Diabetic foot ulcers occur in approximately 15% of patients with Diabetes and if not treated appropriately can lead to severe consequences including infection, hospitalization and amputation. As podiatrists, we serve as the frontline experts for managing these types of wounds that can vary tremendously in terms of complexity and management.
During your first visit, your physician will obtain plain radiographs of your foot to assess the underlying bony anatomy and to see how this may be contributing to development of the foot ulcer. Most patients that have diabetic ulcers are also neuropathic, meaning they have numbness in their lower extremities and are unable to feel pressure differences when walking; this is what can cause the ulcers to form and worsen. Depending on how deep the ulcer is, whether there is underlying infection or if the bone is noticeable clinically, your physician may also obtain advanced imaging to evaluate for infection within the bone.
Several different factors need to be taken into account in order to heal diabetic wounds:
- Off-loading—Sometimes, a specialized off-loading pad is constructed for the patient so pressure is avoided at the location of the ulcer. We may even recommend a device called a “Total Contact Cast”—basically, a cast completely encompassing the foot and the lower leg but still allowing you to walk. This does a good job of off-loading and re-distributing pedal pressures so that wound healing can proceed.
- Blood flow—Without adequate blood flow to the bottom of the foot, diabetic wounds will never heal. We may recommend non-invasive vascular tests in order to determine your base-line blood flow into your lower extremities. If there are any questions of blockages or abnormal values, we will refer you to a vascular specialist who can assist with getting optimal blood flow to the areas in the foot/ankle needed most.
- Optimization of blood sugars—It is crucial to ensure adequate control of your blood sugars in order to provide an optimal environment for wound healing. Depending on your HgA1c value and overall blood glucose control, we may have you referred to an endocrinologist who can recommend any changes to your diabetic control regimen. Without a good handle on your HgA1c, a diabetic ulcer will have difficulty healing
- Nutrition—It is just as important what you eat as is how you take care of your wound. A diet rich in protein, good fats and low sugar is crucial to provide the building blocks for cellular integrity and ultimately optimized wound healing.
- Infection control—It is crucial to treat any underlying infection as this will invariably cause wound healing to stall. Whether there is soft tissue or bone infection, this ultimately needs to be addressed by your physician before the infection can worsen and cause further problems.
Your foot and ankle surgeon will develop a comprehensive treatment plan for you depending on the size and complexity of your diabetic foot ulcer(s).