Diabetic Foot Doctor for Diabetic Foot Ulcer
A diabetic foot ulcer is an open wound commonly located at the base of the foot, caused by areas of pressure. Diabetic foot ulcers affect approximately 15 percent of patients with diabetes. People with diabetes are often affected by foot ulcers if they have neuropathy, or nerve pain.
Diabetic Foot Ulcer Causes in Plano, Dallas, Prosper & Allen, TX
Foot ulcers form when skin tissue breaks down and causes exposure of subcutaneous tissue, tendon, muscle and bone. If it is not treated quickly, it can get infected and even lead to lower-extremity amputation. Most patients with diabetes tend to develop foot ulcers. There are several factors that could lead to a diabetic foot ulcer.
Poor circulation from vascular disease leads to inefficient blood flow to the feet. It can also lead to foot ulcers and difficulty healing. Diabetic patients can develop neuropathy after many years. Neuropathy is an inability to feel foot pain due to nerve damage, which is caused by increased blood sugar levels. This can also lead to a diabetic foot ulcer. High glucose levels can slow down the healing process, which could lead to infection. Other causes of foot ulcers include:
- Foot deformities
- Irritation and friction
- Ill-fitting shoes
- Charcot arthropathy
The best-known risk factors include diabetic neuropathy, foot deformities and peripheral arterial disease. A cautious physical examination, followed by monofilament testing for neuropathy and non-invasive testing for blood vessel inadequacy, helps a diabetic foot doctor identify patients susceptible to foot ulcers, and who already have ulcers or other foot problems.
Proper education regarding foot hygiene, nail care, diabetic foot care and diabetic shoes are significant to reduce the risk of sustaining an injury that could lead to the formation of foot ulcers. Foot ulcerations can cause soft tissue infection or bone infection which can lead to amputation. The risk of lower extremity amputations is 15 to 46 times higher in diabetic patients than in people who don’t have diabetes mellitus. The risk factors of diabetic foot ulcers include:
- Race – Native Americans, African Americans and Hispanics
- Age – Older adults, especially older men
- Obesity – Individuals who are overweight
- Excessive alcohol – Individuals who drink excessively over long periods of time
- Smoking – Smokers have a higher risk of developing foot ulcers
- People who use insulin frequently
- Patients with diabetes-related kidney issues
- Patients with heart disease
- Wearing poorly fitted shoes
- Improper trimming and care of toenails
- Patients with diabetic eye disease (diabetic retinopathy)
Diabetic foot ulcer symptoms
The signs of diabetic foot ulcers are not always obvious, especially in the early stages. You may not see any signs until the ulcer has become infected. You may not feel any pain due to nerve damage and this will prevent you from knowing that you have foot ulcers. However, you need to be very observant and take notice of every little change that takes place on your foot.
Symptoms of diabetic foot ulcers include:
- Skin discoloration around the affected area (increased redness)
- Loss of sensation or numbness
- Unusual swelling and warmth around the affected area
- Dry and thickened skin around the wound
- Black tissue surrounding the ulcer
- Gangrene (tissue death due to infections)
- Foot pain
- Drainage coming from the wound
- Bad odors from the wound
- Skin cracking
- Bleeding from the wound
- Advanced stages lead to fever
Diagnosing diabetic foot ulcers
When diagnosing a diabetic foot ulcer, your foot doctor will conduct a thorough physical examination of your foot to evaluate for any signs of pre-ulcerative lesions, circulation issues, or nerve damage. Your foot doctor will ask you some health-related questions such as the type of shoes you normally wear and how you keep your feet clean and healthy.
You may be asked to stand and walk so we can assess the weight of your body and the pressure on your feet. If you limp, this may indicate structural damage. Further imaging and diagnostic testing may be required to evaluate the extent of wound/bone infection. You may undergo tests that include:
Blood tests – A blood test allows your diabetic foot doctor to screen for infections. If the ulcer is reddish in color, swollen or you feel warm around the area, a blood test may also be conducted.
MRI scans – MRI scans are done so that your doctor can know the extent of damage caused by the ulcer. It shows the bones and reveals any inflammations that may have occurred.
X-rays – You may undergo an X-ray so that your doctor can examine the internal bones and tendons for any infection or damages. Changes in the alignment of bones, loss of bone mass, weakened bones and fractures may occur. Early detections of any of these conditions help to prevent a worse case of amputations.
CT Scan – You may also undergo a CT scan to check and examine internal organs and bones.
Bacterial cultures – Your foot doctor may take a sample of the ulcer with a cotton bud or any other thin medical instruments to check for bacteria.
Treating diabetic foot ulcer
Diabetic foot ulcers should be treated at an early stage to prevent the ulcer from getting infected and progressing. The key factors for appropriate treatment of diabetic foot ulcer are:
- Managing blood glucose and other related health problems – Keep your blood glucose under control and ensure that you treat every health condition as early as possible.
- Preventing the ulcer from getting infected – You can keep it from getting infected by keeping the wound clean and keeping the ulcer dry with frequent dressing changes.
- Taking pressure off the area (off-loading) – Take pressure off your feet by sitting or lying down. Off-loading pressure helps to lessen the stress exerted on the affected foot. Excessive pressure can make the ulcer expand and lead to infection. Individuals that are overweight are advised to take necessary measures to lose excess weight. Also, do not stand on your feet for a long period of time. Do not walk bare feet because this can cause pressure areas to form and lead to breakdown in the skin.
- Removing dead skin and tissue (debridement) – Debridement is the removal of dead skin tissue from the surface of the wound. Removing the dead skin and other foreign substances helps to prevent infection and allows for a faster healing process.
- Applying medication and dressing the ulcer – After the dead skin tissue is removed, the wound will be cleaned, and the necessary medications will be applied before it’s dressed and bandaged. You may be given antibiotics, anti-platelets, or anti-clotting medications to prevent infection and facilitate the healing process. You may also be prescribed over-the-counter medications and creams such as silver sulfadiazine cream, polyhexamethylene biguanide gel or solutions, iodine and medical-grade honey in ointment or gel form.
- Surgery – Surgery is the last resort when all other conservative treatment methods have failed. Your foot surgeon may perform surgical procedures to alleviate pressure from the affected area like removing foot deformities such as hammertoe, bunion, or a bump on side of foot. In extreme cases where the ulcer has gotten infected and refused to heal, your podiatrist may suggest amputation to prevent the infection from spreading to other parts of the body.
Do you have a diabetic foot ulcer? Schedule an appointment with Graff Foot Ankle and Wound Care today. Call (972) 403-7733 or use our convenient Request an Appointment form to schedule your visit.