Diabetic Foot Ulcers

Diabetic foot ulcers are a major public health problem.  The United States spends billions of dollars each year treating these types of wounds. The New England Journal of Medicine estimates that 15 percent of the 21 million diabetic people in the U.S. can expect to develop a foot ulcer during their lifetime. 

Diabetic foot ulcers are deep wounds which are often slow to heal. Unfortunately, many patients with these ulcers eventually require lower extremity amputation. In fact, 85 percent of all leg amputations in diabetics are preceded by foot ulceration. Proper foot care and preventative measures are therefore essential to help decrease the formation of diabetic foot ulcers and prevent amputations.

Damage to the sensory nerves of the foot (neuropathy) caused by diabetes is the underlying reason foot ulcers form. Neuropathy, present in about 60 percent of diabetics, leads to decreased pain sensation in the feet. Because of the reduced sensation, diabetics may suffer unrecognized trauma to their feet from tight-fitting shoes, insect bites or from stepping on sharp objects. The resulting wounds can go unnoticed for some time and can become infected. Once present, diabetic foot ulcers are difficult to heal because of infection and blood flow problems, as well as the diabetes itself.
           
“Foot ulcers in diabetics are very challenging,” said Rajeev Mysorekar, M.D., program director of the St. John’s Mercy Hyperbaric and Wound Treatment Center. “The help of many trained medical specialists may be needed to achieve healing.”

In order for these wounds to heal, underlying blood flow problems need to be improved or corrected and infection needs to be treated. A very important aspect of treatment is to avoid all pressure on the wound, often through the use of specialized orthotic shoes. Appropriate local wound care should be performed, and the patient should maintain optimal nutrition and blood sugar control. Some patients may require surgery to remove all infected or nonviable tissues.

“In some cases,” said Dr. Mysorekar, “hyperbaric oxygen treatment, utilizing oxygen under pressure, may also be needed to help deeply infected wounds heal completely.”

At St. John’s Mercy Hyperbaric and Wound Treatment Center, now celebrating five years of healing difficult wounds, Dr. Mysorekar and his staff can offer diagnostic evaluation and treatment for chronic and complicated wounds in an outpatient setting.

 “We also offer a Diabetic Foot Clinic, where patients can learn proper foot care techniques as well as receive routine foot care”, mentioned Dr. Mysorekar.

The majority of diabetic foot ulcers can be prevented by following some simple guidelines. Any person with diabetes should check his or her feet daily for signs of trauma or pressure. Toenails should be kept clean and properly trimmed, calluses should be removed, and proper-fitting shoes must be worn. Screening tests to detect neuropathy can help identify those patients at risk of developing ulcers. People with diabetes should also eat a well-balanced, healthy diet and avoid smoking. Regular visits to a doctor will help ensure proper blood sugar control and general wellness. By following these recommendations patients can greatly decrease their chances of eventually needing an amputation.

For more information, please contact us at 314-989-1181.