By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Diabetic foot ulceration can lead to significant morbidity and mortality and is probably one of the most-feared complications of diabetes. Loss of limb (amputation) is a frequent outcome of diabetic foot ulceration.

Risk Factors
Common risk factors for the development of foot ulcers in diabetics include:

• Peripheral vascular disease
• Neuropathy
• Poor glycemic control
• Cigarette smoking
• Diabetic nephropathy
• Previous foot ulcerations/amputations

By far, the two most common risk factors are neuropathy and peripheral vascular disease.

Neuropathy can affect autonomic, sensory and motor components of the nervous system. Compromised innervation of muscles of the foot leads to altered flexion/extension of the affected foot, which often creates anatomic abnormalities such as pressure points and bony prominences. These can predispose the patient to ulceration and skin breakdown. In addition, autonomic dysfunction leads to diminished sweating, resulting in dry skin that may develop fissures or cracks which can become susceptible to infection. Loss of sensation means that diabetic patients are often unable to feel pain when wounds are developing, allowing such wounds to progress due to ambulation and weight bearing on the affected foot.

Diabetics often experience atherosclerosis earlier and more severely than non-diabetic individuals. Peripheral vascular disease (PVD) is common in diabetics and often affects the aortoiliac segment and the superficial femoral artery. Peroneal, anterior and posterior tibials are also commonly affected in diabetics.

Prevention
The best offense is a good defense. Diabetics should be taught to inspect their feet regularly and should know how to recognize a problem with their feet before it becomes a major issue. The following information should be imparted to diabetic patients and should be repeated regularly:

• Inspect feet daily- if the patient is unable to perform this task themselves, a family member should be taught how to perform a thorough assessment of foot health.
• Cleanse feet daily and apply a moisturizer to prevent dryness and the formation of cracks. Dry thoroughly between the toes.
• Diabetic socks or thick padded socks should be worn inside shoes that fit properly and offer good support- custom shoes should be considered if foot deformity exists.
• Remind patients to avoid hot soaks, harsh chemical agents and heating pads.
• Minor wounds, such as small cuts or scrapes, should be cleansed and treated with a topical antiseptic- any wound, no matter how minor, that fails to heal quickly should be inspected by a physician.
• Nails should be trimmed straight across. If the patient cannot manage nail care themselves, it should be performed routinely by someone trained in the care of diabetic feet (i.e., a podiatrist)- ingrown toenails should be treated promptly and any signs of infections should be reported to the physician.

Prevention also includes quitting smoking, maintaining tight glucose control, weight control and control of blood pressure.

Diabetic foot ulcers affect approximately 15% of all diabetics at some point in their lives. Teaching patients how to properly care for their feet is the key to preventing diabetic foot ulceration. Prompt recognition and treatment of wounds can prevent amputation, thus patients must understand the importance of working with their healthcare team to maintain the health of their feet.

Source
1. Pendsey, S. Understanding diabetic foot. Int J Diabetes Dev Ctries. 2010; 30(2): 75-79

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.