Diabetic foot management -
These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process. The science of wound care has advanced significantly over the past ten years.
We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.
Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.
For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist may order evaluation test such as noninvasive studies and or consult a vascular surgeon. Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to accomplish this will enhance healing and reduce the risk of complications.
A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate. Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound.
Healing may occur within weeks or require several months. The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis.
He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention. Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer.
Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatric physician can provide guidance in selecting the proper shoes. Learning how to check your feet is crucial in noticing a potential problem as early as possible.
Inspect your feet every day—especially between the toes and the sole—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. Adapted from APMA. Updated visitor policies.
Other Michigan Medicine Sites About Michigan Medicine UofMHealth. org Medical School Nursing Find a Clinical Trial. Frequently Asked Questions: Diabetic Foot Ulcers. What Is a Diabetic Foot Ulcer? Deformities — The structure and appearance of the feet and foot joints can indicate diabetes-related complications.
Nerve damage can lead to joint and other foot deformities. The toes may have a peculiar "claw toe" appearance picture 2 , and the foot arch and other bones may appear collapsed. This destruction of the bones and joints is called "Charcot arthropathy" picture 3.
Signs of poor circulation — A weak pulse, cold feet, thin or blue skin, and lack of hair in the area suggest that your feet are not getting enough blood flow. There are several things you can do to reduce your chances of developing foot problems.
In addition to managing your blood sugar, practicing good foot care habits and checking your feet daily are important for preventing complications. Avoid activities that can injure the feet — Certain activities increase the risk of foot injury or burns and are not recommended.
These include walking barefoot since you could step on something without realizing it , using a heating pad or hot water bottle on your feet, and stepping into a hot bath before testing the temperature. Use care when trimming the nails — Trim your toenails straight across, and avoid cutting them down the sides or too short figure 1.
You can use a nail file to remove any sharp edges to prevent the toenail from digging into your skin. Never cut your cuticles or allow anyone else eg, a manicurist to do so. See a foot care provider such as a podiatrist if you need treatment of an ingrown toenail or callus.
Wash and check your feet daily — Use lukewarm water and mild soap to clean your feet. Thoroughly dry your feet, paying special attention to the spaces between the toes, by gently patting them with a clean, absorbent towel. Apply a moisturizing cream or lotion.
Check the entire surface of both feet for skin breaks, blisters, swelling, or redness, including between and underneath the toes where damage may not be easily visible. Do not pop blisters or otherwise break the skin on your feet.
Let your health care provider know right away if you notice any changes or problems. See 'Self-exams' above. Choose socks and shoes carefully — Wear cotton socks that fit well, and be sure to change your socks every day.
Select shoes that are snug but not tight, with a wide toe box figure 2 , and break new shoes in gradually to prevent any blisters. It may be helpful to rotate several different pairs of comfortable, well-fitting shoes to avoid consistent pressure on one part of your foot.
If you have foot deformities or ulcers, ask your foot care provider about customized shoes; this can reduce your chances of developing foot ulcers in the future. Shoe inserts may also help cushion your step and decrease pressure on the soles of your feet.
Be sure to get regular foot exams — Checking for foot-related complications should be a routine part of most medical visits; however, this is sometimes overlooked.
Don't hesitate to ask your provider for a foot check at least once a year, or more frequently if you have risk factors or notice any changes. See 'Clinical exams' above and 'Risk factors' above.
Quit smoking — Smoking can worsen heart and circulation problems and reduce circulation to the feet. If you smoke, quitting is one of the most important things you can do to improve your health and reduce your risk of complications. While this can be difficult, your health care provider can help you and provide other resources for support.
See "Patient education: Quitting smoking Beyond the Basics ". Importance of blood sugar management — In general, you can reduce your risk of all diabetes-related complications, including foot problems, by keeping your blood sugar levels as close to your target as possible.
Careful management of blood sugar levels can reduce the risk of circulation problems and nerve damage that often lead to foot complications. Managing your blood sugar requires seeing your doctor regularly, making healthy diet and lifestyle changes, and taking your medications as directed.
More information about managing your diabetes is available separately. See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics " and "Patient education: Type 2 diabetes: Treatment Beyond the Basics " and "Patient education: Glucose monitoring in diabetes Beyond the Basics " and "Patient education: Preventing complications from diabetes Beyond the Basics ".
TREATMENT OF FOOT ULCERS. Superficial ulcers — Superficial ulcers involve only the top layers of skin picture 1. Treatment usually includes cleaning the ulcer and removing dead skin and tissue by a health care provider; this is called "debridement.
After debridement, the area will be covered with a dressing to keep it clean and moist. If the foot is infected, you will get antibiotics. You should clean the ulcer and apply a clean dressing twice daily or as instructed by your foot care provider; you may need to have someone help you with this.
Keep weight off the affected foot as much as possible and elevate it when you are sitting or lying down. Depending on the location of the ulcer, you might also get a cast or other device to take pressure off the area when you walk.
Your health care provider should check your ulcer at least once per week to make sure that it is healing properly. More extensive ulcers — Ulcers that extend into the deeper layers of the foot, involving muscle and bone picture 4 , usually require treatment in the hospital.
Laboratory tests and X-rays may be done, and intravenous IV antibiotics are often given. In addition to debridement to remove dead skin and tissue, surgery may be necessary to remove infected bone.
You may also get something called "negative pressure wound therapy"; this involves covering the ulcer with a bandage and using a special vacuum device to help increase blood flow and speed healing.
If part of the toes or foot become severely damaged, causing areas of dead tissue gangrene , partial or complete amputation may be required.
Amputation is reserved for wounds that do not heal despite aggressive treatment, or times when health is threatened by the gangrene. Untreated gangrene can be life threatening. Some people with severe foot ulcers and peripheral vascular disease poor circulation may require a procedure to restore blood flow to the foot.
See "Patient education: Peripheral artery disease and claudication Beyond the Basics ". While foot problems in diabetes are common and can be serious, keep in mind that there are things you can do to help prevent them.
Quitting smoking, if you smoke, is one of the most important things you can do for your overall health and to prevent foot problems. In addition, while daily self-care can be challenging, managing your diabetes from day to day, including foot care, is the best way to reduce your risk of developing complications.
See 'Preventing foot problems in diabetes' above. Your health care provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.
Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.
These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Nerve damage caused by diabetes The Basics Patient education: The ABCs of diabetes The Basics Patient education: Gangrene The Basics Patient education: Diabetes and infections The Basics.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics Patient education: Type 2 diabetes: Overview Beyond the Basics Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics Patient education: Preventing complications from diabetes Beyond the Basics Patient education: Diabetic neuropathy Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Quitting smoking Beyond the Basics Patient education: Peripheral artery disease and claudication Beyond the Basics.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based.
Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Screening for diabetic polyneuropathy Evaluation of the diabetic foot Management of diabetic foot ulcers. Why UpToDate?
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View Topic. Font Size Small Normal Large. Patient education: Foot care for people with diabetes Beyond the Basics.
Foot disorders such as Diabetic foot management, infection, and gangrene are the doot Diabetic foot management of hospitalization in patients with Nanagement mellitus. Neuropathy is often a Isotonic hydration drinks factor to ulceration and amputation. The diabetic foot and its sequelae account for billions of dollars in direct medical expenditures, as well as lengthy hospital stays and periods of disability. Approximately 85 percent of all diabetes-related lower-extremity amputations are preceded by foot ulcers. The etiology of diabetic foot ulcers usually has many components.
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