Treatments
Prevention and Lifestyle Changes
There are many things you can do to prevent foot ulcers and other diabetic foot problems. Many of these things also double as treatments for some of the problems. You may be referred to our podiatry department as the CardioVascular Institute works closely with the podiatrists there.
Control Your Blood Sugar Levels
High blood sugar levels lower immune response and prevent wound healing. Improved blood sugar control -- with necessary adjustments in diet or medications -- help in fighting infections and healing wounds.
Check Your Feet Daily
Look for cuts, sores, blisters, redness and swelling around your feet and ankles and between your toes. Make sure to check the soles of your feet as well. If you find anything abnormal, call your doctor.
Clean Your Feet Daily
Wash them in warm water, but don't soak them because that can dry them out by removing protective oils. Make sure the water is not too hot by testing it first with your hand. Dry your feet thoroughly between the toes before putting shoes and socks on. Do not wear garters or tight stockings.
Moisturize Your Feet
Apply moisturizing lotion to your feet every day to keep them smooth and to prevent dryness and cracking. Don't put the lotion between your toes, however, as it may attract bacteria and increase your risk of infection.
Trim Your Toenails Regularly
Use a nail trimmer to keep your nails neat in order to avoid irritating your skin. Smooth any rough spots with a nail file. You may want to have a podiatrist do this for you on a regular basis. If your toenails become thick, yellowed or are growing into your toes, call your doctor.
Have Calluses Trimmed
Calluses occur more often and build up faster on the feet of people with diabetes. If you get too many calluses, you may need special therapeutic shoes or inserts. Calluses, if not trimmed, can thicken, break down and turn into ulcers. But do not try to cut calluses or corns yourself. This can lead to ulcers or infections. Instead, have a podiatrist do it. And do not try to remove calluses or corns with chemical agents. These products can burn your skin.
Always Wear Properly Fitting Shoes and Socks
Do this even when inside to avoid injuring your feet. Socks with some padding are best. You should wear shoes that fit well, preferably wide shoes that don't compress your toes. Avoid open-toe or open-heel shoes. Women should not wear high heeled shoes.
Protect Your Feet From Extremes of Heat and Cold
Use sunscreen at the beach or whenever they are exposed to sunlight. Don't place your feet near radiators or space heaters and do not use heating pads or hot water bottles on your feet. In extreme cold, check your feet often to monitor for frostbite.
Reduce Pressure
Keeping pressure off feet ulcers can promote healing. Sometimes, special boots or casts are placed on the feet to reduce pressure on the ulcer.
Avoid or Quit Smoking
Smoking causes damage to the small blood vessels in the feet and legs.
Exercise Regularly
Exercise improves circulation as well as overall health. Walking, swimming or bicycling may be good ones to try, while minimizing stress to your feet. Check with your doctor before beginning any exercise program. For patients with neuropathy walking for exercise may not be advisable. Check with your doctor.
Wound Care
For patients with a sore or ulcer on the foot, proper care by a provider skilled in the treatment of diabetic foot problems is essential.
Wound Treatment
Wound treatment involves:
- Elimination of any infection with antibiotics
- Use of medications and dressings to promote wound healing
- Avoiding bearing weight on the foot
- Evaluation of the circulation to be sure blood flow is adequate for healing
Treatment of diabetic foot ulcers can be complex and take many weeks. Some care is usually provided in the doctor's office but much of it at home, occasionally by visiting nurses.
Wound Care Agents
There are a variety of wound care agents that are used to promote healing including:
- Gels
- Ointments
- Artificial skin substitutes
Hospitalization May Be Required
Hospitalization may be required for some of the following:
Skin Grafts
For some wounds, placement of a skin graft may rapidly reduce the time of healing. This is a simple surgical procedure performed under anesthesia in the operating room and usually requires a hospital stay of about five days.
Debridement
The removal of dead tissue around a wound, called debridement, is sometimes needed to clean the wound and promote healing.
This may be done in the office or in the operating room depending on the extent of debridement.
Angioplasty
If a foot wound is not healing due to poor circulation, your doctor may recommend angioplasty, possibly with the use of a stent. This is a minimally invasive procedure compared to open surgery.
In angioplasty, your doctor inserts a long, thin tube or catheter into a small puncture over an artery in your arm or groin. The catheter, which has a balloon at its tip, is guided through your artery to the blocked area. Once in place, the balloon is inflated and pushes the plaque in your artery against the artery walls, making the passageway wider.
In some cases, your doctor may place a tiny mesh-like tube, called a stent, into the narrowed area of your artery, keeping it open. The stent remains there permanently. This procedure requires an overnight stay in the hospital.
Bypass Surgery
Your doctor may recommend bypass surgery, depending on the severity of the blockage in your artery.
For this operation, a vein is taken to create a bypass around the blocked area of the artery. A graft using man-made materials may also be used. Your surgeon attaches the bypass graft above and below the area that is blocked, creating a new path for the blood to flow to your leg tissues.
This is done in the operating room and requires a three to five day hospital stay.
Amputation
People with diabetes are more likely to have a foot or leg amputated than those without the disease. The reasons are artery disease, which reduces blood flow to the feet, and nerve damage (neuropathy), which reduces sensation. Combined, these two issues increase the risk of getting foot ulcers and infections that can lead to amputation.
The surgeons in the CardioVascular Institute pride themselves on being able to avoid amputation in most patients who they treat. Unfortunately, in some circumstances it is the only possible treatment.