If you’ve ever had a shot of Novocain at the dentist, you know how it feels to try to talk or eat afterward kind of like knitting with boxing gloves on. People who have lost the sensation in their feet have a similar experience. Neuropathy often causes an unnatural and awkward stride, which puts repeated pressure on the same spot of your foot. Over time, this area will callus and may eventually develop into a pressure ulcer. Other diabetic foot ulcers may be caused by poor circulation in your legs and feet. Beyond practicing good foot care, the best thing you can do to prevent limb threate
How They Happen
ning complications from ulcers is detect them early and treat them properly. Most ulcers form on the bottom of the foot, although shoes that don’t fit well can cause sores and subsequent ulcers on the top of the foot or the ankle. Usually ulcers start as a callus, small sore, abrasion, or blister that would be “no big deal” in someone without diabetes. However, high blood glucose levels, poor circulation, and nerve damage are a recipe for ulceration in people with diabetes. There are two categories of foot ulcers-vascular and neuropathic Cor “pressure”) ulcer. The former is caused by peripheral vascular disease; the latter is the result of the loss of sensation that accompanies peripheral neuropathy. People who have PN may put increased pressure on the same area of their foot repeatedly, resulting in callusing at first, and eventually in ulceration. Ulcers caused by PVD are usually painful, while those caused by PN are not.
Infection is the primary risk with foot ulcers, so proper wound care is essential. Ulcers should remain moist and covered in a breathable dressing at all times (except when changing bandages). Oxygen is essential to the healing process. An antibiotic ointment may be applied if infection is present. Oral antibiotic medication should also be prescribed. If you have a pressure ulcer, debridement removal of callused, dead skin may also be performed at the podiatrist’s office. Your doctor may also prescribe one of several new “human based” ulcer treatments, such as Apligraf (Organogenesis) and Regranex . Apligraf is a bioengineered tissue that contains skin cells and proteins, and Regranex is a gel containing platelet growth factors that promote healing and new skin growth. Ulcers that are the result of PVD may show up on the lower leg as well as the foot. The toes are also a common location, and if circulation is poor enough, tissue necrosis (tissue death) or gangrene may be evident in the surrounding blackened skin. These patients may need an arterial bypass to restore blood flow to their feet and legs. Osteomyelitis, or bone infection, may occur if infection in the ulcer spreads deeply enough. This is usually diagnosed with a bone scan or magnetic resonance imaging (MRI) and treated with intravenous antibiotic therapy.