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Foot Ulcers? Here's What May Be in Store

Without prompt attention, amputation may follow.

Prompt Attention is Essential to Avoid AmputationIf you have diabetes, it's extremely important to check your feet daily for small wounds and ulcers. Not receiving prompt treatment can result in amputation.

If you've been diagnosed with diabetes, you have no doubt been warned to do regular foot inspections and to be on the lookout for foot ulcers, which affect about a quarter of those with diabetes and can be serious.

Now, in a new study, British researchers who followed men and women with infected foot ulcers for 12 months offer a sobering view of what may be in store, including amputations.1

"Over half of the participants in our study did not see their diabetic foot ulcer heal over a year," says Mwidimi Ndosi, PhD, MSc, BSC, a senior lecturer in rheumatology nursing at the University of the West of England, Bristol. Infected foot ulcers related to diabetes have poorer outcomes than a previous large European study found, he tells OnTrackDiabetes. The median healing time (half took longer, half less) was 4.5 months.

A Closer Look at the Study

Dr. Ndosi and his colleagues followed the men and women for a year to see how well the ulcers healed. Here's a look at the people in the group:

  • Average age, 64.
  • The majority had a single ulcer, but some had multiple wounds.
  • Most had type 2 diabetes, but 40 of the 299 had type 1 diabetes.1

The men and women were treated from November 2011 through May 2013. The findings:

  • After a year, 45% reported the ulcer healed.
  • About 10% found it came back.
  • 17.4% had at least a partial amputation of a lower limb.
  • 6% needed surgery to restore blood flow.

The longer the ulcer was present, the worse the outcome. Healing less likely during the follow up for ulcers present for more than 2 months. Those with a single ulcer—the majority of the study participants—were more likely to experience healing that those with multiple ulcers. The deeper and wider the ulcer, the worse the results.1

During the study, 15% of participants died. The impact of the ulcer on the death is not clear but may be related. 

Expert Perspective

The findings are no surprise to Bela Pandit, DPM, a foot and ankle surgeon in Evergreen Park, Illinois. She reviewed the findings. The study does reinforce the message that a foot ulcer needs immediate professional attention, she says.

"I see people wait weeks, months, years," she says, thinking it will get better. "If there is any slight opening, the key message is you have to see a health care professional, preferably one who deals with ulcers and wounds," Dr. Pandit says.

Even a wound the size of a pinpoint that's bleeding, she says, needs attention in those with diabetes.

While some patients try home care, thinking it will heal it, she recommends against it. "I do recommend cleaning it and putting on a sterile bandage," she says. The next step, however, is to schedule an appointment with either a podiatrist or an MD who is a specialist in wound care, she says. "You can't mess around with these things," she tells her patients.

Prevention Is Key

At diagnosis, ask your doctor to assess your risk of developing a foot problem, Dr. Ndosi says. If foot problems occur, have another assessment, he says.

Dr. Pandit adds: "The number one tip is to check or have someone you trust check your feet every day. When your nerves are compromised, you may not realize you have a cut."

Other prevention strategies: Always get properly fitted for shoes and socks, she adds. Socks that cause lines on your foot, for instance, can dig in and lead to problems. When choosing shoes, "make sure your shoe has extra depth and you can easily wiggle your toes up and down and side to side."

 

Updated on: January 11, 2018
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