Over time, elevated blood sugars lead to blockage of arteries in the legs (peripheral arterial occlusive disease) and damage to afferent nerve fibers (neuropathy). The result is poor circulation, accompanied by burning, tingling, and loss of sensation in the lower extremeties, reducing awareness of sore spots that could lead to early treatment, and impaired healing. Medical attention and patient compliance are vital to saving the limb; diabetic foot ulcers are the most common cause of lower extremity amputations.

Managing Diabetes

Get blood sugars under control. The most accurate indicator of diabetic control is the hemoglobin A1c. Doctors measure this in a simple and convenient blood test. No fasting is required prior to the blood draw. According to revisions of diabetic guidelines by the American Diabetes Association, "For optimal diabetic control, the recommended ADA target for most people with diabetes is an A1c level no greater than 7 percent. It is hoped that achieving this target would help prevent serious diabetes-related complications, including nephropathy, neuropathy, retinopathy, and gum disease." At home, it is important to monitor blood sugars, take prescribed medication as directed, and eat a low carbohydrate, high protein, fiber rich diet. Avoid alcohol. Protecting ulcers from increased pressure may mean staying off the feet. This creates an additional problem by reducing exercise, which is a valuable tool in blood sugar control. Upper body and chair exercises, as well as devices which protect the ulcer when standing and walking, offer alternatives. Lose weight if needed. Blood sugars increase with additional fat cells. Losing even five percent of body weight can lower blood sugar significantly. Don't use tobacco. Smoking further constricts circulation and damages skin. Smokers also deplete vitamin C and other antioxidants more rapidly than nonsmokers, according to Phyllis Balch, nutritionist and author of "Prescription for Nutritional Healing."

Wound Care

Diabetic ulcers require the help of professional wound care experts. The Visiting Nurses Association is a good source. Several products are available to debride, cleanse, seal moisture, fight infection, and can be left in place sometimes for days. Because these products can harm surrounding tissues if not used properly, they are not available over the counter. Before such technological advances, wound care experts relied on packing wounds with saline-moistened gauze, which would stick to and remove dead (necrotic) tissue when changed, and wet-to-dry dressings. Frequent dressing changes were a necessary part of this regimen. Circulation to the diabetic foot ulcers can be improved with whirlpool baths, which also help debridement, or the removal of necrotic tissue. Alternating warm and cold soaks increases circulation as well; care should be taken not to exceed recommended temperatures. Elevation of the affected limb higher than the heart when resting reduces swelling and improves blood flow. Surgical debridement may be necessary to improve healing. This is done under anesthesia by a trained surgeon.

Prevention

Early detection and treatment of sore spots is essential to the prevention of diabetic ulcers. Diabetics should never go barefoot and should inspect their feet and shoes daily. Use a pumice stone on a regular basis to control callouses.

Source:

David G Armstrong, DPM, Lawrence A Lavery, DPM, MPH, Diabetic Foot Ulcers: Prevention, Diagnosis, and Classification, American Academy of Family Physicians, March 15, 1998

Laurie Barclay, MD, Charles Vega, MD, American Diabetes Association Revises Diabetes Guidelines, MedscapeCME, 12/31/09

Phyllis Balch, CNC, "Prescription for Nutritional Healing," Avery, 2004

More Information:

American Podiatry Medical Association