What are Ulcers?
Ulcers are persistent wounds or sores that do not heal properly or become chronic. Diabetic ulcers are becoming one of the most common causes of amputation of a toe or limb. A small sore can turn into a large wound in a very small amount of time. If you are diabetic, it is important to seek proper care to stop an existing ulcer from progressing into an uncontrollable wound. These precautions can be summarized into offloading, decreasing bacterial load, and insuring adequate blood flow. Foot ulcers can develop due to metatarsal deformities that impact the bottom of the foot, exposing areas to constant pressure that causes the skin to callus, separate, and possibly become infected. Ulcers may or may not cause pain and can be accompanied by swelling, discomfort, redness, itching, burning, and irritation. For bed-ridden patients, foot ulcers can form on the backs of the heels due to constant pressure on the skin from the bed.
Ulcers have four stages of severity that are based on how deeply the wound or sore penetrates through the skin:
- The first stage of an ulcer involves redness and irritation that occur where bones protrude or constant pressure is applied. The affected area’s skin may stay red even after pressure to the spot is alleviated. There may be accompanying discomfort and pain.
- The second stage of an ulcer involves the top two layers of skin. Blistering, peeling, and cracking skin are signs of stage two ulcers. Tenderness and pain are felt in the area of the ulcer.
- The third stage of an ulcer involves deeper penetration in skin breakdown. The tissue between the skin and muscle are affected, and broken, bleeding skin appears. At this point, pain may diminish because of more severe tissue damage.
- The fourth stage of an ulcer involves even deeper penetration of damaged tissue, pervading all the way to the muscle, tendon, and bone. It can result in bone or blood infections. Again, the damaged tissue may not generate pain or discomfort.
Offloading simply means to not put weight on the ulcer. Offloading is accomplished by wearing special shoes that allow you to walk but decrease pressure on the ulcer site. Excess walking will put pressure and friction on the wound site. These forces prevent the skin cells from healing the wound. If a diabetic with a history of diabetic wounds goes barefoot just once, an ulcer can open in a short amount of time. Moist, dead skin is a perfect environment for bacteria to multiply and potentially infect a wound. By seeing your podiatrist regularly, this dead skin can be “debrided” or removed from around the ulcer. This decreases the amount of bacteria threatening the wound so as to decrease the chance of the ulcer becoming infected. Blood is the substance that contains all the growth factors and oxygen needed for the body to heal itself. You may be confused to why you leave your podiatrist with your wound bleeding. Debriding the wound not only removes dead skin, but it removes any dead material inside the wound to insure the base of the ulcer is receiving blood to its surface. Depending on the severity of the ulcer your podiatrist may suggest the following treatments as well.
- Skin Grafts
- Wound Dressings
- Mist Treatment
- Molecular Testing for Infected Wounds
- Antibiotic Foot Soaks
- Total Contact Casting
- Topical Therapies
- Compression Garments
- Orthotics/Diabetic Shoes
With proper vigilance, a diabetic can avoid ulcerations and amputations altogether. The best way to treat a diabetic foot ulcer is to prevent its development in the first place. You are at high risk if you have or do the following:
- Poor circulation
- A foot deformity (e.g., bunion, hammer toe)
- Wear inappropriate shoes
- Uncontrolled blood sugar
- History of a previous foot ulceration
Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet everyday- especially the sole and between the toes- for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality.
Village Podiatry Center’s Diabetic Foot Care Program includes:
- Routine nail care and foot inspections
- Patient education for self-help
- Wound care
- Surgical care when needed
- Peripheral Vascular Disease
- Diabetic Shoes
- Custom Orthotics
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