Diabetic foot ulcers (or DFUs) are complex, chronic wounds which can have a major long-term impact on the morbidity, mortality, and quality of life for a diabetic individual. People who develop diabetic foot ulcers are at greater risk of dangerous complications than those without a history of diabetic foot ulcers, so it is a must for sufferers of diabetes and medical staff to be aware of the risks, in order to avoid and prevent their development in the first place.
As with normal ulcers, gangrene from untreated diabetic foot ulcers and foot wounds can lead to an amputation being needed. This is the worst-case scenario and, naturally, the last resort. Nevertheless, it is life-threatening and often terrifying for the individual. Gangrene occurs when the foot wound becomes infected, causing sepsis or even infection of the bone (osteomyelitis) which can spread to other parts of the body from the foot. In order to save the individual, the dangerous tissue needs to be removed.
According to a study by Hinchcliffe et. al in 2012, a lower limb needs to be amputated due to complications arising from diabetes at an estimate of every 20 seconds. Diabetic foot wounds, unfortunately, are relatively common and are often a major economic and social impact on sufferers of diabetes and their families. Around 25% of people with diabetics will develop a diabetic foot ulcer during their lifetime (Singh et. al, 2005).
Unlike other chronic wounds, the development and progression of diabetic foot ulcers are often complicated by wide-ranging diabetic changes, such as:
As seen below, a foot with nerve damage will often have a high arch, and possibly toe deformities such as claw, hammer or mallet toes, and crossing toes. The muscle may also be atrophied around the arch due to disuse. Sufferers may also have an irregular gait, for instance, foot slapping, knock knees or duck walking. They may also have bunions or arthritis or hard skin on the foot as well, which can worsen ulcers and cause bleeding, buildup of scar tissue and fibrosis.
Successful diagnosis and treatment of patients with diabetic foot ulcers involves a holistic approach that includes controlling the diabetes, effective wound care, infection control, pressure relieving strategies and restoring blood flow to the lower limbs. A qualified podiatrist can help to formulate a treatment and care plan for you, and have a pressure scan (as seen below) taken to highlight abnormal areas of plantar pressure.
This scan is then used to gather data on the areas where an individual is at high risk of tissue breakdown or ulcer development. Much more advanced than the scans which can be done at health shoe shops, medical grade scans offer advanced sensors which can detect even the smallest amount of pressure deviations. This process can be made even more accurate by incorporating video analysis.
A podiatrist can also prescribe a weight offloading device known as an orthotic, which the patient can wear in their shoes. They are comfortable devices which can be worn daily and are similar to insoles, which help as a proactive step towards keeping their foot healthy and safe from dangerous diabetic foot ulcers. It is important to note here that ready-made orthotics available commercially can be very dangerous and may worsen the problem, however, because every patient’s circumstances are different. Custom orthotics, while more pricey, are tailored specially to the patient and their foot shape.
Family Podiatry Centre is a leader in custom-made orthotics made using CAD/CAM technology, making us the best choice for such devices. However, even if you would like not to opt for them at this juncture, it is important to consult a podiatrist on how to manage the risks of diabetic foot ulcers if you suffer from diabetes.