Have you ever heard of a diabetic foot ulcer? Do you know that statistics show that 1 in 4 people with diabetes will develop a diabetic foot ulcer?
What is a Diabetic Foot Ulcer?
A Diabetic Foot Ulcer is a very common complication of diabetes and is often related to poor circulation or reduced blood flow to the extremities. It can be either a closed (early stages) or open wound or sore that usually develops on the bottom of the foot, though can appear on other areas of the foot.
It is extremely important for these ulcers to be detected early, but ideally, prevented all together. As a diabetic, checking your feet daily is essential in the prevention of a diabetic foot ulcer. Also, letting your doctor or podiatrist know if you find anything that looks or feels different is imperative and can prevent a diabetic foot ulcer as well.
Let’s explore the early stages of a diabetic foot ulcer and how you can detect and prevent them!
Understanding Early Stage Diabetic Foot Ulcers
As we established, a diabetic foot ulcer is a wound that develops on the foot of a person with diabetes and is a result of complications of diabetes. A diabetic foot ulcer has 6 stages:
0 - No open wound or ulcers. The foot appears normal.
1 - At this stage, the ulcer appears superficial and is not yet impacting the deeper layers of the skin.
2 - The ulcer is deeper and extends to the tendon, ligament, bone, or joint of the foot.
3 - The ulcer has penetrated the deeper layers of the skin and tissue and other issues may be present such as an abscess, sepsis, or osteomyelitis.
4 - Gangrene is now present at the forefoot and tissue death at the front of the foot or the heels.
5 - At this very unfortunate stage, the entire foot has gangrene and an amputation may be the only option to save the person’s life.
It is extremely critical for people living with diabetes to perform good foot care and to check their feet daily. Any sign of a diabetic foot ulcer, even something that may just appear to be a small callous, should be watched very closely, treated, and even reported to your healthcare provider. If detected early enough, conservative treatment may be enough.
Signs of an Early Stage Diabetic Foot Ulcer
There are a few different signs that help with early detection. During your daily foot exam, which all diabetics should be performing, ensure you are looking for any areas that are pink or red, swelling, open blisters, sores, or callouses, as well as any other areas with discoloration of the skin.
Even if you think it is just a simple callous, cut, or wound, say something and have a professional look at it. Early detection is key to prevention and ensuring you are looking for the physical signs mentioned above, can help prevent major complications that can stem from what seems to be a simple sore on your foot.
Other signs to look out for include sensory changes such as the sensation of numbness or tingling. If you feel pain or any tenderness at all, these are also warning signs of a diabetic foot ulcer.
I had a client who was walking on the beach barefoot and stubbed his toe on something in the sand. He explained how he remembers it hurting initially and then being a little sore, but just assumed it would go away in a few days.
What seemed to be a simple wound to his foot, turned out to be a full blown open wound requiring him to have IV antibiotics infused at the hospital daily. He also had to see a wound specialist for several months and was very lucky his diabetic foot ulcer eventually healed.
He waited too long and wasn’t performing daily foot checks, not even knowing he should. This was the result of him never learning about diabetic foot ulcers, how to check for them, and ways to prevent progression of them.
Causes of Early Stage Diabetic Foot Ulcers
There are a few causes of early stage diabetic foot ulcers and things that can be implemented to prevent the progression, or even the start of one. If blood glucose levels are not being properly managed and glucose levels are consistently elevated, this can lead to damage to the small arteries and veins, leading to poor blood circulation.
Peripheral neuropathy is another factor that can lead to an early stage diabetic foot ulcer. As I explained to my client above, the tricky thing about diabetics who have peripheral neuropathy is that you may not be aware of the injury, as you don’t feel it like a person who does not have peripheral neuropathy would feel it. If you can’t feel the injury, even a tiny blister or wound can quickly turn to a large wound that may become infected.
Other lifestyle and environmental factors can include poor-fitting footwear, lack of any footwear (as was the case with my client who wanted to walk the beach barefoot), sustained friction or pressure to the feet, lack of foot care, and or delayed healing of the wound related to elevated blood sugar levels.
Some of these things aren’t being taught to people living with diabetes and therefore they see no issue in walking barefoot for example. Many people have poorly fitting shoes and also don’t even realize the potential consequences of shoes that are causing friction or prolonged pressure to their feet.
It is imperative to discuss diabetic foot care with your healthcare provider and start doing this every day.
Prevention Tips for Early Stage Diabetic Foot Ulcers
Just like brushing your teeth, a daily foot care routine should be added to the schedule of every person living with diabetes. Starting with setting aside just 2 minutes a day, you can create a new, sustainable habit to your daily routine to prevent a DFU.
Ensure you check for any signs of ulcers, wounds, cuts, or callouses. Clean your feet with warm water and soap, dry them, and apply moisturizer to the feet, avoiding in between the toes.
Discuss proper footwear with your doctor or podiatrist, as they may be able to refer you to a place that specializes in specific diabetic foot wear that is meant to fit well and prevent diabetic foot ulcers.
Here they will help you find well-fitted shoes and can make recommendations for protective insoles as well. Consider avoiding higher risk footwear such as sandals, heels, or other footwear that expose your feet.
The most effective way to prevent diabetic foot ulcers is to manage your blood sugar levels by adhering to the nutritional intake, exercise routine, and medication regimen recommended by your healthcare provider.
Ensuring a well balanced diet of whole foods, vegetables, protein, fiber, healthy fats, and complex carbs, and avoiding processed foods as much as possible, is going to help immensely with blood sugar management.
Also having a daily exercise routine will help with not only blood circulation, but also in helping decrease blood sugar levels. An easy way to bring blood sugar down, following a meal, is by simply going for a brisk 30 minute walk after consuming the meal.
Regular check ups with your healthcare provider and or podiatrist is also very helpful in preventing diabetic foot ulcers. Podiatrists recommend routine foot exams and most insurance companies cover these exams as they help very much in the prevention of a full blown infected diabetic foot ulcers.
They also will often recommend you visit a footwear store that has specific socks and custom orthotics that are also often covered by insurance, with a letter or prescription from your doctor.
When to Seek Medical Attention
In addition to your routine appointments to assess current glucose management plan, it is very important to seek medical attention as soon as possible if you notice any signs of a diabetic foot ulcer. If you notice any of the signs of an early diabetic foot ulcer mentioned above, you should get into their schedule right away and closely follow the advice given.
If you do not seek medical attention in a timely manner, it can lead to a later stage diabetic foot ulcer and you can end up needing IV antibiotics, frequent wound care, surgery to remove dead tissue, and even potentially the loss of toes, foot, or limb.
Remember, learning the early signs of recognizing and preventing early stage foot ulcers can literally save your life. Adopting preventative measures and performing daily foot checks can help you recognize even the possibility of an early stage foot ulcer.
Seek medical advice when needed. If something doesn’t feel or look right or you just have even a question about it, reach out to your health care provider.
Many complications of diabetes are preventable with the proper management of your blood sugar levels. If you would like to understand more about preventing complications or want to create a blood sugar management plan that works for your lifestyle, reach out to me today.
Together, we can build a sustainable plan that works best for you!
Meet the Author
Hi! I’m Beth, a Registered Nurse and Certified Diabetes Educator. I provide diabetes coaching for newly diagnosed people with diabetes and also work with people who have been living with diabetes for some time.
With 1:1 coaching, you will feel empowered and supported to confidently manage your diabetes effectively - without it controlling your life! I can help you make sure that you feel good, stay in optimal health and take care of your well-being at all times.
First call is on me! Let’s talk.
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