Diabetics are at risk of developing an open wound on the bottom of the foot called a diabetic foot ulcer. These ulcers, if left untreated, lead to complications such as infection and lower leg amputations.
This offloading technique encases the entire foot and leg in a special cast that redistributes pressure.
What is a Diabetic Foot Ulcer?
A diabetic foot ulcer is an open wound or sore that occurs in about 15 percent of people with diabetes and is commonly located on the bottom of the feet. These ulcers are difficult to heal and lead to infection, which can result in lower leg amputation. These ulcers are a significant burden on patients with diabetes, leading to decreased quality of life and impacting employment status, self-esteem and overall health.
Diabetic ulcers are caused by a complication of diabetes called neuropathy, which causes loss of sensation in the feet. Without sensation, scrapes and cuts can go unnoticed, which allows bacteria to enter the skin and cause an infection. Eventually the infection can cause damage to the nerves in the foot, which may lead to bones breaking off (Charcot foot).
People with diabetes are at increased risk of developing diabetic ulcers because chronically high blood sugar levels damage the nervous system and impair the body’s ability to fight off infections. In addition, diabetes can cause peripheral artery disease which limits blood flow to the feet and legs and increases the risk for developing an ulcer. Treatment for foot and toe ulcers is individualized depending on what medical condition — if any – is causing the ulcers. It might involve removing pressure from the area by wearing a cast, special shoes or braces, or using crutches. It might also include debridement of the ulcer, antibiotics, and keeping blood glucose levels under control, since elevated blood sugar reduces healing time and can increase the virulence of the microorganisms that infect the ulcer.
What is the Charcot Foot?
Developing this devastating foot problem is common in people with diabetes, especially those with more than 20 years of diabetes. It happens when the nerves in the feet lose their ability to sense temperature, pain and the effects of injury. Eventually, the bones in the feet and ankles start to break or dislocate, due to the reduced sensation caused by neuropathy. Because the weakened bones do not hurt, patients often continue to walk. This leads to repeated trauma and the development of foot ulcers. If left untreated, the collapsed bones can lead to infection and amputation.
When the Charcot foot is diagnosed early, NYU Langone diabetic foot specialists can stabilize fractures and joint dislocations using casts and braces to let the bones heal. Custom shoes and special inserts will help prevent recurrence of the condition and protect the foot after the bones have healed. In the rare instance of recurrent ulceration despite a well-designed regimen, reconstructive surgery to realign and redistribute pressure favorably on the foot may be required.
Since the signs and symptoms of Charcot foot are often ignored, the condition can go unrecognized until severe complications develop. Acute cases of Charcot foot may appear to mimic cellulitis or deep venous thrombosis. Proper recognition and diagnosis, immediate immobilization and a lifelong program of preventive foot care can minimize this serious complication.
How is a Diabetic Foot Ulcer Treated?
Patients with diabetes who develop foot ulcers are prone to major complications that can lead to amputation. They can develop a foot ulcer due to diabetic neuropathy, or loss of feeling in the feet, and poor circulation in the legs and feet. The nerve damage, or neuropathy, is caused by elevated blood glucose levels over long periods of time. Poor circulation, or ischemia, restricts the flow of oxygen and nutrients to the feet, and increases the risk of infection and slow healing in the feet.
When a person finds an open wound on their foot or toe, they should see a podiatrist right away to receive treatment. Depending on the size and location of the ulcer, and whether it is infected or not, it may be treated with debridement, or the removal of the hyperkeratotic skin and infected tissue. It is important to get an infection under control as soon as possible, because it can spread quickly.
If you have diabetes, it is important to check your feet and toes on a daily basis for any sores or wounds. It is also important to wear comfortable shoes and to not walk barefoot, as this can put pressure on the feet. The doctor can also recommend other lifestyle changes, such as better glycemic control and exercise to improve circulation, to prevent further problems with the feet.
How is a Charcot Foot Treated?
When a foot ulcer develops, your doctor will need to debride (clean) it and use a cast or special shoe inserts to keep pressure off the wound.
If a Charcot foot is not treated, the bones in the feet will break down and the foot will become deformed. This is very dangerous, as it increases your risk for infection and lower-leg amputation.
The best way to prevent a diabetic foot ulcer is by checking your feet every day for swelling, redness, warmth and any wounds. Your doctor can tell if you have a foot problem by looking at the bottom of your foot or asking you to stand up on one leg while they look at it.
Total Contact Casting is used to protect a deteriorating foot or ulcer. It is applied to the entire foot and ankle and molds around any prominent areas of bone. This relieves the pressure on these bony prominences and reduces amputation risks. It also decreases the amount of swollen area in the foot. Studies have shown that a TCC reduces plantar pressure by 32% under the fifth metatarsal head, 69% under the fourth metatarsal head and 65% under the first metatarsal head and lower leg. It also reduces oedema.