What is a diabetic foot ulcer?

Have an ulcer on your foot that won’t heal? While there could be numerous causes for the same, diabetes is a significant one. So, if you’re seeing any changes to the skin around the wound, discharge of fluid or pus, redness, pain, swelling, or discolouration, you must visit a doctor at the earliest.
What is a diabetic foot ulcer? 
A diabetic foot ulcer is a wound that typically occurs on your foot and is most often seen in people living with diabetes. This type of ulcer starts as a small injury; like a bler, cracked and dry skin, or a small cut or scrape you may have had. But, unlike other wounds, these don’t heal over time and can become infected leading to some serious complications – which is why seeking prompt treatment for diabetic foot ulcers is imperative.
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The most important risk factor to develop diabetic ulcers is diabetic peripheral neuropathy, a condition where the nerves, especially in your lower extremities, get damaged due to diabetes. One other reason for the development of diabetic foot ulcers is Peripheral Artery Disease (PAD), a condition where the arteries in the legs have a blockage. Statically, about 15 to 25 per cent of people worldwide develop diabetic foot ulcers and about 50 per cent of those people develop these due to PAD.
It’s important to know that diabetic foot ulcers are preventable. Following a simple, daily foot care regimen can help prevent the onset of this condition.
Symptoms and diagnosis of diabetic foot ulcers 
Unfortunately, the signs and symptoms of a diabetic foot ulcer are not always obvious and in some cases may be noticed only after the ulcer is infected. One of the first signs of a diabetic foot ulcer is leaking or drainage of fluid from your foot that may stain your socks or leak out. Other early symptoms are swelling, redness, and noticing a foul odour from the region where the discharge is seen. Your doctor will likely diagnose a foot ulcer performing a physical exam, and if needed, he may recommend one or more diagnostic tests to get more information about the injury. Finally, your doctor will likely identify the seriousness of the ulcer on a scale of 0 to 5 using the Wagner Ulcer Classification System.

Causes of diabetic foot ulcers
Diabetic foot ulcers are most commonly caused due to:Nerve damagePoor circulation, especially in your extremitiesHigh blood sugar (hyperglycemia)
Risk factors for diabetic foot ulcers
All people with diabetes are at risk for foot ulcers, but, some factors increase the risk of developing a diabetic foot ulcer. They are:
Diabetic neuropathyPoorly fitting shoesPoor foot hygieneImproper trimming of toenails or ingrown toenailsPrevious hory of foot ulcersPeripheral artery diseaseVaricose veins
All people with diabetes are at risk for foot ulcers, but, some factors increase the risk of developing a diabetic foot ulcer. (Source: Getty Images/Thinkstock)
Treatment of diabetic foot ulcers
The treatment of diabetic foot ulcers depends on the severity of the ulcer. In less severe cases, your doctor may clean the wound, remove any dead skin in the area and bandage it with a sterile dressing. In more severe cases your doctor may need to perform surgery to treat the infection.
Prevention of foot ulcers 
One of the most important aspects of diabetic foot ulcers is to prevent their onset. The first step to preventing this condition is to care for your feet daily. This includes examining your feet regularly. Do not walk bare feet, even indoors if you are having neuropathy
Wearing comfortable shoes that don’t pinch or bite your feet, drying your feet thoroughly, especially between the toes, after a bath or after you have washed them, cutting your nails with care and most importantly speaking to your doctor when you notice an injury on your feet.
You could even ask your doctor to check your feet for any signs of injury when you go in for a regular diabetes consultation.
These steps are even more important if you are at a higher than normal risk of diabetic foot ulcers.

Some dos and don’ts
*Wear the right footwear. Your shoes should have a good insole, a thick or protective sole, and be covered around the toes.
*Don’t wear tight shoes as they can pinch or hurt your feet. Another important aspect is to always check the inside of your shoes for any foreign bodies that can injure you when you wear them.
*Get your feet regularly examined your treating physician for any signs of ulcers.
*Cut your nails carefully. If you have ingrown nails that are likely to cause damage to your feet, speak to your doctor and get a professional to help treat the condition.
*Wear shoes even when at home, as they can protect your feet and prevent any injuries.
*Avoid hot fomentation as it can lead to blers which can progress into ulcers.
*Don’t sit cross-legged since it reduces blood flow to the lower half of your legs and feet.
Finally, prevention is the best way to avoid the onset of diabetic foot ulcers. So, it’s time to take care of your feet and keep an eye out for any ulcers you may have. Treat your feet as you treat your face.
(Dr Ghanshyam Goyal is a consultant diabetolog and diabetic foot special, ILS Hospital, Salt Lake, Kolkata)
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