Foot ulcers are an open sore or wound most commonly located on the sole of the foot. When we stand, our body weight is pressing down on the soles of our feet. Pressure can also come from shoes that do not fit properly, or from thick calluses or toenails. Too much pressure on the skin will cut off blood supply which the skin needs to survive. Without a proper supply of blood, the skin will begin to break down and this is when ulcers start to form. The first warning signs of an ulcer are blisters.
Normally when the body feels that there is too much pressure for too long an alarm is sent to the brain to tell you to take some pressure off your feet; however, people with diabetes are prone to a disorder called peripheral neuropathy. People who have peripheral neuropathy do not receive the message to take pressure off their foot. Since people with peripheral neuropathy have less feeling in their feet, ulcers can go unnoticed for long periods of time, increasing the chances of infection. Additionally the nerve damage that occurs in people with diabetes causes them to not notice how hard they are pressing down on their heels or on the balls of their feet as they walk, which makes it even easier for ulcers to develop.
Foot ulcers are a major complication for the 1.5 million Canadians with diabetes, as 15-30% of people with diabetes will develop a foot ulcer. It is important that ulcers are treated right away because the longer that they stay open, the higher the chances that an infection will develop.
In general, the skin acts as a protective layer that prevents harmful bacteria from entering our bodies. When the skin is broken down and an ulcer is present, these harmful bacteria are free to enter the body and spread.
Warning signs that an ulcer is infected are:
An infected foot ulcer is a problem because the infection can make its way into the bone, which may cause a partial amputation of the foot.
Most foot ulcers will eventually heal when pressure is taken off the foot and when Good Ulcer Care (GUC) is given. GUC includes off-loading (taking pressure off the foot), using moist dressings and debridement (removal of any dead tissue around the ulcer). People with diabetes are generally slower healers compared to those without diabetes, and even with GUC, some foot ulcers will not heal.
In addition to off-loading and GUC, there are other treatments that are available to help heal a diabetic foot ulcer, including the use of growth factors to produce new healthy skin cells. While there are treatments available for diabetic foot ulcers, there is still a need for treatments that are more powerful than those currently available. As a result, new treatment options are being developed to be used in conjunction with GUC.