About 1 in 10 people with diabetes will develop a foot ulcer. An ulcer is an example of a wound that, for various reasons, will not heal (Lorimet et al, 2006).

Some people with diabetes find that their skin does not heal as well as it previously did. As a result, a minor injury is likely to breakdown further exposing the underlying tissues. A foot ulcer can become infected and the infection can develop into a severe infection particularly if the diabetes is poorly controlled. It is important to look after your foot ulcer to reduce the risk of infection.

It is imperative that you control your blood sugar level to allow for faster healing. Uncontrolled levels of sugar in your blood may hinder the healing of your foot ulcer.
Smoking reduces circulation to your feet. This can be another factor that may delay healing and even cause amputation.

Controlling your diabetes, cholesterol, blood pressure levels and reducing your smoking will decrease the chances of having any foot problems.
Your Podiatry assessment has shown the presence of a diabetic foot ulcer. Regular Podiatry treatment is essential for your diabetic ulcer. Please refer to your Podiatrist for a treatment plan.

DANGER SIGNS

Please pay close attention to any of the following danger signs:

• Is there any new pain or throbbing?
• Does your foot feel hotter than normal? Or hotter than the other foot?
• Are there any new signs of redness, soreness, swelling, foul odor?
• Is there any discharge?
• Do you have any flu-like symptoms (hot or shivery)?

If you come across any of these signs, call your Podiatrist or your Doctor immediately and explain that you have a diabetic foot ulcer and your findings.

Treatment for your Diabetic Foot Ulcer

Diabetic foot ulcers can sometimes remain hidden beneath hard skin and can gather dead tissue around them. Your Podiatrist will need to remove this to promote wound healing and reduce the pressure on the wound bed. At times, this may cause the ulcer to bleed however, this is completely normal. DO NOT TRY THIS YOURSELF!

Dressing

The Podiatrist will choose the most appropriate dressing for your foot ulcer. It is important to leave this dressing ON and DRY between appointments. Do NOT leave the foot ulcers uncovered or open to the air. This will give access to bacteria and other micro-organisms to enter the wound and cause an infection.

Antibiotic Treatment

You will be given antibiotics if there are any signs of infection in the wound or surrounding area. Please report any issues you have with the antibiotics (rashes, nausea, or diarrhea, etc) to the health professional who prescribed them to you. If this person is unavailable, please contact your Doctor immediately. Do not stop taking your antibiotics unless a Doctor tells you. Make sure you have enough antibiotics to complete the course so that your treatment is uninterrupted.

If the infection is spreading, you may need to attend the hospital to have antibiotics straight into your bloodstream to treat the infection quicker. This happens rarely.

Daily checks

Continue to check both your feet every day and the surrounding area where your dressing was placed. If you spot any problems or danger signs, please contact your Podiatrist. In the meantime, continue to moisturize the exposed areas of your feet avoiding any broken skin or in between the toes.

Pressure offloading devices

The pressure is often the cause for a foot ulcer. In order to allow the ulcer to heal, the pressure force must be reduced and if possible, removed altogether. This can be achieved with the use of pressure deflective padding. This padding should NOT be removed in between appointments. If your current footwear does not fit, you may be advised to purchase different footwear. In addition, you may be asked to wear a cast or a pressure reducing shoe until your ulcer has healed. You should NOT wear any other footwear until your Podiatrist tells you.

In line with trying to reduce any pressure on your foot ulcer, avoid any unnecessary standing or walking. A wound cannot heal if it is constantly under pressure. Rest as much as possible and keep your feet in an elevated position to help it heal.

Operations

If your circulation is reduced, you may be referred for an operation to increase blood supply to the ulcerated area.

If an infection becomes severe, you may need an operation to clean out the wound and stimulate healthy tissue growth to the foot ulcer.

If an infection is severe or there has been too much tissue loss, an amputation may be needed to save the healthy parts of the foot.

Healed Ulcer

Once your ulcer has healed, you need to pay close attention to your feet to prevent another ulcer developing. The skin’s integrity may change after having an ulcer. Continue to check your feet daily and keep a close eye for any skin breakdown or any danger signs. If you find anything, place a sterile cotton plaster over it and contact your Podiatrist or Doctor.

Wear the footwear that was approved by your Podiatrist. If you had bespoke shoes made or bespoke orthotics, please ensure that you wear them even at home. If any problems arise, contact your Podiatrist.

References

Lorimer D, French G, O’Donnell M, Burrow J G, Wall B. (2006). Metabolic disorders. In: Lorimer D, French G, O’Donnell M, Burrow J G, Wall B Neale’s Disorders of the Foot. 7th edition. London: Churchill Livingstone. 243.
Mathers CD, Loncar D. PLos Med. (2006) Projections of global mortality and burden of disease from 2002 to 2030. 3(11):e442.
WHO. (2017). Diabetes Fact Sheet. Available: http://www.who.int/mediacentre/factsheets/fs312/en/. Last accessed 10th March 2018.