Some people with diabetes develop foot ulcers.
A foot ulcer is where an area of skin in the foot has broken down and the underlying tissue is visible. This can be even after a mild injury such as stepping on a small stone or because of pressure damage from tight fitting shoes.
Foot ulcers are more common in diabetes because of one or both of the following problems which occur in some people with diabetes:
Diabetes is a disease characterised by increase in blood sugar levels. This leads to deposition of sugar in the tissues damaging the nerves. This is called peripheral neuropathy of diabetes (Diabetic Neuropathy). The nerves that take messages of sensation and pain from the feet are commonly affected. Additionally, numbness in the feet makes them prone to injury. Also, if you cannot feel pain from the foot, you do not protect small wounds by not walking on them. Therefore, they can quickly become worse and develop into ulcers.
If you have diabetes you have an increased risk of developing narrowing of the arteries (peripheral vascular disease). The arteries in the legs are quite commonly affected. This can cause a reduced blood supply (poor circulation) to the feet. Therefore, if you get a minor cut or injury, it may take longer to heal and be prone to becoming worse and developing into an ulcer especially when neuropathy is also there.
YES. Foot ulcers if not treated can cause deep infection; gangrene and can rarely land up in amputation of leg. Adequate treatment by a foot specialist and good blood sugar control is necessary to prevent such complications.
The damage to the nerve (Diabetic Neuropathy) is the main reason for the loss of sensation which further leads to apathy in management of the wound in early stages and further leads to complications.
DFU is mainly due to lack of blood circulation or due to some abnormal pressure due to deformity of or bone collapse. One needs to identify the cause and treat the basic cause. In case of poor blood circulation, a peripheral angioplasty of the lower limb blood vessels may be necessary along with the medications to heal the wound. If the wound however is due to mechanical cause of deformity or bony prominence then a bony cause needs to be addressed before the wound heals. Hence a specific time period cannot be given to all the address.
Most people with diabetes are reviewed at least once a year by a doctor and other health professionals.
Check your blood sugars especially do HBA1c regularly to know your average blood sugars. As a rule, the better the control of your diabetes, the less likely you are to develop complications such as foot ulcers.
Research has shown that people with diabetes who take good care of their feet and protect their feet from injury, are much less likely to develop foot ulcers.
You should tell your doctor about it. Please avoid self dressing or treatment. Most of the ulcers will heal with regular dressings and or if needed contact cast treatment. In some cases, the ulcer becomes worse, badly infected and does not heal. In these cases surgery is needed to control the infection. Sometimes the ulcer is not due to lack of circulation or numbness and infection. In such cases it is usually because of the bone pressure and a bone prominence under the arch of the foot. These ulcers can become very large and must be treated by excision of prominent bone.
Diabetic heel ulcer Diabetic heel ulcer after treatment
Picture on the left showing diabetic heel ulcers. Note the healing with good diabetic control and regular treatment