Diabetes and Wounds: Caring for Sores

Avoid amputation with the prevention and early treatment of skin sores.

When you have diabetes, it's vital to treat foot injuries right away. Even minor wounds can turn into serious foot ulcers, which can cost you a foot -- or an entire leg -- if you don’t care for them quickly and thoroughly. These easy steps can prevent problems down the road.

Common Causes

What you put on your feet matters. "You can get a foot ulcer from something as simple as walking in new or tight-fitting shoes or getting a small pebble stuck in the shoe,” says Raul Guzman, MD, a vascular surgeon at the Joslin Diabetes Center in Boston.

If you have diabetes, you may get a kind of nerve damage that stops the feeling in your feet. Doctors call this neuropathy. If you can’t feel your feet, you may not know you’re hurt, and a small cut or sore can turn into something bigger.

Or you might have poor blood flow to your feet, which makes it hard for even minor cuts to heal.

Your doctor can tell you whether you have nerve damage or blood-flow problems. Guzman says he can do a test that shows how blood moves through your body. If the results are normal, you can have standard wound-care treatments. “If the results of this blood-flow test are abnormal, that means you have poor circulation that needs to be repaired,” he says.

Surgery can help. “We can use a balloon and stent,” Guzman says, “or we can do a bypass procedure, where we connect the artery above the blockage to one of the arteries in the calf or foot.”

Wound Treatment Options

If you do injure your foot, don't try to take care of it at home. Go to a wound-care center or your doctor, even for blisters, calluses, and scratches.

“Put on some antibiotic ointment and see a wound center or your doctor, at the latest, the next day,” says Harold Brem, MD, chief of the wound healing and regenerative medicine division at Winthrop University Hospital in Mineola, NY. “These are limb- and life-threatening problems, so do not take chances.”

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Your doctor will know the proper way to clean and treat the wound. He may prescribe a cream to use at home.

If you develop a foot ulcer, the doctor will probably have to clean it out. He may call this process debridement. Then he’ll bandage it if it needs it, Guzman says.

In recent years, cutting-edge treatments like stem cells and growth factors have been used to treat foot ulcers. “These are no longer extreme measures,” Brem says.

You should also keep weight off of your foot as you heal. There are different types of casts or boots the doctor can give you to help, Guzman says.

Go With a Preventive Defense

Your best bet to avoid sores is to keep your feet healthy. Here's how:

  • Check your feet daily. If you've lost feeling in your feet, look to see if something is wrong. It’s hard for many people to inspect the bottoms of their feet even if they use a mirror, Guzman says. Ask a spouse or friend to help you.
  • Wash them well. When you shower, soap your feet with warm water and fully dry them, even between the toes. Moisture that gets trapped there can be harmful. Use lotion or cream to keep skin from drying or cracking, which can cause sores. “Treat your skin as the most important organ in the body,” Brem says.
  • Dress for comfort. Keep your feet cushioned with soft socks and comfy footwear. Avoid high heels and pointy, narrow styles, which can harm your feet. Your doctor may prescribe special shoes if you need them. “Shoes are extremely important,” Brem says. “Something like [sneakers] can be the difference between a significant ulcer and not. You need proper padding.”
  • Trim your toenails. People with diabetes should see a podiatrist, a doctor who specializes in foot care. Ask him if he should cut your toenails to prevent injury. This is common for people who have neuropathy or who’ve had foot ulcers before. “Only have an expert clip your nails if you have diabetes,” Brem says. “Never go to a salon.”
WebMD Feature Reviewed by Michael Dansinger, MD on December 21, 2015

Sources

SOURCES:

Harold Brem, MD, chief, Wound Healing and Regenerative Medicine, Winthrop-University Hospital, Mineola, NY; professor of surgery, Stony Brook University School of Medicine.

Raul Guzman, MD, vascular surgeon, Joslin Diabetes Center, Boston; associate professor of surgery, Harvard Medical School.

American Diabetes Association: “Foot complications.”

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