Poorly controlled diabetes can result in acute and chronic foot ulcers. They form as a result of the skin tissue breaking down, thereby exposing the layers underneath. Diabetic foot ulcers are most common under the balls of your feet and under your big toes. Not only this, they can affect your feet down to the bones.
One of the first signs of a diabetic foot ulcer is drainage from your foot. This typically stains your socks and leaks out of your shoes. Other symptoms of a diabetic foot ulcer are irritation, redness, unusual swelling, and odours from one or both feet. The most visible sign of a diabetic foot ulcer is black tissue (called eschar), surrounding the ulcer.
Causes of Diabetic Foot Ulcers
Diabetic foot ulcers can be caused by various reasons. In this article, we’ll talk about the top 5 causes of a diabetic foot ulcer…
- High Blood Sugar Levels: Diabetes causes elevated levels of glucose in the blood and is a metabolic disease. Elevated blood glucose levels narrow the body’s blood vessels and stiffen its arteries. This restricts the delivery of blood and oxygen to the tissues. This, in turn, prevents the body’s natural healing abilities to work effectively.
- Poor Circulation: If you have diabetes, you are at risk to develop peripheral arterial disease (PAD), which restricts blood flow to the feet and legs. PAD is especially difficult for those with chronic wounds, like diabetic foot ulcers. This is because it can seriously interfere with the body’s ability to heal itself. If left untreated, PAD can result in amputation of the affected limb.
- Nerve Damage: Uncontrolled blood sugar levels can result in nerve damage in people with diabetes. Diabetic neuropathies are a form of nerve disease that cause a loss of sensation, including the ability to feel pain. For those who have nerve damage, a small cut, blister, or surgical wound can result in infection and a diabetic foot ulcer.
- Issues with your Immune System: Diabetes can slow down your immune system, which inhibits the body’s ability to clear away dead and damaged tissue. It also prevents the body from building new skin cells, once a wound or injury has occurred. This can negatively affect the body’s ability to send white blood cells to fight bacteria in an infected diabetic foot ulcer.
- Infection: Diabetics are more susceptible to infection, as they have weaker immune systems. In diabetics, it is common for a wound to develop an infection like a non-healing or infected diabetic foot ulcer.
Types of Diabetic Foot Ulcers
There are different types of diabetic foot ulcers. Some of them are:
- Neuropathic ulcers: These occur when there is peripheral diabetic neuropathy, but there is no ischemia, caused by peripheral artery disease.
- Ischemic ulcers: These occur when there is peripheral artery disease present, but without the involvement of diabetic peripheral neuropathy.
- Neuroischemic ulcers: These occur when the person has both peripheral neuropathy, as well as ischemia resulting from peripheral artery disease.
Signs and Symptoms of Diabetic Foot Ulcers
Diabetic Foot Ulcers present with different signs and symptoms. Some of the diabetic foot ulcer symptoms are:
- Changes in skin colour
- Changes in skin temperature
- Swelling in the foot or ankle
- Pain in the legs
- Open sores on the feet that are draining and slow to heal
- Ingrown toenails or toenails affected with fungus
- Corns or calluses
- Dry cracks in the skin, especially around the heel or other areas of the feet
- Foot odour that is unusual or that will not go away
All of these signs and symptoms may not be present all at once, depending on the severity of the condition.
Complications of Diabetic Foot Ulcers
Certain complications can arise due to diabetic foot ulcers. Some of them are:
- Skin and bone infections: A small cut or wound can lead to infection and to a diabetic foot ulcer. This is due to nerve and blood vessel damage and immune system problems. Most infections happen in ulcers previously treated with antibiotics. While infected diabetic foot ulcers can be treated with antibiotics, severe cases may require treatment in a hospital.
- Abscess: Sometimes the diabetic foot ulcer can eat into tissues and bones, resulting in a pocket of pus, called an abscess. The common treatment is to drain the abscess. However, this may require removal of some bone or tissue, though newer methods like oxygen therapy are less invasive.
- Gangrene: Diabetes affects the blood vessels of your fingers and toes. When blood flow is cut off, the tissue can die. The treatment for gangrene is oxygen therapy, or then, surgery to remove the affected area.
- Deformities: The muscles in your feet can be weakened by nerve damage and can lead to problems, such as claw feet, hammertoes, or pes cavus. The latter is a high arch that will not flatten even when you put weight on it.
- Charcot foot: Diabetic foot ulcers can weaken the bones in your feet so much so that they can break. Nerve damage can also weaken sensation so much that you do not realize it. You will keep walking on broken bones and your feet may change shape due to this.
- Amputation: Problems with blood flow and nerves make it more likely for someone with diabetes to get a foot injury and not even realize it till infection and a diabetic foot ulcer set in. If the infection cannot be healed, if it leads to an abscess, or if it leads to gangrene, then amputation is often the best treatment.
Treatment of a diabetic foot ulcer requires great precision and expertise. Each patient is different and presents with different signs and symptoms. It is imperative that your vascular surgeon be highly skilled in diabetic foot ulcer treatment.
Dr. Abhilash Sandhyala, of the Flow Vascular Clinic, is one such vascular surgeon. He will take your detailed history and present signs and symptoms to chart out a treatment plan for your diabetic foot ulcer that is right just for you. He will understand what you are going through and will treat you in a holistic and empathetic way.
If you have any of the complications due to a diabetic foot ulcer, he will not only treat those complications, but will also treat the underlying cause. So, if you have a diabetic foot ulcer, do not hesitate, because prompt treatment is key to resolving your ulcer and preventing further complications. Do connect with Dr. Abhilash Sandhyala immediately, and rest easy, knowing you are in the best hands!
For more information about the treatment for Diabetic Foot Ulcers, as well as the treatment for DVT, or other vascular conditions, contact Dr. Abhilash Sandhyala at (+91) 9989649498 or 9959033037, or at [email protected] or visit our website at www.drabhilash.com
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Dr. Abhilash Sandhyala · Flow Vascular Clinic, Kukatpally, Hyderabad