Patient & Family Guide Diabetic Foot Ulcer 2018 www.nshealth.ca
Diabetic Foot Ulcer What is a diabetic foot ulcer? The term foot ulcer is used to describe an open sore that happens below the ankle and may be on any part of the foot. Some people with diabetes may develop a foot ulcer. These ulcers are often slow to heal and may get infected. Who is at risk for a diabetic foot ulcer? You may be at risk for getting a diabetic foot ulcer if you: have less sensation (feeling), known as neuropathy have poorly controlled diabetes have less blood flow to feet have poorly fitting and/or new footwear have orthotics that are not maintained on a regular basis walk in bare feet or sock feet 1 have poor foot hygiene/ingrown toenails have foot problems, such as a bunion or callus, that put pressure on different points of the foot smoke are overweight/obese have lower limb swelling have injured your foot
How do I know if I have diabetic neuropathy? Diabetic neuropathy is a type of nerve damage that can happen if you have diabetes. Neuropathy happens because high blood sugar damages nerves. Even small increases in your blood sugar over time can lead to neuropathy. Both hands and feet may be affected. Symptoms of neuropathy include: a change in sensation, or tingling/burning in the foot, ankle and lower leg, which may be worse at night a change in the shape of the foot, including a clawing of the toes and stiffness in the first toe dry skin and calluses on the feet being less able to feel a shoe on your foot being more likely to stumble or trip Nerves of the foot 2
How do I know if I have a diabetic foot ulcer? You may notice: a buildup of thick callus that may get discoloured and boggy or spongy a painless blister that leads to a loss of skin over part of the foot open sores over bony parts on the sole or sides of the foot an open sore that is oozing and may have a bad smell stains from bleeding or drainage on socks, inside of shoes, or on bed sheetss blistered areas or open sores after wearing new shoes or walking barefoot What is the treatment for a diabetic foot ulcer? Treatment will: remove or reduce pressure from the ulcer area (called off-loading ) prevent more skin from breaking down or cracking use wound dressings to help the ulcer heal and lower the risk of infection 3
To remove or reduce the pressure from an ulcer area(s) until the ulcer closes: reduce activities such as running, walking, and standing wear your prescribed off-loading device during all walking and standing get fitted with proper orthotics and appropriate shoes after the foot ulcer heals What is off-loading? Off-loading helps to reduce the impact of your body weight when your foot touches the ground. Off-loading devices are modified for each person to remove pressure over their specific ulcer sites. This is done by a foot specialist known as a pedorthist (ped-or-thist). Your health care provider or pedorthist will talk with you about which off-loading device is best for you. Wound dressing A wound dressing will help your ulcer close. Your health care provider will talk with you about which dressing and wound care is best for your ulcer. 4
How can I prevent another diabetic foot ulcer? Once the ulcer has closed, prevention must be your main goal. You may be able to prevent another diabetic foot ulcer by doing the following: Keep your diabetes well controlled and have regular checkups with your health care provider. Do not smoke. Do not walk in bare feet or sock feet. Wear footwear that has been fitted by a trained professional. Check your shoes before wearing and shake them to remove any objects. Look at your feet every day. If you have trouble seeing, ask someone else look at them. Have your health care provider look at any cracks or ulcers as soon as possible. If custom orthotics and/or shoes have been prescribed for you, wear them whenever you walk. Do not make any changes to your shoes or orthotics. Practice regular foot and nail care. Do not cut your own toenails. Have your nails cut by a specialist in diabetic foot care. 5
Avoid soaking your feet. When you wash your feet, use mild soap and water and dry thoroughly between your toes. Moisturize your feet every day but not between your toes. Do not apply wart treatment products to your feet unless your health care provider tells you to. Tips for foot orthotics and shoes Have your custom orthotics and/or shoes reassessed every 6 months by a qualified pedorthist or podiatrist ( po-di-a-trist ). Have your custom orthotics and/or shoes reassessed by the provider whenever you notice a new area of redness or blistering on your feet. Ask the provider about modifying the type of shoe that you wear most often. What are your questions? Please ask. We are here to help you. 6
Notes: Looking for more health information? Find this pamphlet and all our patient resources here: http://library.nshealth.ca/patientguides Contact your local public library for books, videos, magazines, and other resources. For more information, go to http://library.novascotia.ca Connect with a registered nurse in Nova Scotia any time: call 811 or visit https://811.novascotia.ca Learn about other programs and services in your community: call 211 or visit http://ns.211.ca Nova Scotia Health Authority promotes a smoke-free, vape-free, and scent-free environment. Please do not use perfumed products. Thank you! www.nshealth.ca Prepared by: Barbie Murray, CNS MDLUC and Bonnie Heckel, CNS Vascular Surgery Illustration by: LifeART Super Anatomy 3 Images, Copyright 1994, TechPool Studios Corp. USA Designed by: NSHA Library Services The information in this brochure is for informational and educational purposes only. The information is not intended to be and does not constitute health care or medical advice. If you have any questions, please ask your health care provider. WK85-1904 August 2018 Nova Scotia Health Authority The information in this pamphlet is to be updated every 3 years or as needed.