A diabetic foot ulcer is an open sore or wound commonly found on the bottom of the foot. Diabetes is the leading cause of nonaccidental leg and foot amputations in the US. According to the American Podiatric Medical Association, about 14-24% of diabetics who develop a foot ulcer will eventually need amputation.
Ulcers can form due to many factors including a lack of feeling in the foot, poor circulation, foot deformities, irritation, and trauma. Anyone that has diabetes can develop a foot ulcer. People who use insulin are more likely to develop an ulcer, along with people that have diabetes-related kidney, eye, and heart disease. Being overweight, using alcohol and tobacco also increase the risk of developing a foot ulcer. The most common factors to developing a foot ulcer are neuropathy and vascular disease. Neuropathy is a reduced or complete lack of ability to feel pain in the feet due to nerve damage. In those with diabetes, this is most commonly caused by elevated blood glucose levels over time and can occur without pain or one being aware of the problem. Vascular disease can complicate an ulcer by reducing the body's ability to heal and increase the risk of infection. Again, high blood glucose can reduce the body's ability to prevent infection and slow healing.
The primary goal in treating a foot ulcer is to obtain healing as soon as possible to prevent an infection. A podiatric physician is specially trained in ulcer treatment and should be visited immediately after an ulcer is noticed. In treating an ulcer a podiatrist will normally work to prevent infection, remove pressure from the area (called off-loading), remove dead skin and tissue (called debridement), use a medication or dressing to the ulcer, and manage blood glucose or other health problems. Keeping the ulcer from becoming infected is of extreme importance. This can be done by keeping blood glucose levels under tight control, keeping the ulcer clean and bandaged, washing the ulcer daily, and wearing appropriate shoes. Most of the wounds that are not infected can be treated without surgery, however if all treatment fails surgery might be needed.