Diabetic Lower Extremity Wounds (Foot Wounds)

There is one diabetic related amputation performed every 20 seconds with over 2,500 limbs being lost per day due to infection and a poorly controlled disease process.¹ 25% of those with diabetes will have a lifetime risk of developing a lower extremity wound with more than 50% of those becoming infected requiring hospitalization.² Once an individual has had a lower extremity wound they carry a 68% risk of reamputation over 5 years unless one changes their habits and life styles.³ All of this can be prevented with a team approach towards care and a focus on prevention.⁴

A diabetic foot ulcer is an open sore or wound that is commonly located on the bottom of the foot. Diabetes is currently the leading cause of all non-traumatic lower extremity amputations in the United States.

Anyone who has diabetes can develop a foot ulcer. Those who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, heart and circulatory disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers and subsequent amputations. Other causes include:

• Lack of sensation to the foot
• Poor circulation
• Foot deformities
• Irritation from shoes (such as friction or pressure)
• Trauma
• Neuropathy (loss of sensation leading to a reduced or complete lack of ability to feel pain in the feet due to nerve damage)
• Vascular disease

Many who develop foot ulcers have lost the ability to feel pain. Pain is not a symptom of a foot ulcer and often the first sign many notice is drainage on their socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

The best way to treat a diabetic foot wound is to prevent it from developing. Recommended guidelines include seeing a podiatrist on a regular basis. Your podiatrist can determine if you are at high risk of developing a foot ulcer and can implement a strategy for prevention. However, if an ulcer is noticed, seek medical care immediately. Foot ulcers in patients with diabetes should be treated urgently and aggressively to reduce the risk of infection and amputation, improve function and quality of life and reduce health-care costs. If you suspect you have an ulcer, in addition to seeking medical care:

• Keep blood sugar levels under control
• Keep wound site clean
• Apply the appropriate wound dressing or bandage as instructed by your physician
• Avoid walking barefoot

The primary goal in diabetic foot ulcer treatment is healing the wound as soon as possible. The faster the healing, the less chance exists for infection and amputation. There are several key factors in the appropriate treatment of a diabetic foot ulcer:

• Removing dead skin and tissue, called “debridement”
• Applying medications and/or dressings to the ulcer
• Prevention of infection
• Removing the pressure off the area, called “off-loading”
• You may be asked to wear special footgear such as a brace, castings, etc.
• Managing blood sugar levels and other health problems
• Adequate circulation

Not all ulcers are considered infected; however, if your physician diagnoses an infection, a diabetic foot ulcer treatment program of antibiotics, wound care, and possibly hospitalization may be required.

Surgical Treatment Options

A majority of non-infected foot ulcers are treated without surgery; however, if this treatment fails, surgical management may be appropriate. Surgical options may include:

• Shaving or the removal of the bone(s)
• Surgical care to correct various deformities such as hammertoes, bunions or bony “bumps”

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day—especially the bottom and between the toes—for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality.

Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatric physician as soon as possible; no matter how simple they may seem to you.

Learn More

A podiatrist is routinely seeing patients at the Memorial Hermann-Texas Medical Center Wound Care Clinic. For more information regarding diabetic foot wounds or to schedule an appointment, call (713) 704-5900.

1. Wild S, Roglic G, Sicree, King. Global Prevalence of Diabetes - Estimates from the year 200 and projections for 2030. Diabetes Care 2004 May; 27(5)1047-1053.
2. Bharara M, Mills JL, Suresh K, Rilo HL, Armstrong DG. Diabetes and landmine-related amputations: a call to arms to save limbs. Int Wound J. 2009;6(1):2-3.
3. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers inpatients with diabetes. JAMA 2005;293:217–28.
4. Armstrong DG WJ, Robbins JM. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007(4):286-287.