Patients with diabetes mellitus are at risk for foot ulcerations due to nerve damage and poor circulation in their feet.
Peripheral neuropathy secondary to diabetes can lead to loss of sensation and feeling in the feet. Any trauma to the foot like a small scrape or cut may go unrecognized for days to weeks in a patient with neuropathy leading to infection and if severe enough possible amputation.
Decreased sensation secondary to neuropathy in the diabetic foot can lead to a condition called Charcot foot leading to bony collapse, fractures and dislocations of joints. As a result, a patient may have increased swelling and deformity of the foot.
Abnormal weight bearing forces on the bottom of the feet secondary to bony prominences with lack of sensation in the feet can lead to diabetic ulcerations. These are commonly called neuropathic ulcerations.
Patients with long standing and poorly controlled diabetes can develop poor circulation of the smaller arteries in the feet. This can lead to ischemic ulcerations.
Treatment for diabetic foot ulcers involves understanding the etiology of the wound. Most wound care for diabetic foot ulcers involves wound care therapy through debridement of the wound with scalpels and blades to remove debris and non-viable tissue.
Patients are instructed on using topical anti-bacterial medications with gauze and tape to keep the wound moist to lower the risk of infection and improve healing time.
Those with diabetes need to be educated on the importance of improving sugar control, daily foot inspections, maintaining an ideal body weight, avoiding smoking and wearing proper shoe gear.
Those patients with severe diabetic foot ulcerations may need to be put into casts and boots in order to reduce pressure on the ulcer. Surgical intervention is used for refractory diabetic foot ulcers that become chronic and non-healing.