The Connection Between Diabetes and Foot Ulcers: What You Need to Know

What Are Foot Ulcers and Why Should You Be Concerned?

Foot ulcers are open sores or wounds that typically develop on the bottom of the foot, often as a result of diabetes-related complications. These ulcers can be slow to heal and may become infected, leading to serious consequences if left untreated. In fact, research shows that 14-24% of people with diabetic foot ulcers eventually require amputation. The risk of developing diabetic foot ulcer causes increases with the duration of diabetes and the presence of other diabetes-related complications, such as neuropathy and poor circulation.

Common diabetic foot ulcer symptoms include:

• Drainage from the affected area
• Skin discoloration or changes in skin temperature
• Noticeable lumps or deformities
• Tingling, burning, or pain in the feet (although this may be absent in cases of severe nerve damage)

Regular foot checks and prompt medical attention are essential for preventing the progression of foot ulcers and reducing the risk of amputation.

What Causes Foot Ulcers in People with Diabetes?

Diabetic foot ulcer causes are primarily related to the long-term effects of high blood sugar levels on the body. The two main factors that contribute to the development of diabetic foot ulcers are:

• Neuropathy: High blood sugar levels can damage the nerves in the feet, leading to a loss of sensation. This means that minor injuries may go unnoticed and untreated, increasing the risk of ulceration.
• Poor circulation: Diabetes can cause the narrowing of blood vessels, reducing blood flow to the feet. This impairs the body's ability to heal wounds and fight infection, making it more difficult for foot ulcers to heal.

How Do Foot Ulcers Develop in Diabetic Patients?

The development of diabetic foot ulcers is a gradual process that involves several key factors. Here's a closer look at how foot ulcers typically develop:

• Neuropathy: Long-term exposure to high blood sugar levels damages the nerves in the feet, leading to diabetic neuropathy. This results in a reduced ability to feel pain, pressure, or temperature changes in the feet.
• Unnoticed injuries: Due to the loss of sensation, minor injuries such as cuts, blisters, or pressure points from ill-fitting shoes may go unnoticed. These undetected injuries can quickly progress into open sores or ulcers.
• Poor circulation: Diabetes can cause peripheral artery disease (PAD), which narrows the blood vessels and reduces blood flow to the feet. This decreased circulation makes it harder for the body to heal wounds and fight infection.
• Increased pressure: Foot deformities, such as bunions or hammertoes, can change the way weight is distributed across the feet, creating areas of high pressure. These pressure points are more susceptible to skin breakdown and ulceration.
• Impaired immune response: High blood sugar levels can weaken the immune system, making it more difficult for the body to fight off infections. This increases the risk of foot ulcers becoming infected and delays healing.

What Are the Signs and Symptoms of Foot Ulcers in Diabetic Patients?

Recognising the diabetic foot ulcer symptoms is crucial for early detection and treatment. However, due to nerve damage, some people with diabetes may not experience pain or discomfort from foot ulcers. Here are some signs to watch for:

• Open sores or wounds on the foot, particularly on the bottom or sides of the foot
• Drainage from the wound, which may be clear, yellowish, or bloody
• Skin discolouration, such as redness or blackened areas
• Swelling or inflammation around the wound
• Unusual odours coming from the wound or foot
• Visible lumps or deformities on the foot

How Can Diabetics Prevent Foot Ulcers?

Diabetic foot ulcer prevention involves a combination of good diabetes management, proper foot care, and regular check-ups with your healthcare team. Here are some key strategies for diabetic foot ulcer prevention:

• Manage your blood sugar levels: Keeping your blood sugar levels within the target range can help prevent nerve damage and improve circulation in your feet.
• Practice good foot hygiene: Wash your feet daily with warm water and mild soap, dry them thoroughly, and apply a moisturiser.
• Wear appropriate footwear: Choose well-fitting, comfortable shoes that provide adequate support and cushioning.
• Inspect your feet daily: Check your feet every day for cuts, blisters, redness, swelling, or any other signs of injury or infection. Use a mirror to examine the bottom of your feet if needed.
• Don't go barefoot: Always wear shoes or slippers, even indoors, to protect your feet from injury.
• Trim your toenails carefully: Cut your toenails straight across and file any sharp edges to prevent ingrown nails and injury.
• Maintain a healthy lifestyle: Exercise regularly, eat a balanced diet, and don't smoke. These habits can help improve circulation, manage blood sugar levels, and promote overall foot health.

How Are Foot Ulcers in Diabetics Treated?

Diabetic foot ulcer treatment focuses on promoting healing, preventing infection, and reducing the risk of complications. The specific treatment plan will depend on the severity and location of the ulcer, as well as the presence of any infection. Common diabetic foot ulcer treatment approaches include:

• Wound care
• Offloading
• Antibiotics
• Debridement
• Tight blood sugar control

What Are the Complications of Untreated Foot Ulcers in Diabetics?

Untreated diabetic foot ulcers can lead to serious complications that can have a significant impact on your health and quality of life. These complications include:

• Infection: Foot ulcers can become infected with bacteria, which can spread to the surrounding tissue and even the bone (osteomyelitis). Severe infections may require intravenous antibiotics or surgical intervention.
• Gangrene: In some cases, poor circulation and infection can cause the tissue around the ulcer to die, leading to gangrene. This serious condition may require amputation of the affected area to prevent the spread of infection.
• Charcot foot: Neuropathy can cause the bones in the foot to weaken and collapse, leading to a condition called Charcot foot. This can cause significant deformity and increase the risk of ulceration and amputation.
• Amputation: In severe cases, untreated foot ulcers cause the need for amputation of the toe, foot, or lower leg.

When Should Diabetics Seek Medical Attention for Foot Ulcers?

If you have diabetes, it's essential to seek medical attention as soon as you notice any signs of a foot ulcer or injury. Don't wait for the problem to resolve on its own, as this can lead to serious complications.

What Lifestyle Changes Can Help Diabetics Improve Foot Health?

In addition to proper foot care and regular check-ups with your healthcare team, making certain lifestyle changes can help improve your overall foot health and reduce the risk of developing foot ulcers.

FAQs

Can foot ulcers heal without medical treatment?

While some minor foot ulcers may heal on their own with proper home care, it's essential to seek medical attention for any open wound on your foot if you have diabetes. Delaying treatment can lead to serious complications, such as infection or amputation.

What are the best shoes for people with diabetic foot ulcers?

The best shoes for people with diabetic foot ulcers are those that provide adequate support, cushioning, and space for the toes. Look for shoes with a wide toe box, a firm heel counter, and a flexible sole. Custom-made orthotics or inserts can be suggested to redistribute pressure and promote healing.

How long does it take for a foot ulcer to heal?

The healing time for a diabetic foot ulcer varies depending on the size, depth, and location of the wound, as well as the presence of any infection or other complications. With proper treatment and care, most foot ulcers heal within several weeks to a few months. However, some ulcers may take longer or require additional interventions, such as surgery.

Can foot ulcers lead to amputation?

Yes, if untreated. That's why prompt medical attention and diabetic ulcer treatment are so vital.

When to see a doctor?

Inspect your feet daily and consult your doctor immediately about any skin breaks, discolouration, swelling, odour, or discharge. With diabetic foot ulcers, delaying care is very risky.

Can I continue exercising with a foot ulcer?

Follow your doctor's advice. Non-weightbearing exercises may be permitted, but avoid putting pressure on the ulcer.

Conclusion

Living with diabetes requires special attention to foot health. By understanding diabetic foot ulcer symptoms, causes, treatment, and prevention, you can act quickly to stop problems before they start.

If you need help managing your diabetic foot health, Metropolis Healthcare offers advanced diabetic panels and other pathology tests with the convenience of at-home sample collection. Our team of expert phlebotomists, stringent quality protocols, and user-friendly digital reports empower you to take control of your health.