How should we deal with what seems to be a deluge of foot ulcers?
Understanding the underlying causes of diabetic foot ulcers is important. More than 8% of the population in the United States is diagnosed with diabetes. Of these, approximately 15% will develop a diabetic foot ulcer and 84% of these will have a lower leg amputation.
Many of the complications associated with diabetes result from damaged nerves. This leaves the individual unable to feel sensations in the foot due to a loss of the usual protective sensation in the foot and an alteration of the biomechanics and musculature of the foot.
Peripheral arterial disease, a reduction of arterial blood supply to the foot, is another complication that promotes foot ulcer development. Other factors that can promote foot wounds include improperly fitting footwear, trauma to the foot, and even deformities of the foot and nails. These wounds often become infected.
A diabetic foot ulcer usually presents on the plantar or weight-bearing aspect of the foot. Tissue in the wound base will be red and may appear as healthy granulation tissue. Callus formation will surround the wound bed. The bottom of the foot is usually dry and sometimes scaly. Many times fissures are present.
An essential therapeutic component of diabetic foot wound care is glucose control. All stages of wound healing are interrupted if the blood glucose level is elevated.
Adequate blood supply is also critical to wound healing. A primary therapy is off-loading pressure on the feet, particularly the affected foot. Local wound care is provided based on basic wound care principles with particular attention to infection control. Standard care includes sharp debridement of the callus, also called the “hyperkeratotic edge.” Diabetic foot professionals are available to provide these interventions.