Michael J. Petrocelli, D.P.M., F.A.C.F.A.S., C.W.S.P.
Board Certified Ankle and Foot Surgeon and Board Certified Wound Care Specialist
In the US nearly 30 million people have diabetes, and a vast majority of our population unknowingly has what’s known as prediabetes, which quickly escalates into the disease within a short amount of time. Millions of people with diabetes will suffer from diabetic foot ulcers more than once in their lifetimes. Diabetes is a progressive disease that is many times, not taken seriously enough by people predisposed to the disorder.
High blood sugar damages various organs within the body, but also has a severely adverse effect on nerves. This nerve damage happens when the blood supply is limited. The small blood vessels, which supply blood and nutrients to the nerves becomes impaired. When the nerves are no longer fed nutrients, they either die, or their signals to the brain are ineffective. The lack of brain signaling from the nerve endings makes it difficult for a person to feel pain in their foot, so often injuries and these disorders are overlooked. This syndrome is called peripheral diabetic neuropathy.
Because of this nerve damage, people with diabetes are at a higher risk of developing foot ulcers. A foot wound may not sound overly alarming to most people, but foot ulcers can be life-threatening. These small sores go undetected due to the lack of feeling. If a patient delays treatment, foot ulcers can lead to amputation, strokes, heart attacks and severe infections that can spread throughout the entire body.
Because of the nerve damage, the feet will most likely not secrete oils or sweat properly and can develop cracks and deep slits from dry skin. Calluses can also split, and once these issues start to take place, bleeding, infections and non-healing wounds form on the bottom of the foot and toes. The lack of blood supply and the nerve issues does not allow the wound to heal properly on its own.
Along with this disorder, the individual will continue to put pressure on the foot; this rubbing action is similar to wearing a hole in your sock or shoe.
If foot ulcers are left untreated in diabetic patients, they can develop into gangrene. Unfortunately, in these cases, it is not uncommon for patients to need amputation of their toes, foot, or leg due to progressive infection. It is always best to see a podiatrist proactively if you have diabetes. And if you are experiencing any foot sores, cuts or excessive cracks, you should schedule an appointment with your physician immediately.
According to the American Podiatric Medical Association, “For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” You may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process.
The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal, there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.
Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.
Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.” Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.”
Wound Care Treatment:
• Hyperbaric oxygen treatments
• Saline debridement
• Therapeutic footwear
• Wound care
People with diabetes are encouraged to do self-checks on their feet daily. As soon as you notice any redness or wounds, it is imperative to see your podiatrist.
Collier Podiatry is available to answer your questions and make your appointment. Please visit their website at www.collierpodiatry.com, or call them at (239) 775-0019.
Collier Podiatry, P.A.
Michael J. Petrocelli
D.P.M., F.A.C.F.A.S., C.W.S.P.
NCH Countryside Commons
1715 Heritage Trail, Suite 204
Naples, FL 34112
Phone: (239) 775-0019
Fax: (239) 775-0219