A diabetic foot ulcer is one of the health complications caused due to uncontrolled diabetes. High blood glucose levels can cause nerve damage. In addition, people with diabetes may also suffer from lower extremity arterial disease, which is a condition that leads to reduced blood flow. These problems make the feet vulnerable to skin sores, also known as ulcers. They usually occur under the big toes and surrounding areas.
As per researchers, about 25 percent of people who have diabetes can develop foot ulcers during their lifetime. In some cases, these foot ulcers can cause severe infections. If untreated, this may require partial or total amputation.
Common symptoms of diabetic foot ulcers include:
Blisters or other wounds on the foot
An ulcer that does not heal quickly
Diabetic foot ulcers can form due to multiple reasons. High sugar levels can cause nerve damage known as diabetic neuropathy. Diabetic neuropathy makes you lose the sensation of pressure, pain & or temptation. This may also result in numbness, and you may not notice a blister, sore, or cut. Wounds that go unnoticed can be infected.
Poor blood circulation is another leading cause of diabetic foot ulcers. People with diabetes may develop peripheral artery disease (PAD), which causes arteries to narrow. The reduced blood flow makes it difficult for a diabetic foot ulcer to heal.
Diabetic foot ulcers can be broadly classified as:
Neuropathic Ulcers: These types of ulcers result from sensory nerve damage due to high blood sugar levels. This results from peripheral neuropathy, a condition with complete loss of sensation or inability to feel pain.
Vascular Ulcers: These ulcers are formed when the blood vessels are damaged due to high glucose levels, which decrease the blood flow to the feet.
Doctors also use Wagner Grades to describe the severity of an ulcer. The grades allow the doctor to monitor and treat diabetic foot ulcers depending on the condition. The classification is generally described in number, starting from 0 to 5:
There is no diabetic foot ulcer, but there is a high risk of developing one.
The surface of the ulcer is partial or superficial
The ulcer has extended to tendon, ligament, or capsule
The ulcer is deep with abscess or osteomyelitis
Ulcer has caused partial-foot gangrene
Extensive gangrenous involvement of the entire foot
Your doctor will perform a physical examination and ask about the symptoms. The doctor may also examine your toes, feet, and legs to check for an ulcer or blister present. Depending on the diagnosis, they may recommend the following tests to confirm the diabetic foot ulcers:
Blood Tests: The doctor may prescribe a blood test to check if any infection is caused to the ulcer.
Magnetic resonance imaging (MRI): This test is done to look into the foot's soft tissues. The doctor gets detailed information about the extent of damage caused by the ulcer.
Radiograph: This test is done to get accurate images of the ulcer from different angles to determine its type.
Depending on the diagnosis, your doctor may recommend the following treatments for diabetic foot ulcers:
Medications: The doctor may prescribe antibiotics or anti-clotting medications to treat the ulcer. The doctor may recommend a specific ointment to treat this condition.
Pressure Off-loading: The doctor may suggest wearing special footgear or a brace or applying specialized castings to reduce the pressure and irritation to the ulcer area. This helps to speed up the healing process.
Debridement: In this procedure, the doctor cleans the dead or infected skin and tissues affected with diabetic ulcers. The doctor may use a sharp tool known as a scalpel to remove the infected or dead skin and tissues. The wound is then washed with a disinfectant solution.
Achilles Tendon Lengthening: In this procedure, the surgeon stretches the Achilles tendon to allow the person to talk without bending the knee and releasing the tension of the tendon. This allows better body alignment and takes off pressure from the ulcer, allowing it to heal.
Atherectomy: The surgeon clears the clogged artery by cutting or vaporizing the plaque in this procedure. During the procedure, the surgeon inserts the catheter into the artery to remove the clog from the artery, performed under local anesthesia.
People with diabetes are at high risk of developing diabetic foot ulcers. However, some factors may also increase the risk of developing this condition. These include poor hygiene, alcohol consumption, obesity, tobacco use, etc. In some instances, diabetic foot ulcers can lead to skin infections, abscess formation, sepsis, foot deformities, and gangrene. In extreme cases, foot ulcers can result in need for partial or complete foot amputation.
Many people may fully recover from diabetic foot ulcers. If the ulcer is not that deep, the outlook is generally good with the recommended treatment. However, the foot ulcers may also reoccur. In extreme cases, the lower extremity amputation may be required in about 24 per cent of the patients.