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Diabetic Foot Ulcers: Causes, Types, Symptoms, Diagnosis, Treatment And How To Prevent Them

Every year National Diabetes Awareness Month is observed in November and communities from all over the world come together to raise awareness and educate people to help people spot diabetes at an early stage. According to the International Diabetes Federation, diabetes was responsible for 4 million deaths in 2017.

Diabetes is a chronic disease which if left untreated can lead to life-changing complications. One such common complication of diabetes is diabetic foot ulcers, which happen as a result of the breaking down of skin tissues, thereby exposing the layers underneath.

According to a study, the prevalence of diabetic foot ulcers among diabetic patients in North India was 14.30% [1] and in the United States, 85% of foot amputations were a result of diabetic foot ulcers [2] .

What Causes Diabetic Foot Ulcers

Diabetic foot ulcers mostly occur under your big toes and the balls of your feet. It is most commonly caused due to the following reasons.

  • Poor circulation - Improper blood flow to the feet can cause pain and make it more difficult for the ulcers to heal.
  • Nerve damage (diabetic neuropathy) - Over time, diabetes can cause nerve damage which leads to a loss of feeling in the feet. This makes you less sensitive to foot pain and could result in painless wounds that can cause ulcers [3] .
  • High blood sugar - If your blood sugar levels are high, the healing process of an infected foot ulcer is considerably slow. So, managing your blood sugar levels is extremely important.
  • Irritated or wounded feet - Cracks, corns, calluses, and bleeding wounds may occur in the feet leading to diabetic foot ulcers.

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Types Of Diabetic Foot Ulcers

  • Neuropathic ulcers happen when there is peripheral diabetic neuropathy.
  • Ischemic ulcers occur when there is peripheral artery disease.
  • When a person has both peripheral diabetic neuropathy and ischemic ulcers, neuroischemic ulcers occur.

Symptoms Of Diabetic Foot Ulcers [4]

  • Wounds with or without drainage
  • A loss of feeling in the feet
  • Painless blisters or wounds
  • Numbness or tingling sensation
  • Red streaks
  • Skin discolouration
  • Chills
  • Fever
  • Redness
  • Shock
  • Uncontrollable blood sugar.

Risk Factors Of Diabetic Foot Ulcers [5]

  • Poor hygiene
  • Wearing poor quality shoes
  • Not trimming your toenails properly
  • Heart and kidney disease
  • Obesity
  • Alcohol consumption
  • Eye disease
  • Tobacco use.

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Complications Of Diabetic Foot Ulcers [6]

  • Foot ulcers and wounds that don't heal
  • Foot deformity
  • Infections which include abscesses, skin and bone infections
  • Charcot's foot
  • Gangrene.

When To See A Doctor

People with diabetes should consult a doctor if he or she notices the following changes:

  • Swelling in the foot or ankle
  • A change in skin colour on the foot
  • Ingrown toenails
  • Temperature changes in the feet
  • Dry, cracked skin on the heels
  • Athlete's foot or other fungal infections.
  • Continuous sores on the feet
  • Pain or tingling sensation in the feet or ankles.

Diagnosis Of Diabetic Foot Ulcers [7]

Your doctor will ask about your medical history and then conduct a physical examination by inspecting the foot, toes and toenails for blisters, cuts or ingrown toenails.

Other diagnostic tests include the following:

  • X-ray - X-ray imaging is done to evaluate changes in the alignment of the bones in the foot.

Blood test - If the doctor notices signs of infection like redness, swelling and warmth in the affected foot, he or she may recommend a blood test.

  • MRI scan - An MRI scan is recommended to check the extent of damage caused by an ulcer.

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Treatment Of Diabetic Foot Ulcers [8]

The treatment varies depending on the severity of the disease. Medications and surgery are some of the treatment options for diabetic foot ulcers.

Medications

Antibiotics, antiplatelet drugs or anti-clotting medications are prescribed by the doctors to treat diabetic foot ulcers. Some over-the-counter treatments for diabetic foot ulcers include polyhexamethylene biguanide (PHMB) gel, dressings containing silver or silver sulfadiazine cream, and povidone or cadexomer iodine.

Surgery

When medications don't help in healing diabetic foot ulcers, surgery is recommended. The surgical options include the following:

  • Reducing pressure around the ulcer by shaving or excision of bones
  • Removing foot deformities
  • Amputation of the foot
  • Endovascular surgery is performed using thin long tubes called catheters to place a stent, to ensure that the blood vessels are open.

Other treatment procedures include regulating glucose control, keeping the ulcers covered and moist using dressings and medications, and ensuring proper blood circulation in the affected foot.

Prevention Of Diabetic Foot Ulcers [9]

  • Check your feet daily for blisters, cuts, sores, redness, cracks and swelling.
  • Keep your feet clean to prevent infections by washing them in lukewarm water.
  • Keep your feet dry by sprinkling little talcum powder in between your toes.
  • Don't move around barefoot.
  • Trim your toenails
  • Wear proper shoes and wear light cotton socks
  • Protect the feet from extreme hot and cold temperatures
  • Control your blood sugar levels
  • Avoid smoking
  • Go for regular foot check-ups.
View Article References
  1. [1] Shahi, S. K., Kumar, A., Kumar, S., Singh, S. K., Gupta, S. K., & Singh, T. B. (2012). Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India.The journal of diabetic foot complications,4(3), 83-91.
  2. [2] Boulton, A. J., Armstrong, D. G., Kirsner, R. S., Attinger, C. E., Lavery, L. A., Lipsky, B. A., ... & Steinberg, J. S. (2018). Diagnosis and management of diabetic foot complications.
  3. [3] Abbott, C. A., Vileikyte, L., Williamson, S., Carrington, A. L., & Boulton, A. J. (1998). Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration.Diabetes care,21(7), 1071-1075.
  4. [4] Amin, N., & Doupis, J. (2016). Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities.World journal of diabetes,7(7), 153-164.
  5. [5] Nongmaithem, M., Bawa, A. P. S., Pithwa, A. K., Bhatia, S. K., Singh, G., & Gooptu, S. (2016). A study of risk factors and foot care behavior among diabetics.Journal of family medicine and primary care,5(2), 399.
  6. [6] Mariam, T. G., Alemayehu, A., Tesfaye, E., Mequannt, W., Temesgen, K., Yetwale, F., & Limenih, M. A. (2017). Prevalence of diabetic foot ulcer and associated factors among adult diabetic patients who attend the diabetic follow-up clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study.Journal of diabetes research,2017.
  7. [7] Armstrong, D. G., & Lavery, L. A. (1998). Diabetic foot ulcers: prevention, diagnosis and classification.American family physician,57(6), 1325-32.
  8. [8] Alexiadou, K., & Doupis, J. (2012). Management of diabetic foot ulcers.Diabetes therapy : research, treatment and education of diabetes and related disorders,3(1), 4.
  9. [9] Iraj, B., Khorvash, F., Ebneshahidi, A., & Askari, G. (2013). Prevention of diabetic foot ulcer.International journal of preventive medicine,4(3), 373-376.

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