Diabetic Foot Ulcers

Comprehensive wound care provided by the bay area’s leading wound care experts.

Diabetes can often lead to numbness and loss of sensation in the extremities (diabetic peripheral neuropathy), which can cause injuries and other health complications that affect the feet to go unnoticed. When an unnoticed affliction is combined with poor blood circulation and possible infection, it can lead to diabetic foot ulcers and other wounds that cannot heal on their own.

Diabetic foot ulcers and other unhealing wounds are a common complication of poorly controlled diabetes, and if neglected they can lead to a dangerous infection that can require surgery or even amputation. Anyone with diabetes can develop foot ulcers, but the good news is that they can usually be prevented with caution and proper foot care.

You can recognize diabetic ulcers by their location and appearance. These ulcers are caused by skin tissue breaking down to explore the layers beneath, possibly even all the way to the bone. They usually develop on big toes and the balls of the feet, though they can develop anywhere on the foot.

Many people who develop diabetic ulcers have lost the ability to feel pain, this means pain is not a common symptom. If you are at risk for diabetic ulcers you should watch for drainage on your socks, redness, and swelling, or if the ulcer has progressed significantly and has become infected a strong odor may be present.

Treatment Modalities

Wound Debridement

Wound Debridement is an important part of wound healing. Debridement is the process of removing necrotic or dead tissue that occurs during wound healing. This tissue inhibits the body’s ability to recover and develop new tissue during the healing process, making debridement critical or preparing a wound for quick and efficient healing.

Offloading

Offloading refers to removing pressure from the affected appendage. Offloading is achieved through a variety of methods including:

  • Shoes/socks that disperse pressure points
  • Wheelchair/scooter/or any device to minimize
  • Weight on the foot
  • Removable cast
  • Total contact cast
  • Half-shoes

All of these offloading methods are effective and the best option for any patient will be decided by the clinician and patient together.

Infection Control

Infection control is a critical element of any wound treatment, and can only be effective if both patient and care providers are dedicated to the proper infection control practices. Proper clinical infection control practices require the existence of an official Infection Control Program which should include:

  • Proper hand hygiene
  • Use of gloves, gowns, mask and face/eye shields when necessary
  • Safe injection practices
  • Proper handling of contaminated material.

Patient best practices should include:

  • Keeping draining wounds covered with clean/dry bandages
  • Keeping hands clean with soap and alcohol-based gels
  • Maintain good general hygiene including regular bathing
  • Do not share items that can come in contact with the wound such as towels, clothing, bedding, bar soap, razors, etc.
  • Avoid skin to skin contact with other individuals

There are many other precautions that could be detailed but following good hygienic practices will eliminate the majority of infection risks.

Restoring Blood Flow

Poor circulation is a primary contributor to complications with wound healing, restoring blood flow to areas showing signs of reduced circulation is critical to proper wound care and avoiding amputation. There are various ways patients can assist in restoring blood flow, such as:

  • Stop tobacco use
  • Maintain a healthy weight
  • Control blood glucose levels
  • Control blood pressure
  • Eat a diet low in sodium and added sugar
  • Keep physically active, if restricted by limited mobility or chronic pain seek additional options from your care provider

In severe cases, your provider may recommend surgical treatments, and in any case, early diagnosis is key to patient success.

Advanced Wound Dressings

When caring for wounds, clinicians have a wealth of options for bandages and dressings. These options are considered superior to the basic gauze and tape and are referred to as Advanced Wound Dressings. Advanced dressings reduce heal times, have less risk of infection, and have drainage issues.

Skin Substitutes

Skin substitutes have been used to aid in wound closure for centuries. They also help to control wound pain and replace the skin functions to promote proper wound healing. Skin substitutes come in two varieties, temporary and permanent. Temporary substitutes function as a wound covering and primarily serve to protect a wound from bacteria and additional trauma while providing a moist, clean and healthy environment for wound healing. Permanent substitutes are used to fully replace all layers of the skin and are most common with severe burns.

Foot Reconstruction

There are many structural conditions of the foot and ankle that cause complex deformities, which can cause pain and difficulty walking. They may also cause calluses and wounds or ulcerations. Deformities may be due to flat feet, high arch feet, Charcot deformity (collapse of joints of the foot), rheumatoid arthritis deformities, and post-traumatic deformities.

These sorts of deformities may cause significant disability and change in lifestyle. Foot reconstruction surgery is often a last resort when conservative treatment such as orthotics, shoe gear modifications, braces, and other modalities are ineffective. Reconstructive surgery may include shifting of bones, tendon lengthening or transfers, fusions, and external fixation.

Negative Pressure Wound Therapy

Negative pressure wound therapy also known as “NPWT” is an option for treating burns, various types of ulcers and other chronic wounds. NPWT is a uses a dressing that creates a seal over the wound and around tubing which is attached to a pump which will draw out fluid and infection from a wound to help it heal. NPWT is a great option for some, but not all, patients. Based on your wound and medical situation, your provider will decide if you are a good candidate for this method of wound treatment.

Total Contact Casting
A common treatment for diabetic foot ulcers relies on the application of a hard cast to relieve pressure on the areas of the foot that are most prone to ulceration. This technique is most commonly referred to as Total Contact Casting and is an option that may be presented by a provider post-diagnosis.

Why Marin?

Experience + Technology = Healing

We use the latest advancements in wound care to heal our patients. The treatment of a slow or non-healing wound starts with making a precise diagnosis. Without understanding the cause of the wound, and an accurate treatment plan cannot be made. Marin uses an integral approach to wound care which incorporates the use of relevant diagnostic tests.

Groundbreaking Clinical Studies

Our physicians have saved thousands of limbs over the years through education and research efforts. In 2003, Dr. Alex Reyzelman opened the Center for Clinical Research. CCR partners with a wide range of pharmaceuticals, medi­cal device companies, biotechnology, and contract research organizations to bring education and awareness of the positive benefits of clinical trials to patients, physicians, and the wider healthcare community.

World Renowned Surgical Services

Our doctors perform inpatient surgical procedures at prestigious local hospitals such as UCSF Medical Center, California Pacific Medical Center, Eden Medi­cal Center, Alta Bates Medical Center, Summit Medical Center, San Ramon Regional Medical Center and St. Mary's Medical Center. We work closely with vascular surgeons in a coordinated effort to prevent amputa­tions. We are affiliated with UCSF Center for Limb Presezvation & Diabetic Foot.

Amputation Prevention

Foot ulcers most commonly lead the pathway to amputations. Our team is focused on intercepting the progression and inhibiting the recurrence of the ulcers. The goal of treating a patient with a diabetic foot wound is to achieve complete healing as quickly as possible in order to prevent amputation. We strive to restore the patients quality of life, giving them the ability to lead an active, pain free lifestyle.

UCSF Center for Limb Preservation

In 2011 Dr. Reyzelman dedicated time and effort building a Limb Preservation and Wound Care Center at UCSF. He partnered with Dr. Michael Conte MD, a Vascular Surgeon, to help diabetic patients in need of advanced wound care and limb preservation. This multi-disciplinary approach pools the expertise of vascular surgeons, podiatrists, reconstructive microsurgeons, and other specialists to provide integrated, multidisciplinary, care for patients at high risk of foot and leg amputation, particularly diabetic patients.

Your first step towards an active, pain-free lifestyle starts here.