Diabetic foot ulcers (DFU’s). This is an issue that’s very near and dear to our hearts here at Sole Motion Podiatry, as every week we see first-hand the effects that ulcers have on the lives, mobility and well-being of those affected. Moreover, in 85% cases, diabetic foot ulcers are completely preventable, yet they currently remain the leading cause of lower limb amputation in Australia aside from traumatic injuries. Specifically, there are 10,000 hospital admissions and 4,400 amputations every year in Australia as a result of DFU’s – the second-highest rate in the developed world.
Given the significance of diabetic foot ulcers, today we’re sharing all about why they occur and how to prevent either another – or your first – diabetic foot ulcer. Our hope is that this information can help improve lives and ease the impact on the families of those affected. We’ve linked numerous studies and resources for you to continue learning if you like, but if you have any questions – please reach out.
We’re starting with an overview of DFU’s because one thing that has become evident both in our discussions with new patients and in the research conducted around the topic, is that ulcer care, prevention and the why behind it all, is poorly understood by many – and this knowledge is power.
A foot ulcer is an open sore on your foot. They range in size, both in terms of how wide they are and how deep into the foot they go. When you have diabetes, your risk of developing a DFU skyrockets because of the way that diabetes affects both your sensation and your circulation.
Your sensation – better described as your ability to feel what is happening to and around your feet – is compromised because of the way that diabetes affects your nerves. This results in a problem called diabetic neuropathy, which affects up to 50% of patients with type 1 and type 2 diabetes.
As you lose your ability to detect the sensations around your feet, you may miss the occurrence or development of wounds – even small ones like cuts, scratches or blisters. When a wound is undetected, it is left untreated and not cared for appropriately. This leaves it vulnerable to getting worse, increasing in size, becoming infected and ulcerating.
Your circulation, that is, your blood flow, is also impaired in diabetes due to the effect that diabetes has on your blood vessels. When your blood flow to your feet is compromised, you get less oxygen, nutrients and reparative cells to the area. This means that your wounds take longer to heal – and the longer they’re ‘open’, the longer they’re vulnerable to infection. Don’t forget – down by your feet isn’t the most hygienic or sanitary place, either!
If you do develop an infection, your compromised circulation means that your ability to fight the infection is also impaired, leaving you more vulnerable to ulceration.
Now that we’ve understood why you’re at a much higher risk, let’s talk about how to prevent an ulcer from developing. Here are a number of proven methods to help reduce your DFU risk – and like you may have guessed, it all starts with an appointment with your podiatrist.
Knowing your risk means attending your comprehensive foot exam every year – as well as the other appointments in between with your GP or diabetes specialist. Your foot exam is performed by us – your podiatrist. Here, we observe and document the characteristics and features of your feet, any notable changes since last years’ visit, palpate your pulses to check blood flow, and perform neurological (sensory) testing to determine the level of sensation present in multiple areas around your feet. This can include monofilament testing, vibration sensation, hot/cold and sharp/blunt testing, reflex testing and other tests.
Just like reading this counts as education, make sure that you don’t just listen but understand exactly what is happening to your feet, what your risks are and why. When you understand what is happening, you can make the best, informed choices for your foot health. So ask questions – to us, your doctors and other members of your care team (see below).
A care team is a group of health professionals that focus on different areas of diabetic health to help you best manage your diabetes. Your care team may involve a diabetes nurse or educator, a nutritionist, your GP, a physio or occupational therapist and your podiatrist – to name a few.
Having a podiatrist on your care team is essential. Aside from risk assessment and education, we also care for your skin and toenails so that you don’t have to worry about trimming your nails and removing callus, for example, yourself. By having a professional care for these elements, you reduce your risk of accidental injury to your feet – and therefore help reduce your ulcer risk.
There’s a big difference between shoes designed for style that may have all sorts of seams, stitches and rough edges on the inside of the shoes – and those that are made to help reduce the risk of any rubbing, pressure and damage that may place someone vulnerable to DFU’s at a higher risk. This is what therapeutic footwear can offer.
We recommend wearing enclosed shoes both inside and outside of the home to best protect your feet from unnoticed damage – even if it’s just an enclosed and hard-soled slipper inside the house.
Orthotics can help off-load high pressure (and therefore high-risk) areas on the bottom of the feet, especially where there are prominent bones, bunions. The need and benefit of orthotics will be assessed on a case-by-case basis by your podiatrist and should not be a one-size-fits-all approach.
Wear a pair of clean socks daily, and avoid wearing tight socks with restrictive seams4.
Checking your feet on a daily basis can be a lifesaver – literally. If you can’t see the bottoms of your feet, hold them up to a mirror. Look for any cuts or wounds you haven’t noticed before, redness, swelling, maceration between the toes, discolouration, signs of infection, and anything that seems out of the ordinary.
Ensure you dry your feet well after every shower or swim – this can help prevent the breakdown of the skin. Try to wash your feet in temperatures of below 37 degrees – and get a feel for the temperature using your elbow. This can help prevent accidental burns. Avoid exposing your feet to direct sources of extreme heat or cold. This includes hot water bottles directly on the skin, heating pads, and keeping your feet too close to heaters or open fires4.
When an infection is present, our temperature rises – either throughout our whole body if it’s a systemic infection, or in the affected area if the infection is localised. Studies have shown that having those with a high-risk of lower limb complications (like ulcers) use a skin thermometer to measure the temperature at multiple sites on the feet is a simple and effective way to detect early warning signs to raise with their doctor or podiatrist.
Don’t forget to stay away from any medicated corn/callus pads – these can be harmful to the surrounding skin and we’ve seen them start too many ulcers in our line of work.
Due to the multifaceted and systemic nature of diabetes, staying mindful and in control of your overall health, and making healthy choices, can help improve your prognosis. This includes ceasing smoking, exercising regularly, monitoring your blood glucose and managing it as best possible, controlling blood pressure and cholesterol4, and very importantly – alerting your care team if anything that doesn’t seem right or you’re struggling to stay in control.
We love helping our patients get the best outcomes for their foot health – especially when the potential problems are largely preventable! If you have been diagnosed with diabetes – whether it’s been months or decades – give our experienced podiatry team a call us on 1300-FX-FEET or book your appointment online click here.