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Foot Ulcers

• What is a 'diabetic foot ulcer'?
• Who is likely to get a foot ulcer?
• Why is nerve supply and circulation so important?
• I already have an ulcer - what should I do?
• What is the treatment?

What is a 'diabetic foot ulcer'?

A diabetic foot ulcer is a wound or sore that develops anywhere on the feet of someone with diabetes.

Who is likely to get a foot ulcer?

Anyone can get a foot ulcer. People with diabetes are more prone to developing these ulcers and when they occur, the tendency to heal is also impaired. People with diabetes are more highly at risk of ulceration if they have:

• poor blood sugar control
• neuropathy (nerve damage)
• peripheral vascular disease (poor circulation)
• any deformity of the foot with abnormal load bearing
• in-growing toenails, bunions, corns or callosities
• problems with excess weight
• poorly fitting footwear
• poor eyesight
• swollen feet

Why is nerve supply and circulation so important?

Your feet bear the burden of carrying your weight all day long. The pressure and stress on the walking surface of your feet is considerable. An intact nerve supply helps by making you aware of abnormal stresses and minor injuries such as blisters and abrasions which you would otherwise not recognise. For example, having neuropathy may result in you walking about with a 'shoe cut' for many days, turning a relatively minor injury into a fully developed ulcer. Bugs which cause infections gain entry through such breaks in the skin. Poor circulation compounds these problems as a good blood supply is needed to fight infection and to help repair the damage! Refer to the leaflets / web pages on neuropathy and peripheral vascular disease for more information.

I already have an ulcer - what should I do?

You should let your doctor know about any ulcer unless already healing. Remember that ulcers often appear to be tiny, such as those which develop in relation to callosities. These lesions often have more than a passing resemblance to volcanoes, with the small opening at the top masking a large disturbance below the surface! Absence of pain often makes these ulcers easy to ignore.

If the ulcer is on a weight bearing surface avoid un-necessary walking. The pressures sustained during relatively minor activity are often enough to keep an ulcer going. Neuropathic ulcers in particular heal quickly when you take the weight off your feet. If your doctor advises rest, this is exactly what you should do!

Watch out for 'danger signs' indicating infection:

• increasing pain or redness
• foot feels warm or hot to touch
• increasing swelling of the foot
• foul smelling discharge (pus)
• fever or shivers, feeling unwell with 'flu like' symptoms

Watch out for danger signs indicating serious circulatory problems:

• change in colour of a toe or foot (bluish or blackish discolouration) - this should be communicated to your doctor as a matter of urgency

 Only use dressings and medications advised by your doctor. Do NOT use cleaning agents such as surgical spirits or hydrogen peroxide which may in fact delay wound healing. Using 'normal saline' is perfectly safe.

What is the treatment?

Treatment of a diabetic foot ulcer is a specialised area which is often best advised by a multidisciplinary team comprising a diabetes specialist, podiatrist, orthotist and vascular surgeon. The initial assessment will seek to identify the cause of your ulcer. The treatment would depend on many different factors, including the presence or absence of neuropathy, circulatory disturbance, infection. Deep seated infections involving bones and joints of the foot can be particularly challenging and may require many months of powerful antibiotics.

 

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Hospitals Diabetes Service
October 2002