Departments and Specialties

Wound Treatment Center at Monmouth Medical Center

Wound Care for Diabetics

Diabetic Ulcers

Foot ulcers are a significant complication of diabetes mellitus and often precede lower extremity amputation. The risk of lower extremity amputation is much higher in diabetics than in non-diabetics, as well as the fact that foot complications is one of the most frequent reason for hospitalizations in the diabetic patient population. The vast majority of diabetic foot complications resulting in amputation begins with the formation of skin ulcers.

Risk factors for ulceration come under two categories; general contributions and local foot issues. General contributions include:

• Uncontrolled high blood sugars
• Duration of diabetes
• Peripheral vascular disease
• Blindness or visual loss
• Chronic renal failure
• Older age

Local issues include:

• Peripheral neuropathy
• Structural foot deformities
• Trauma and improperly fitted shoes
• Callus
• History of prior ulcer amputation
• Prolonged elevated pressure
• Limited joint mobility

The first mechanism of injury may be caused by prolonged low pressure over a bony prominence (ie, bunion, or hammertoe deformity). This, along with the loss of protective sensation (neuropathy) can set up the beginning of the ulcer.

Frequently these ulcers are covered by callus or fibrotic tissue and frequently they are painless. Even in the presence of severe infection, many patients have few subjective complaints and are often more concerned with soiled footwear and stockings than with the penetrating wound.

Adequate removal of the necrotic tissue and callus should be the first step in evaluation of a foot ulcer. After this debridement, the involvement of underlying tissues or structures must be determined. Once additional structural involvement is established, an appropriate wound classification and subsequent treatment plan can be implemented.

Hyperglycemia, impaired immunological response, neuropathy and peripheral vascular disease are the major factors leading to limb threatening diabetic foot infections. Infections can develop, spread rapidly. Lack of wound healing, systemic sepsis, or unresolved infection can lead to extensive tissue necrosis and gangrene, requiring amputation to prevent more limb loss.

Careful inspection of the diabetic foot on a regular basis is one of the easiest and most effective measures for preventing foot complications. A systematic examination of the feet can address these risk factors so that appropriate treatment can be instituted.

For more wound care information for diabetics, click here.

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