Following a diagnosis of diabetes, most patients become far more conscious of maintaining a healthy diet in an effort to control their glucose levels. But it’s not only about the blood sugar. Diabetes is a complicated disease that, if not managed properly, can affect different parts of the body such as the heart and blood vessels, the kidneys, the eyes and even the feet.
Diet and exercise are an important part of treatment, but so is foot care. Approximately 15 percent of people with diabetes will develop a foot ulcer at some point, according to the National Institutes of Health. Without proper care, foot ulcers can result in complications and, in some cases, amputation.
The good news is that foot ulcers can be prevented — and when they occur, they can be resolved with proper and timely treatment.
“Treatment success depends on when you come in for medical attention,” explained Milton Jimenez, M.D. [1], a hyperbaric medicine specialist at South Miami Hospital [2]. “The more time that goes by before you get treatment, the worse it will become and the harder it will be to resolve.”
What is a Foot Ulcer?
A diabetic foot ulcer can begin with something as small as a cut or blister that exposes the underlying tissue, inviting infection. Elevated blood glucose can damage blood vessels and compromise the body’s healing capacity, allowing infection to take hold.
Several factors may be at play in making foot ulcers a problem among people with diabetes. Nerve damage from diabetic neuropathy [3] can cause reduced sensitivity or loss of feeling in the feet, allowing even minor cuts to become infected or develop into ulcers without the patient noticing.
In addition, many people with diabetes have peripheral arterial disease (PAD) [4], hardening and narrowing the blood vessels in the legs. Ulcers may develop and worsen because blood flow is insufficient to heal cuts or sores on the feet.
If you have diabetes and develop a wound or sore that does not close within a few days, it could be a diabetic foot ulcer. Pain may not necessarily be a symptom. Many times, the first thing you may notice is some drainage on your socks.
How to Respond
The prospect of a foot ulcer can be frightening to patients and their families, so some people delay treatment rather than dealing with the problem head-on, Dr. Jimenez said. “They hope it will go away,” he said. “Some people try to self-treat, when they need to seek medical attention right away.”
People with diabetes should work closely with their primary care physician or endocrinologist and take an active role in all aspects of their health, including the condition of their feet, Dr. Jimenez said. “It is important for patients to understand they need to check their feet every day,” he said. “If they need antibiotics, they should get antibiotics — and they should take them.”
South Miami Hospital [5] and Mariners Hospital [6] offer treatment in their hyperbaric chambers for advanced wounds that are not responding to traditional treatment of medication and debridement (the removal of infected tissue) by a physician. In those cases, healing may be accelerated by providing 100 percent oxygen in the pressurized hyperbaric chamber, Dr. Jimenez said. Treatments take about 90 minutes and can last up to six weeks, he said.
“If a wound has not healed for a month, it’s definitely something that should be tried,” he said. “With proper wound care and follow up, these wounds can heal.”
Foot Care Tips
There are many things you can do to keep your feet healthy, according to Baptist Health professionals, the U.S. Centers for Disease Control and Prevention [7] and American Diabetes Association [8]. Here are some things to keep in mind:
- Take care of your diabetes. Work to keep your blood glucose within your target range. High blood glucose levels make it hard to heal wounds and fight infection.
- Check your feet every day. Look for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help. Set aside a specified time every day to do this, whether it is in the morning or before you go to bed.
- Be more active. Exercise is good for circulation and stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes — but don’t walk when you have open sores.
- Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. If the shape of your feet has changed, do not try to squeeze into old shoes — you may need a new pair. Therapeutic shoes may help for comfort and protection, so check with your doctor.
- Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for five minutes, two or three times a day. Don’t cross your legs for long periods of time. Don’t sit for extended periods. If you don’t have sores, get up and walk around periodically.
- Take your foot care seriously. Wash your feet every day with warm (not hot) water, and dry them carefully. To avoid cracked skin and calluses, apply lotion over the tops and bottoms of your feet — but never between your toes, where the added moisture can cause problems.
- Seek medical care. If you discover a foot problem that does not heal within a few days, do not try to treat it yourself. Seek professional advice as soon as possible for the best possible outcome. Trying to solve the problem yourself with hydrogen peroxide, whirlpools and soaking is not recommended, as these practices could lead to further complications.
- Don’t smoke. Smoking affects the small blood vessels and can cause decreased blood flow to the feet, making it difficult for wounds to heal.