Wound Care and Ulcers

What is an ulcer?

An ulcer is an open sore or wound and most commonly occurs on the bottom of the foot.  15% of patients with diabetes develop ulcers.  It is important to seek treatment because 6% of those who develop a foot ulcer will be hospitalized due to infection or other ulcer related complications.

Who is at risk to develop an ulcer? 

•    Anyone who has diabetes 
•    Those with poor circulation and heart disease
•    Anyone having neuropathy, or loss of sensation
•    Someone who is overweight and using alcohol and/or  tobacco 

Once an ulcer or suspicious wound is noticed, seek podiatric medical care immediately.  Foot ulcers in patients with diabetes should be treated for several reasons such as; reducing the risk of infection and amputation, improving function and quality of life, and reducing healthcare costs.  Elevations in blood glucose as in diabetes can reduce the body’s ability to fight off a potential infection and also delay healing.  Vascular disease or poor circulation can complicate a foot ulcer, reducing the body’s ability to heal and increase the risk for infection.  

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible.  One rule applies, the faster the healing, the less chance for infection.  There several key factors in the appropriate treatment of a foot ulcer:

•    Prevention of infection
•    Taking the pressure off the area, called “offloading”
•    Removing dead skin and tissue, called “debridement”
•    Applying medication or dressings to the ulceration
•    Managing and identifying factors of patient health contributing to an ulcer

The science of wound care has advanced significantly over the past 10 years.  The thought of “let the air get at it” is now known to be harmful to healing.  We know that wounds and ulcers heal faster, with a lower risk of infection if they’re kept covered and moist.  Appropriate wound care management includes the use of dressings and topically applied medications.  These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.  For wounds to heal there must be adequate circulation to the ulcerated area.  Part of the podiatric evaluation is determining circulation levels with noninvasive tests and appropriate referrals if necessary to aid wound healing potential.  

The best way to treat diabetic or any other foot ulcer is to prevent its development in the first place.  Recommended guidelines include seeking a podiatrist on a regular basis.  He or she can determine if you are at high risk for developing a foot ulcer and implementing strategies for prevention.