Posted: Monday, May 22, 2023

Management of Diabetic Foot Wounds

If you have diabetes, you have a higher chance of developing foot wounds or ulcers. A diabetic foot ulcer can occur anywhere on the foot below the ankle. They’re mostly found under the big toes or the balls of the feet where pressure is applied most when walking. Diabetes, or higher-than-normal blood glucose levels, can damage nerves, which may result in a loss of sensation in the foot. Sometimes, this leads to foot deformity or pressure points which then become sores. If, due to neuropathy, you can’t feel pain and keep walking, an ulcer can form. According to the National Institute of Health, the lifetime risk of developing a diabetic foot ulcer is between 19 and 34 percent. An estimated 9.1 to 26.1 million diabetic individuals globally have foot ulcers.

One of the first signs of a foot ulcer is drainage. Swelling, irritation, redness or an odor also may indicate an ulcer. The longer it takes to seek treatment, the worse the prognosis, especially since foot ulcers can take a long time to heal -- sometimes more than 100 days. “When it comes to prevention, self-inspection is the key. We don’t think about our feet until there’s a problem, and sometimes if you don’t feel your feet because of neuropathy, you don’t even know there’s a problem, so vigilance is key,” board-certified podiatrist Dr. David Franklin from East Tennessee Medical Group said.

Treatment for foot wounds generally begins with relieving pressure on the area. “We’re ambulatory, that’s how we get from point A to point B, so to look at a patient and say ‘you can’t walk on this at all’ is impractical. Sometimes we put people in an offloading type of cast, but usually we’re utilizing fracture boots to take pressure out of the foot to get the wound to heal. There also are any number of medicated dressing products we can use,” Franklin said. As a supervising physician with Blount Memorial Total Rehabilitation’s MEND clinicFranklin often assists in treating more serious foot wounds and ulcers. “Unfortunately, a lot of these folks also have some level of vascular disease. That doesn’t always mean it won’t heal, but that could be part of the reason a wound wouldn’t heal and they would need a referral to a vascular surgeon to restore bloodflow to the foot,” Franklin explained.

Recurrence also is an issue. If you have a diabetic ulcer, you are more likely to get another. Part of managing the recurrence of diabetic foot ulcers is managing glucose levels. “In addition, if you don’t go back and deal with the underlying mechanical pathology, you’re going to have the same thing happen over and over again. So, we can use specially made inserts or shoes for diabetics that accommodate the foot, bracing, and compression wraps. Sometimes we use prophylactic surgery for a deformity or malalignment to put the foot back in a better position and take the pressure off to resolve the issue,” Franklin said.

“But again, early intervention is the key. Don’t wait until it’s too late to salvage the situation. Come in when you notice something is different, or you see something worrisome or that you haven’t seen with your foot before,” Franklin added.

For more information about treatments for diabetic wounds, or to make an appointment with one of our podiatrists, call East Tennessee Medical Group at 865-984-3864.

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