I'm not just a PT, I'm also a parent!

I'm not just a PT, I'm also a parent!

Monday, October 29, 2012

Diabetic Foot Ulcers

In the United States, nearly 19 million people have been diagnosed with Diabetes.  Diabetes is a chronic disease in which the body's glucose levels are higher than normal, resulting from the body's inability to produce and/or use insulin properly.  There are several different types of Diabetes, including Type I Diabetes, Type II Diabetes, and Gestational Diabetes.

Symptoms of Type I Diabetes include:
  • frequent urination
  • excessive hunger or thirst
  • unusual weight loss
  • fatigue
  • irritability
Complications of Diabetes include heart disease, stroke, high blood pressure, peripheral neuropathy, blindness, kidney dysfunction, Diabetic ulcers, charcot foot and amputations.

What is a Diabetic Foot Ulcer?

While nonhealing wounds, or ulcers are commonplace in hospitals and nursing homes, people living in the community are also at risk and frequently will develop a diabetic foot ulcer.  A diabetic foot ulcer is a wound that is located on the ball of the foot, the side of the foot, or beneath the big toe.  They form as the result of decreased sensation caused by neuropathy, skin changes (dry, peeling, cracking), improper footwear, and decreased circulation to the leg and foot.  Because of the underlying Diabetes, diabetic foot ulcers are often slow to heal and may go undetected for some time due to decreased sensation.

Accessed from http://trialx.com/curebyte/2011/06/17/clinical-trials-and-related-photos-for-diabetes-foot-ulcers/
 At first, you may notice a reddened area that will not blanch (turn white) when you apply pressure to it with your finger.  This is a Stage I ulcer.  Stage II ulcers appear like blisters.  A Stage III ulcer is open and crater-like.

Preventing Diabetic Foot Ulcers

There are several ways to help prevent Diabetic foot ulcers:
  • Keep your skin clean and dry
  • Do not apply lotion or moisturizers between your toes, as this may encourage infection
  • Wear proper footwear that is not too tight, does not rub, and does not have complicated straps and buckles which create pressure areas
  • Perform daily skin checks, looking for areas of redness, blisters, or open areas
  • See your doctor regularly
If you notice an ulcer developing on your foot, please see your doctor immediately!  The sooner treatment begins, the less complicated the wound will get, decreasing your risk of a hospital stay, IV antibiotics, intense wound care, and/or an amputation.

Treatment of Diabetic Foot Ulcers

There are many treatment options for Diabetic foot ulcers, depending on the severity of the condition.  These options include:
  • keeping the wound clean and moist (new cells will not grow in a dry environment)
  • using appropriate bandages and/or wound dressings
  • antibiotics (topical solutions, silver nitrate, oral antibiotics, or IV antibiotics) to fight infection
  • wound debridement by a Physical Therapist or other wound care specialist.  This can be non-selective (i.e. pulsed lavage) or selective/sharp debridement using scissors, scalpels, tweezers, etc.
  • negative pressure wound therapy (AKA wound vac) 
  • surgical debridement
Suture set used for sharp debridement

Pulsed Lavage

KCI Wound Vac


  1. It truly depends on numerous factors: the patient's general health, the size/depth/location of the ulcer, nutrition, pressure relief, circulation, hygiene, sensory status, etc.

  2. Total Contact Casting Total Contact Casting is recognized as the Gold Standard for offloading diabetic foot ulceration within the diabetic foot-care community.