even a slightly high blood sugar level can, over time, damage some of your nerves. This is a complication of diabetes called peripheral neuropathy of diabetes.

Narrowing of arteries (blood vessels) going to the feet:If you have diabetes you have an increased risk of developing narrowing of the arteries (peripheral vascular disease). This is caused by fatty deposits called atheroma that build up on the inside lining of arteries.

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.
  • If you have narrowed arteries (.
  • If you have had a foot ulcer in the past.
  • If you have other complications of diabetes, such as kidney or eye problems.
  • 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.

Are foot ulcers serious?

Although foot ulcers can be serious, they usually respond well to treatment. However, foot ulcers can get worse and can take a long time to heal if you have diabetes, particularly if your circulation is not so good. In addition, having diabetes means you are more likely to have infections and an infection in the ulcer can occur.

What can I do to help prevent foot ulcers?

  • Have your feet regularly examined
  • Treatment of diabetes and other health risk factors

Foot care: Good foot care includes:

  • Looking carefully at your feet each day, including between the toes. If you cannot do this yourself, you should get someone else to do it for you:
  • If you see anything new (such as a cut, bruise, blister, redness or bleeding) and don't know what to do, see your doctor or podiatrist (chiropodist).
  • Do not try to deal with corns, calluses, verrucas or other foot problems by yourself. They should be treated by a health professional such as a podiatrist.
  • Use a moisturising oil or cream for dry skin to prevent cracking. However, you should not apply it between the toes as this can cause the skin to become too moist which can lead to an infection developing.
  • Look out for athlete's foot (a common minor skin infection). If you get athlete's foot, it should be treated with an antifungal cream.
  • Cut your nails by following the shape of the end of your toe. But, do not cut down the sides of the nails, or cut them too short, or use anything sharp to clean down the sides of the nails.
  • Wash your feet regularly and dry them carefully, especially between the toes.
  • Do not walk barefoot, even at home.
  • Always wear socks with shoes or other footwear.

Shoes, trainers and other footwear should:

  • Fit well.
  • Have broad fronts with plenty of room for the toes.
  • Have low heels to avoid pressure on the toes.
  • Have good laces, buckles or Velcro® fastening to prevent movement and rubbing of feet within the shoes.
  • When you buy shoes, wear the type of socks that you usually wear.

What if I develop a foot ulcer?

You should tell your doctor or podiatrist straight away if you suspect an ulcer has formed. Treatment aims to dress and protect the ulcer, to prevent or treat any infection and also to help your skin to heal.

  • The ulcer is usually covered with a protective dressing.
  • A podiatrist may need to remove any hard skin that prevents the ulcer from healing.
  • You may also be advised to wear special shoes to keep the pressure off the ulcer.
  • Antibiotics will be advised.
  • Sometimes a small operation is needed to drain pus and clear dead tissue if infection becomes more severe.
  • In some cases, the arteries in the legs are very narrow and an operation to bypass, or widen, the arteries may be advised.

Many foot ulcers will heal with the above measures. However, they can take a long time to heal.

In some cases, the ulcer becomes worse, badly infected and does not heal. Sometimes infection spreads to nearby bones or joints, which can be difficult to clear, even with a long course of antibiotics. Occasionally, the tissue in parts of the foot cannot survive and the only solution then is to amputate the affected part.

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