Understanding Diabetic Foot Ulcers

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).

Diabetic foot ulcers are painful and potentially extremely dangerous | Family Podiatry Centre | Best Foot Doctor Podiatrist DPM Clinic Singapore Malaysia

What causes Diabetic Foot Ulcers?

Unlike other chronic wounds, the development and progression of diabetic foot ulcers are often complicated by wide-ranging diabetic changes, such as:

  • Nerve damage
    • Diabetic individuals may end up walking on vulnerable areas until a wound arises without their knowledge
  • Reduced circulation
    • Diabetics have more delicate bodies due to poor blood circulation, which also inhibits healing.
    • Even minor trauma to fragile areas can cause an ulcer to develop, which can be due to poorly fitted footwear or walking barefoot on rough ground
    • Some individuals may not even be able to sit cross-legged, as the position may cause injury to the skin at the ankle or the top of the foot.
  • Abnormal amounts of pressure being placed on the bottom of the foot due to limited joint mobility and foot deformities

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. 

There are multiple points at which diabetic foot ulcers can form due to excessive pressure | Family Podiatry Centre | Best Foot Doctor Podiatrist DPM Clinic Singapore Malaysia

Best Diabetic Ulcer Treatment

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. 

Foot scans are essential for those suffering from diabetic foot ulcers | Family Podiatry Centre | Best Foot Doctor Podiatrist DPM Clinic Singapore Malaysia

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.

Written by Kardem Kiter
Written by Kardem Kiter

Based in Singapore, Degree in Podiatric Medicine from the University of Johannesburg. Published in The Foot and member of The Golden Key Honour Society.

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