Diabetes Foot Ulcer: Causes, Symptoms, Treatment

Ulcers, usually, are open sores or wounds at the skin’s surface which do not heal quickly or easily as a normal wound should. Instead, they take a lot of time and the healing process is slow and painful. Mostly, ulcers happen on feet and hands, but they can even affect other areas such as the folds of the stomach. A diabetes foot ulcer is a condition that stems from high blood sugar.

While one may argue that ulcers are a minor issue, especially in front of the main condition, i.e. diabetes, we beg to differ. Ulcers, if left untreated or unprotected, can get infected and turn into gangrene, i.e. the condition when the skin tissue dies. Often, gangrene leads to the need for amputation of the infected part of the body. Thus, it is important to take diabetes foot ulcer seriously.

Diabetes foot ulcer arises because the patient’s odds of getting ulcers shoots up with the blood sugar. The high blood sugar or glucose levels damage blood vessels and this makes the healing process slow. Further, in diabetes the nerves that generate sensation of pain are damaged. The damaged nerves prevent a person from feeling the existence of small wounds, and as a result, they turn into more serious ulcers. Diabetes foot ulcers happen due to decreased sensation and slowing down of the healing process mostly in the feet.

Diabetes foot ulcers may look like a small issue but can turn into a sinister one. Hence, it is important to identify and treat them at the right time.

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Some of the common early symptoms of diabetes foot ulcer that you may notice are unusual swelling and redness.

One defining trait of an ulcer, which differentiates it from other forms of skin conditions or wounds, is the presence of a black tissue around it. This black tissue is known as eschar. The reason one gets eschars is due to lack of healthy blood flow around the affected skin. There can even be a painful discharge and resultant numbness in the area with a diabetes foot ulcer. This can further develop into gangrene.

That being said, it is not necessary that every time an ulcer can be identified. There are times when it can only be diagnosed after it becomes infected. The only way to prevent such a situation is to constantly be on the alert for anything unusual that you notice on your feet skin. This includes any unusual pain or discolouration that you notice.

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Following are the causes of diabetes foot ulcer:

• High blood sugar or glucose level results in slowing down of the healing process of the body. Thus, ulcers occur.
• Another major cause of ulcers can be nerve damage which can lead to loss of feeling. Loss of sensitivity leads to complicated ulcers.
• People with high blood sugar also suffer from poor blood circulation. When blood does not flow well to the feet, it does not allow the ulcers to heal.
• Dry skin can also be a cause for ulcers. If your feet crack often and corns and callouses are a norm, ulcers may happen quite frequently too.

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There are multiple everyday risk factors that can cause diabetes foot ulcer. Some are a part of a normal routine, so much so that you won’t even notice the fact that it is something that can lead to serious ulcers and infections. Following are the risk factors for diabetes foot ulcer that you need to look out for:

• Uncontrolled blood sugar
• Heart and kidney diseases
• Obesity due to lack of workout and healthy movement
• Poor feet hygiene
• Wearing shoes that don’t fit well
• Excessive tobacco intake
• Alcohol consumption
• Keeping long toenails and not trimming them properly

Keep watching out for all the aforementioned factors and avoid them as much as possible. These may increase the risk of foot ulcers.

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One way to self-diagnose diabetes foot ulcers is to conduct daily foot inspections. This is a simple procedure which involves a few steps:

Bonus tip: Use a mirror for better access to the inaccessible corners of your feet.

• Check your feet for any signs of redness or swelling.
• Inspect if there is any small cut anywhere on the feet.
• Don’t forget to check the bottom of your feet and also inspect between each toe.
• Keep your toenails short and straight, and do not touch any corn.
• Keep your feet dry while you are inspecting them for ulcers.
• Try to avoid walking barefoot.

In case you observe anything out of the ordinary, any bump or cut which should otherwise not be there and which you are not able to feel much, contact your doctor immediately.

In most of the cases, the doctors will identify either of the three situations:

• Ulcer but no infection
• A deep ulcer that exposes the tendons and joints
• Ultra-deep and extensive ulcers that are infected

The doctor may also rule out ulcers and diagnose some other form of infection. After diagnosis, treatment would be recommended depending on the condition of the diabetes foot ulcer.

Most of the times, depending on the severity of the infection, the doctor prescribes certain antibiotics or even anti-clotting medicines. Apart from that, diabetic shoes, foot braces, compression wraps, shoe inserts, casts, etc. can also be recommended.

Typically, a doctor can remove the ulcers physically by clearing the dead skin or foreign objects that may have caused the ulcer to fester in the first place. In case the doctor suspects a more serious infection, an X-ray can be taken to rule out the possibility of a bone infection.

Some common recommendations to be implemented at home on the recommendation of the doctor are:

• Calcium alginates dressings that curb the growth of bacteria
• Footbaths
• Frequent dressing changes to keep the ulcer dry
• Skin disinfection around the ulcer
• Enzyme treatments

However, before any prescription, the doctor obviously asks for the patient’s medical history.

Some over-the-counter treatments are available for diabetes foot ulcers too in the form of polyhexamethylene biguanide (PHMB) gel, silver sulphadiazine cream, and the likes.

The last treatment option is surgery, but that happens in severe cases where the ulcer has reached a stage wherein it needs to be physically removed so as to avoid amputation.

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A diabetes foot ulcer can be treated by bringing about certain lifestyle changes after consulting with the doctor and figuring out the intensity of the ulcer. Following are the most common recommendations:

• Firstly, keep your feet clean. Maintaining feet hygiene is the most basic thing that should be done to avoid ulcers.
• Keep your toenails trimmed or of decent length. Too short or too long toenails can lead to issues.
• Wear shoes of proper fitting.
• Keep changing your socks.
• Notify your doctor if you notice a callous and get it removed.
• Make sure you keep your feet clean, dry, and moisturised.

Most of these changes are easily manageable.

Home remedies for foot ulcers are also effective. However, try these remedies only after consulting with your doctor. Self treatment is not at all recommended.

Most of the ingredients of these home remedies are easily available:

• Aloevera
• Honey
• Tea tree oil
• Gotu kola
• Turmeric
• Apple cider vinegar
• Vaseline
• Chamomile

We reiterate, indulge in home treatment only after consulting your doctor.