If you’re living with diabetes, one area of the body you need to be especially aware of is your feet. We’ve all likely taken our feet for granted at one time or another, but people living with diabetes are at particular risk for a non-healing diabetic foot ulcer, a potentially life-threatening complication of diabetes.
What are diabetic foot ulcers? A diabetic foot ulcer is a wound, or sore, on the foot of someone living with diabetes. If left untreated, these ulcers can lead to severe infections that may result in amputation. Because the consequences of not treating a diabetic foot ulcer are so potentially dire, it’s important to seek treatment as soon as you realize an ulcer is present.
If You Have a Non-Healing Diabetic Foot Ulcer – You Need to Seek Treatment Immediately
If you’re concerned that you have a non-healing diabetic foot ulcer, make an appointment to see your doctor, and read more to educate yourself.
What are Diabetic Foot Ulcers
Diabetic foot ulcers are wounds that occur on the feet of someone living with diabetes. Here are some facts about these ulcers:
- An ulcer can start out as a small injury – even something as seemingly harmless as a blister, dry skin that has cracked, a splinter or a wound from stepping on a tack.
- Ulcers develop in 15%-25% of people with diabetes.[i]
- The risk for an ulcer is increased if you have diabetic peripheral neuropathy, which is damage to the nerves from diabetes. Diabetic peripheral neuropathy begins with an abnormal sensation in your feet and may eventually move up your legs.[i]
- Up to 50% of people with diabetic foot ulcers have peripheral artery disease (PAD), which is blockage of the arteries in the legs.[iii]
Diabetic foot ulcers are best treated by a team of medical professionals that may include:
- your primary doctor
- a diabetes specialist
- a wound specialist
- a foot specialist
- an infectious disease specialist
- vascular specialists such as a vascular surgeon or an interventional radiologist
Diabetic Foot Ulcers and Peripheral Artery Disease (PAD)
Poor blood flow in the legs can make it harder for the body to heal from an injury. Many times, a non-healing foot ulcer is a symptom of PAD.
Symptoms of PAD can include:
- Non-healing or chronic wounds and sores on feet.
- Fatigue or pain in the legs that comes on with walking but improves with rest
- Pain in the legs at rest
- Blue color to toes, feet or legs
- One leg is colder than the other
- Lack of leg hair
- Toe nails that are not growing
If PAD is present, early treatment (if performed within 8 weeks of the start of evaluation) to reroute the blood flow, can often lead to improved healing over time without the need for major amputation.[ii]
Think You May Have PAD?
If you think you may have PAD, talk about your symptoms and concerns with your doctor.
Don’t Wait – The Consequences of Non-Healing Diabetic Foot Ulcers and PAD
It’s difficult for researchers to determine just how many people have waited, as well as how long they typically wait, before going to the doctor. One study found that ulcers that have been present for about a month and a half before the first doctor visit were less likely to heal than ulcers that were seen and treated sooner.[iv] As previously mentioned, non-healing foot ulcers are often a sign of PAD, because a non-healing sore on the foot, toe, or ankle can be a sign of a malfunctioning circulatory system. This is important to realize, because there are minimally invasive PAD treatments that can help. Doing nothing, however, or waiting too long to see if the sore will heal, or get your PAD treated, can increase your risk for more serious complications, such as chronic infection, gangrene, and even amputation.
Did you know that many lower-limb amputations not related to trauma occur in people with PAD? A foot ulcer is thought to be the initial event that often leads to lower-limb amputations.[v] Foot amputation due to PAD complications, like a non-healing diabetic foot ulcer are decreased when a team of medical specialists is dedicated to treating the PAD that is causing the ulcer.[vi]
If you are living with diabetes and/or PAD and still haven’t made an appointment to see your doctor about a wound on your foot, please set up that appointment as soon as possible. It’s the one thing you should do right away if you notice an ulcer on your foot. The longer you wait, the higher the chances are you’ll develop an infection that could lead to an amputation.
[i] Bartus CL, Margolis DJ. Reducing the incidence of foot ulceration and amputation in diabetes. Curr Diab Rep. 2004;4:413-418. [PubMed]
[ii] Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719-1724.
[iii] Elfzyri, T., Larsson, J., Nyberg, P., Thorne, J., Ericksson, K.F., Apelqvist, J., Early Revascularization after Admittance to a Diabetic Foot Center Affects the Healing Probability of Ischemic Foot Ulcer in Patients with Diabetes. Euro J Vasc Endovascular Surg, 2014, 48(4): p. 440-446.
[iv] Elfzyri, T., Larsson, J., Nyberg, P., Thorne, J., Ericksson, K.F., Apelqvist, J., Early Revascularization after Admittance to a Diabetic Foot Center Affects the Healing Probability of Ischemic Foot Ulcer in Patients with Diabetes. Euro J Vasc Endovascular Surg, 2014, 48(4): p. 440-446.
[v] Brownrigg, J.R.W., Apelqvist, J., Bakker, K., Schaper, N.C., and Hinchliffe, R.J., Evidence-based managed of PAD & the Diabetic Foot. Euro J Vasc and Endovasular Surg, 2013. 45(6): p. 673-681. http://www.ejves.com/article/S1078-5884(13)00136-6/abstract (accessed 7/30/2016)