Preventing and Treating Foot Ulcers | Amputation Prevention Centers

Treating Foot Ulcers
With foot ulcers occurring in approximately 15 percent of patients with diabetes. Preventing and treating foot ulcers when they occur can be an important part of your health routine.

In addition to foot ulcers, if you have diabetes, your risk of amputation is 28 times higher than someone without the condition. Consequently, successfully avoiding foot ulcers or ensuring prompt healing can help you avoid the problem.

Preventing Foot Ulcers

Staving off a foot ulcer is the most beneficial option. To ward them off, follow these steps:

  1. Manage blood sugar: Before eating keep your blood sugar at 80-130 mg/dL before meals and under 180 mg/dL after. A healthy blood sugar level encourages faster healing.
  2. Pamper your feetConduct daily foot inspections, using a mirror to see the bottoms of your feet, if necessary. Look for cracks, cuts, blisters, and other signs of wounds. Wash your feet daily with mild soap and warm water. Dry thoroughly, especially between your toes, and apply talcum powder to deter blisters.
  3. Pick the right shoes: Select shoes that are tight enough to keep fabric from rubbing your skin, causing an ulcer. But, choose ones loose enough to not crowd your toes and be comfortable. If you need them, choose orthopedic shoes that can be custom fitted to the size, shape, and contours of your feet.
  4. Don’t light up: Don’t smoke. It reduces your circulation, making your blood flow problems worse. It can also decrease the feeling in your feet.
  5. See your doctor: Have a foot exam at least once a year to inspect your feet for circulatory issues, early signs of nerve damage, or other foot problems.

 

Treating Foot Ulcers

If you do develop a foot ulcer, there are therapeutic options available. Discuss the best tactic with your doctor.

  1. Debridement: This is the surgical removal of unhealthy tissue and bacteria from the wound in order to promote healing.
  2. Hyperbaric Oxygen Therapy (HBOT): HBOT works by delivering 100% pure oxygen to a patient through increased atmospheric pressure in a large, clear, acrylic chamber. This increased oxygen absorption enhances the body’s ability to heal.
  3. Living Cellular Skin Substitute: This therapy consists of the application of products made of living cells and proteins that can, over time, stimulate wound healing.

Within 4 weeks, if you haven’t healed — or if you have developed a bone infection — consult your doctor.

Be aware, foot ulcers can start small with a callus or a blister. Be sure the keep your weight off the affected foot as much as possible to avoid any worsening of your ulcer. Be vigilant. The soft tissue of your foot is susceptible to infection, so any problems can spread to muscle and bone quickly. If you notice any changes or problems, contact your doctor. Delayed treatment can slow down healing and even lead to amputation.

Contact the Amputation Prevention Centers of America for more information on preventing and treating foot ulcers.

Treating Charcot Foot: Surgery or Not?

Treating Charcot Foot
If you have peripheral neuropathy, there’s a chance you could also develop Charcot foot. This condition weakens the bones of your foot, as well as your joints and soft tissues, while causing painful sores or changing the shape of your foot.

As many as 2.5 percent of patients with diabetes can develop Charcot foot, and it can recur in as many as five percent of cases.

Fortunately, your doctor can help you in treating Charcot foot, largely reversing the damage it causes. Depending upon the severity of your case, you could receive medical or surgical therapy. Any treatment option you receive will have similar goals: take weight off the injured foot, address bone disease, and prevent future foot fractures.

Charcot Foot Diagnosis 

Imaging scans can help your doctor determine what treatment type you need. X-rays offer detailed pictures of dense structures, such as bones. MRI and ultrasound provide good imaging of foot and ankle soft tissues, potentially identifying any bone infections. Bone scans are nuclear tests that can also identify bone infections. A specific test — an indium scan — tags your white blood cells and follows them to the infection site.

Treating Charcot Foot

Whether your doctor recommends surgical or non-surgical treatment, you will get the best long-term results if you closely follow your physician’s instructions. Most specifically, wait until he or she tells you it’s safe to put weight on your foot again.

Also, be sure to check your feet daily for any problems, including scrapes or lingering sores. If any exist, immediately contact your doctor. The sooner you get treatment, the more likely you are to have a good outcome.

Non-surgical treatment: Offloading — keeping your weight off your affected foot — is the most important part of treating Charcot foot without surgery. For anywhere from 8-to-12 weeks, you’ll wear a protective walking boot or cast. The protective footwear should stay in place until any redness, swelling, or heat disappears. The Charcot Restraint Orthotic Walker (CROW) is a commonly used device.

The second step is prescription orthotic shoes. These shoes must fit appropriately, providing enough room for your toes and enough cushioning for the heel, arch, and ball of your foot. The right shoes won’t have any pressure points, reducing the risk of injury or ulcers.

You’ll also need to change your activities to avoid repetitive trauma to both feet.

Surgical treatment: Surgery is recommended for individuals with severe ankle and foot deformities that could make using a brace or other orthotics difficult. These patients are also at a higher risk for developing foot ulcers.

Surgery could involve re-aligning the bones of your foot or removing some that could cause ulcers. According to recent research, most patients with diabetes are able to resume normal walking after surgery.

Because infection risk is high post-surgery, you’ll be instructed not to put your full weight on your foot until your doctor gives you the green light. You’ll also need to commit to wearing protective footwear for life.

Remember, it is possible for Charcot foot to return, so stay vigilant with your foot hygiene.

For more information on treating Charcot foot, contact the Amputation Prevention Centers of America.

After Foot Amputation — What’s Next?

Foot Amputation

A foot amputation can be a scary procedure to face. But, completing a successful operation is your surgeon’s job. Your work begins after the procedure.

Knowing what to expect after a foot amputation can help you toward a speedy, healthy recovery. Your hospital staff will give you medications to alleviate pain and fight infection, but you need to know more. Here’s what you can anticipate:

In the hospital after your foot amputation

After moving to your hospital room post-recovery, nurses will change your bandages and will teach you to do so, as well. You will also start the early stages of physical therapy with stretching and some gentle exercises.

Perhaps, most importantly, you will receive information and guidance about your prosthetic foot (if you’re choosing to get one).

At home 

If your healing progresses well in the hospital, you’ll likely go home after a few days. Once there, be sure you follow your surgeon’s instructions about bathing, activity level, and physical therapy to ensure your best recovery.

Physical therapy starts with gentle stretching and will progress to exercises that will improve your muscle control, enable you to resume daily activities, and help you regain independence. It will also include practice with your prosthetic or assistive devices.

Only take pain medications prescribed by your doctor. Even taking an aspirin can increase your bleeding risk.

If you experience swelling, redness, bleeding, worsening pain, numbness, or tingling, contact your surgeon immediately. These symptoms could be normal, but they could also indicate a need for immediate attention.

Inpatient rehabilitation

If you have additional health problems or you’re not recovering your mobility quickly, your doctor might recommend an inpatient rehabilitation facility.

Healthcare providers will focus on wound healing, rebuilding your strength, preparing your leg for the prosthetic, and improving your mobility. They will also teach you how to care for your new prosthetic.

Ongoing rehabilitation

Prosthetics: If you opt for an artificial foot, you’ll need to be fitted properly, learn how to care for it, and how to walk.

It’s possible your leg will still be swollen when you get fitted for your first prosthetic. If so, you’ll receive a temporary one, getting the permanent one within six to 12 months.

Mental health: Losing a limb can be emotionally traumatic. You can develop feelings of depression, anxiety, grief, denial, and suicide. If you feel any of these emotions, contact your doctor immediately. Your care team has support resources.

Complications

Even successful surgeries carry risks. Blood clots and infections can occur with amputations. If left untreated, these problems can cause nerve pain, phantom pain (pain felt in a removed limb), and bone spurs at the end of your leg.

Contact your surgeon if you experience any complications. While it might be possible to correct the problem with medication, there’s a chance you could need additional surgery.

Ultimately, going into your amputation surgery with a clear understanding of what your next steps will be could put you on a path to a quicker, healthier recovery. If you know what to expect, you can be better prepared.

If you have any questions about a foot amputation, contact the Amputation Prevention Centers of America.

Protect Yourself from Charcot Foot

Charcot Foot

If you have diabetes, you face the possibility of developing many foot problems, including ulcers, non-healing sores, and even amputation. But, there’s another condition you should know about and watch out for: Charcot foot.

Also called Charcot arthropathy, this condition weakens the bones in the feet of people who have peripheral neuropathy. It also attacks the joints and soft tissues. Over time, it can cause painful sores and actually change the shape of your foot.

Why does Charcot foot happen?

Your bones naturally lose calcium when injured, and, according to the Cleveland Clinic, that makes the bones weaker and more susceptible to further damage. The numbness from peripheral neuropathy increases the danger. If you can’t feel a sprain, a break, or an infected or lingering sore, you’re more likely to continue walking on your foot normally. In some cases, slow healing from a foot surgery can be responsible.

What happens?

Prompted by injury that often doesn’t get timely treatment, your bones lose the calcium that keeps them strong. At that point, your foot can start to lose its shape, and your arch can drop below your toes or heel. Doctors often call this “rocker bottom.”

Additionally, your toes might curl, and your ankle can become twisted and unsteady. Any misshapen bones can also press against your shoes, creating new sores that can also get infected and lead to amputation.

What to look for?

Diagnosing Charcot foot can be difficult, according to a study published in American Family Physician, because it mimics other conditions, including cellulitis and blood clots. Initial X-rays and lab tests can also often look normal.

However, there are some symptoms, other than the fallen arch, that can make you suspect Charcot foot. If your foot becomes reddish, warm to the touch, or swollen, talk with you doctor. You should also be concerned if you have instability in your ankle, any misalignment of the bones that form the joint, or a strong pulse in your foot.

Can you prevent it?

Yes, you can do things to potentially side-step Charcot foot. Follow this list for better foot health:

  1. Get regular check-ups with a foot doctor who has experience treating diabetic foot problems.
  2. Check your feet daily for swelling, redness, warm spots, and sores. Check between your toes, too.
  3. Wash your feet daily, and dry them thoroughly.
  4. Always wear socks and shoes.
  5. Keep your blood sugar levels under control — between 80-130 mg/dL before eating, under 180 mg/dL after.
  6. Take extra care to avoid injury, particularly while exercising.

 
Overall, if you begin to see these changes in your feet — especially if your foot begins to change shape — contact your doctor immediately. Any delays can result in further damage to your foot that could lead to infection or amputation.

For questions, please contact Amputation Prevention Centers of America.

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.