What’s that Sore? Diabetic Foot Ulcer 101

Diabetic Foot Ulcer

Do you have a sore on your foot that’s been there for a while without improving? If you have diabetes, chances are you’ve developed a diabetic foot ulcer.

In that case, it’s important to understand what the ulcer is, what caused it, what risks it presents, and how you can treat it.

What’s a diabetic foot ulcer?

According to the American Podiatric Medical Association, diabetic foot ulcers affect approximately 15 percent of people with diabetes. They’re open sores on the feet from the ankle down. Most develop on the bottom of your feet, particularly under your big toe or the ball of your foot. Typically, ulcers begin with foot injuries, such as cuts or blisters.

These wounds can linger for weeks without improvement. Between 14-24 percent of ulcers end with amputation.

Who’s at risk?

Some individuals face a higher ulcer risk. Native-American, African-American, and Hispanic patients are more likely to develop ulcers, as are men and patients over 60. Additionally, individuals with vision problems, chronic kidney disease, and obesity experience greater risk. Heart disease and high blood sugar also impede your body’s ability to heal and fight infection.

Some behaviors also make foot ulcers more likely to develop. Alcohol consumption, poorly-trimmed toenails, tobacco use, poor hygiene, and wearing poorly-fitted shoes (ones without enough cushioning or room for your toes) can promote ulcer formation.

What causes ulcers?

In addition to high blood pressure and injury, there are other causes of ulcer development and poor healing. In fact, nearly 43 percent of ulcers occur in people with both of these conditions:

Diabetic neuropathy: This common complication involves nerve damage in your feet, frequently leading to total sensation loss.  This makes it harder for you to notice any scrapes, cracks, or blisters.

Peripheral artery disease (PAD): This condition blocks arteries in your legs, strictly limiting blood flow. Without proper circulation, your body can’t get enough oxygen to the wound for healing.

Are ulcers life-threatening?

They can be. Without treatment, infectious bacteria can damage and kill your skin and tissues. It can also infect your blood stream or cause a bone infection (osteomyelitis), both of which can lead to sepsis.

If you have PAD, an untreated diabetic foot ulcer can also lead to ischemia where tissue dies, becomes gangrene, potentially leading to death.

What can you do?

Seek treatment for a diabetic foot ulcer within six weeks. Waiting longer drastically reduces your chances to heal.

Your doctor will prescribe medication to prevent or treat infection and will remove dead skin or tissue (debridement). He or she will tell you to alleviate pressure from your foot by wearing a brace, specialized cast, or using a wheelchair or crutches. Control your blood sugar levels (between 80-130 mg/dL before eating and under 180 mg/dL after eating) and monitor your feet daily for any injuries or changes.

With this knowledge, you can keep track of any lingering wounds on your feet and pursue your best treatment options. If you have any questions about a diabetic foot ulcer, please contact the Amputation Prevention Centers of America.

Causes for Leg Amputation

Leg Amputation

Having diabetes doesn’t mean you’ll definitely face a leg amputation, but it does increase your risk. In fact, nearly two-thirds of limb amputations in the United States are diabetes-related.

According to the American Diabetes Association, while the number of amputations has dropped by half over the past 20 years, there are still 73,000 amputations performed annually in adults with diabetes. Foot ulcers are largely the ultimate cause. Ulcers develop in 15 percent of diabetics, and, of that group, 24 percent end up losing a limb. The risk is two to three times higher for black, Hispanic, and Native American patients.

But, what causes the ulcers that lead to losing your leg? There are several factors that put you at risk, and being aware of these problems can help you minimize their impact.

High Blood Sugar

Blood sugar levels that are too high prompt nerve swelling and scarring. Damaged nerves have trouble sending messages, so you’ll eventually go numb in your lower extremities. Without feeling, you’re less likely to notice sores and wounds on your feet. Left untreated, these spots can become ulcers that develop infections that reach down into your bone and impact your entire foot and leg.

Peripheral Artery Disease (PAD)

PAD is more common in individuals with diabetes. The condition, also called atherosclerosis, clogs your arteries and decreases your blood circulation. Poor circulation makes it harder for any ulcers to heal. Without the proper blood supply, your ulcers will continue to worsen, opening the door that leads to infection and potential leg amputation.

Compromised Immune System

If your diabetes isn’t well controlled, your immune system can’t function properly to fight off the infections that lead to leg amputations. Without white blood cells and sufficient blood supply to attack infection, good, healthy tissue dies. At that point, a life-threatening infection can spread quickly to your bones and joints, making an amputation the only treatment option.

Skin Changes

Researchers from the University of Bristol recently discovered ulcers happen in the lower limbs of some diabetic patients because the connective tissue in the skin actually changes. The tissue renews at a faster rate, making collagen abnormal and skin weaker. Weaker skin breaks down faster and forms ulcers more easily.

Although more research is needed to figure out how common the problem is, the researchers said maintaining low blood pressure, blood sugar, and cholesterol levels is a good way to treat the skin changes. The skin alterations can be undetectable for a long time, though, so don’t wait to control your levels until you see problems.

Reduce Your Risk, Control Your Blood Sugar

There are things you can do to limit your amputation risk, however. The biggest step is controlling your blood sugar — keep it at 80-130 mg/dL before meals and 180 mg/dL after eating. Include lean meats, fruits, vegetables, fiber, and whole grains in your diet, and avoid sugar-sweetened juice and soda. Exercise 30 minutes daily. Maintain a healthy weight and blood pressure (less than 120/80), and take your diabetes medications as directed.

Contact Us to Learn More on Causes for a Leg Amputation

Overall, remember that having diabetes doesn’t mean you will lose a limb. Work with your doctor to keep your diabetes under control and ensure your feet are as healthy as possible. If you have any questions or concerns, you can also contact us at Amputation Prevention Centers of America.

Get Your Blood Flowing: Improving Circulation with Diabetes

improving circulation
Your first thought about managing your diabetes might be controlling your blood sugar. But, don’t forget about improving circulation. Your blood needs to pump smoothly so your feet and legs stay as healthy as possible.

If you’re feeling numbness, tingling, or cramping in your feet, peripheral arterial disease (PAD) could be to blame. This condition, that narrows and hardens arteries due to fatty plaque build-up, affects between 8-12 million Americans, and approximately one-third of individuals with diabetes over age 50 live with it.

Poor blood flow plays a large role in the 73,000 amputations that occur among people with diabetes annually, so improving circulation could not only improve how your legs and feet feel, but it could also save you from losing an extremity.

Consider taking these steps to improving circulation:

Exercise: Engage in some form of cardiovascular activity for 30 minutes five days a week to keep your blood pumping. Biking, walking, running, swimming, and aerobics are good options. The most important thing is to be sure you’re moving your toes, feet, ankles, and legs.

Quit smoking: Smoking hardens your arteries, much like PAD, and decreases your circulation. Stopping can help improve how well your blood reaches your legs and feet.

Control your cholesterol: High cholesterol can narrow and harden your arteries, limiting your circulation. Talk with your doctor about what your optimal cholesterol numbers are and shoot for lower.

Keep blood sugar low: Managing your blood sugar levels is also important to maintaining healthy blood flow. Keep your levels between 80-130 mg/dL before eating and under 180 mg/dL after eating. Pay attention to your A1C levels, too, though. The target level for people with diabetes is 6.5 percent.

De-stress: Not only does stress increase your heart rate, blood pressure, and blood sugar levels, but it also sends more blood to your brain, heart, and skeletal muscles. Conscious muscle relaxation, deep breathing, and visualizing comfortable situations, such as using the WarmFeet technique, can lower your heart rate and blood pressure, increase your body temperature, and route blood to more areas of the body, including your extremities. In fact, WarmFeet has been clinically proven to increase circulation and heal foot ulcers.

Wear diabetic compression socks: Compression socks apply pressure to your calves and feet, straightening out your veins so the valves work better and let more blood flow through. Be sure any socks you choose won’t wrinkle and offer extra padding and flat seams. Socks made from acrylic, merino wool, bamboo, and charcoal mixed with spandex minimize the abrasiveness on your feet and decrease the amount of moisture that could come in contact with any foot sores you might develop. Compression socks range from extra-light to extra-firm pressure. Talk with your doctor about what would be best for you.

Take medications correctly: If your doctor prescribes blood thinners, take it as directed. It can’t stop the build-up of plaque on your arteries, but it can improve your circulation.

 

Following these suggestions could help you avoid the negative impacts of poor circulation. The more freely your blood flows, the less pain, discomfort, numbness, and cold temperatures you’ll experience in your feet and legs.

Contact the Amputation Prevention Centers of America for more information on how to improve your circulation.

Low Blood Flow: The Cold Truth About Poor Circulation Leading to Diabetes

Poor Circulation

If your hands and feet stay cold, perhaps even numb, it’s an almost sure sign you have poor circulation. While decreased blood flow can be a symptom of several medical problems, one of the most common is diabetes.

The symptom might seem mild, but if left unchecked, poor circulation puts you at risk for limb, heart, kidney, brain, and eye damage.

Consequently, it’s important to know how your poor circulation developed and how you can improve the condition.

How Does Diabetes-Related Poor Circulation Happen?

  1. Diabetes can lead to poor circulation in several ways. In many cases, high glucose levels can be the culprit. Over time, high glucose levels in your blood can cause damage to the lining of your small blood vessels, impeding your circulation.
  1. Diabetes also increases your risk of peripheral arterial disease (PAD). Based on data from the American Diabetes Association, 1 in 3 people over age 50 with diabetes has PAD. The fatty deposits common to this condition narrow the blood vessels, mainly in your legs and feet. As this happens, your chances of having a stroke or heart attack rise significantly.

 

Identifying Poor Circulation

Diabetic neuropathy — cold or numb hands or feet — is a common sign of poor circulation in diabetes. However, according to United Kingdom-based Global Diabetes Community, you should alert your doctor if you experience these symptoms, as well:

  • Pain when walking, particularly in calves, thighs, and buttocks
  • Chest pain during exertion
  • High blood pressure
  • Infections in your feet
  • Trouble seeing
  • Hair loss on legs or feet
  • Dry, cracked skin on feet
  • Slow-healing wounds on feet
  • Brittle toenails
  • Erectile dysfunction

 

Can You Improve Your Circulation?

Yes, you can. According to The Diabetes Council, there are several things you can to do improve your blood flow.

  • Exercise is one of the best ways to improve blood flow to your hands, feet, legs, and other parts of the body. At least five days a week, try to bike, run, walk, swim, or get some other type of aerobic exercise for 30 minutes. In fact, according to the United Kingdom’s National Health Service, exercising consistently for 6 months can produce a 20-percent improvement in ankle blood pressure. This reduction points to PAD improvement, as well as increased circulation.
  • Keep your blood sugar levels under control. Aim for keeping your blood sugar at the levels recommended by the American Diabetes Association for both before and after meals.
  • Control your blood pressure and cholesterol levels, trying to maintain levels recommended by the American Heart Association. Take medication, if necessary.
  • Wear warm diabetic (compression) socks. If your feet can’t feel temperature, avoid putting them in a hot bath.
  • Check your feet daily for any injuries.
  • Lose weight.
  • Stop smoking.

Pay attention to what your body tells you. If you start to develop symptoms of poor circulation, talk with your doctor or contact the Amputation Prevention Centers of America. Addressing the problem early could prevent infections, amputations, and worsening cardiovascular health issues.

Diabetes

What are diabetic foot ulcers?

Often people ask me, “What are diabetic foot ulcers and why are they so harmful?” So I am here to help you understand what they are, why they occur, and why they can be dangerous.

What is a diabetic foot ulcer?

A diabetic foot ulcer is an open sore on your foot that fails to heal. They often occur on the bottom of your feet but can occur anywhere skin or tissue breaks down or is cut open.

Why do diabetic foot ulcers occur?

Normally, if you injure your foot, you feel pain that alerts you to the injury. You then take steps to treat it: clean the wound, apply a bandage and perhaps ointment, and replace poor fitting shoes if that is the underlying problem. Your body continues the healing process and your foot heals well.

But when you have diabetes, your natural healing process and pain reflexes can be disrupted. If you develop poor circulation in your legs and feet (peripheral arterial disease or PAD), have high blood sugar, or both, healing slows down.

If you have nerve damage (peripheral neuropathy), your feet may feel numb. Or you may have no feeling at all. In either case, the injury may be painless. When that happens, blisters, cuts, and sores can go unnoticed. That’s when serious problems can begin.

Why are diabetic foot ulcers so harmful to me?

Diabetic foot ulcers can be downright dangerous. They are the leading cause of amputation and hospitalization when you have diabetes.

If infection spreads throughout your body, or severe ligament, muscle, and bone damage occurs, amputation may be necessary. In less severe cases, you may need surgery to remove tissue that has died.

In the best circumstances, it takes weeks to several months for a diabetic foot ulcer to heal.

Having diabetes puts you a much greater risk for a foot ulcer. Once you have had one, you are more likely to develop another.

What can I do to prevent them if I have diabetes?

Although preventing a diabetic foot ulcer is not always possible, you can take steps to reduce your risk.

Here are my 6 basic rules to help prevent diabetic foot ulcers:

  1. Keep your blood sugar at your target level throughout the day.
  2. Practice daily foot care. Wash, thoroughly dry, moisturize (except between toes), and carefully inspect your feet every day. Use a mirror or helper if needed.
  3. Eat a healthy diet as advised by your doctor and dietician.
  4. Keep your toenails trimmed, cutting straight across.
  5. Have a podiatrist remove corns and calluses.
  6. Always wear well-fitting shoes and clean, dry socks indoors and out.

Most important, talk to your doctor right away if you have any foot sore or foot problem that does not heal promptly. Report any breaks in your skin and any changes in the feeling, shape, or color of your feet.

Early treatment is key to preventing infections and serious complications. Contact the Amputation Prevention Center of America for more information.