Avoiding Foot Ulcers

By some estimates, as many as 25% of diabetic patients develop foot ulcers. These ulcers are open sores or wounds, most commonly on the bottom of the foot. Reduced nerve sensation, poor blood circulation, and fluctuations in blood sugar can make foot ulcers difficult to heal.

An ulcer may start small but, left unattended, can quickly develop into a medical emergency. 

There are simple precautions diabetics can take to avoid ulcers:

• Carefully examine your feet and toes at least weekly. Look for sores that you may not feel because of reduced sensitivity in our feet called “foot neuropathy"

• Wash and carefully dry your feet. Moisture between toes can damage the skin.

• Don’t let you’re the skin on your feet become dry or cracked – use foot creams, if necessary (but not between toes). Dry skin is more susceptible to cuts and scrapes.

• Wear proper footwear.
• Your shoes should fit properly and not create pressure points anywhere on your feet. A patient with neuropathy can wear poorly fitted shoes without recognizing pressure points or abrasion that someone with normal nerve function wouldn’t tolerate. Estimates of the number of diabetics who will eventually develop peripheral neuropathy range as high as 70%.
• Break in new shoes slowly (wear them for no more than two hours/day for the first week), looking for signs on your feet that the shoes may be rubbing or causing pressure on your skin.
• Your shoes should also protect your feet, especially your toes. The best shoe uppers have reinforced toe areas and sturdy heel counters. Shoe soles should not be excessively soft. Firmer soles and midsoles help restrict the movement of the foot joints thereby limiting stretching of the plantar fascia (the arch tendon of the foot). This helps distribute body weight and impact forces over a larger surface area of the foot – eliminating pressure points.
• Avoid open-toed and high heeled shoes.
• Check inside your shoes before each time you put them on. Look for pebbles or anything else that might cause irritation.

• Always wear shoes or slippers, even at home.

• Do not wear tight socks. Diabetic socks fit loosely and do not inhibit blood flow.

• Monitor and control your blood sugar. Many people can control their blood sugar by exercising and enjoying a healthy diet. For some medication may be required. High blood glucose causes the body to lose fluid which may cause dry skin.

• Do not smoke. It can reduce blood flow to the feet.

• Stay active. Exercise helps promote circulation.

What to do about untreated ulcers

An untreated diabetic ulcer can lead to amputation. The vast majority of this type of amputation today are avoidable. See a doctor immediately if you have ulcers that are not healing. 

Treatment may include antibiotics and/or removal of dead tissue. In some cases, more elaborate treatment may be necessary and could include negative pressure wound therapy.