Living with a Diabetic Foot Ulcer

By Paul Chadwick – Principal Podiatrist, Salford NHS

Diabetes and it's effect on skin

The skin is our body’s outermost organ, providing defence against injury, infection and other harmful organisms. It is especially important for people with diabetes to keep the skin free from any injury because diabetes can cause them to be more prone to infections. Infections often enter the body through wounds and skin injuries. In addition, diabetes slows down the body’s healing process once a wound occurs.

Diabetes can cause conditions over time that can increase a person’s risk to skin injury and may lead to poor skin health. For example, diabetes has the potential to damage the nerves and the blood vessels in the lower legs and feet. This can result in lessened sensation and numbness, as well as poor blood flow to the legs and feet. The concern with these complications is that they make an injury or wound to the legs and feet very difficult to heal. It is important that individuals with diabetes, whether controlled by medications and / or diet, know proper skin care procedures, with the emphasis on foot care.

Complete care of the feet should include a regimen of examination, hygiene and protection.

Examination

Feet should be examined daily for signs of injury:

• blisters
• skin cracks
• calluses
•  
• Use a hand mirror to make sure every surface is seen.
• Don’t forget to check between the toes.
• Inspect shoes before putting them on. A person with nerve impairment due to diabetes may not be able to feel a foreign object which could cause them injury.

Hygiene

Cleanse the feet daily with tepid water. Use gentle liquid cleansers and avoid use of harsh bar soaps. Do not soak feet, however as this contributes to dryness and cracking.

Ensure feet are completely dry – especially in between the toes.

After cleansing and drying, apply a cream or lotion designed to replenish the skin’s moisture. Do not apply creams or lotions between toes.

Make sure toe nails are carefully trimmed or filed. Seek the advice of a HPC Registered Podiatrist to be shown how to do this.

Protection

• Do not walk in your bare feet.
• Wear clean well-fitted socks and shoes
• Wear protective, well fitted boots or shoes
• If calluses or corns appear, do not use chemicals on them, see your GP or podiatrist
• You should have an annual foot check by a doctor, nurse or podiatrist.
• If sensation is decreased to the toes or feet or there is a reduction in circulation see a HPC Registered Podiatrist for foot care
• Never use heating pads, covers or hot water bottles.
• If tapes or dressings are necessary, make sure they have a gentle adhesive and carefully removed

Caring for skin injuries that do occur

There are several important things people with diabetes should do if skin injuries occur:

Seek professional help

Any skin injury that does not show signs of healing within 48 hours should be examined by a healthcare professional: eg GP, HPC Registered Podiatrist, District Nurse, or Diabetes Nurse. This should be done more urgently if there are associated signs such as discolouration, heat or swelling. A healthcare professional can give instructions on appropriate care and will schedule regular appointments to monitor the wound until it is completely healed.

Control the diabetes

This should include blood glucose monitoring, weight control, diet management, exercise and no smoking.

Special foot care

If the wound has occurred on the foot, special shoes may be necessary to accommodate dressings and/or swelling. If the wound is on the sole of the foot, limited weight bearing on that foot will be recommended to avoid aggravating or repeating the injury.

Special wound care

Examination by a healthcare professional will determine if infection is present and whether or not antibiotics are needed during the treatment process. The selected dressing should provide wound protection and promote healing. As a wound progresses, the dressing type may be changed.

Take appropriate precautions

Be sure to read and understand the instructions for any prescribed product. Any rashes, redness or itching that occurs from using a product should be brought to the attention of your healthcare professional as skin sensitivities may require an alternative product. In addition any of the following may be a sign of infection and you will need to see your healthcare professional immediately:

• warmth
• pain
• swelling
• redness
• increase in wound fluid