Foot ulceration is a common problem facing many diabetics. If left untreated, foot ulcers can lead to serious complications which may require severe surgical intervention. Patients who do not develop ulcers are also 50% more likely to live at least another 10 years than those that do.
An article recently published in The New England Journal of Medicine has urged carers to pay closer attention to patients’ feet once they have recovered from an ulcer.
Research has shown that while most diabetic foot ulcers will heal within a year, 40% of patients will experience a recurrence within a year. This increases to 65% within five years.
In the article, Dr David Armstrong, Professor of Surgery and Director of the Southern Arizona Limb Salvage Alliance at the University of Arizona College of Medicine, and his colleagues discussed some evidence-based recommendations on how to prevent the recurrence of diabetic foot ulcer.
Here is a summary of the strategies they recommended:
1) Maintain good control of blood sugar levels
2) Wear prescribed footwear
It is recommended that patients have their footwear assessed by professionals every 1-3 months. There is a large body of evidence indicating that patients who consistently wear prescribed pressure-relieving footwear are less likely to experience ulcer recurrence.
There are also pressure platforms and in-shoe pressure monitors that could detect regions of the foot receiving repetitive stress.
3) Home monitoring of foot skin temperatures
There is evidence to suggest that it is possible to use an infrared thermometer at home to detect ulcer formation before any signs are outwardly visible. Comparing the difference in temperature between feet can be a useful method in detecting the presence of inflammation, a response triggered by damage to tissue in the foot.
The recently marketed “smart-mats” by the start-up company Podimetrics may also make this easier for patients. A patient steps on the mat for 20 seconds, and it measures elevations of temperatures at different areas of the foot.
When inflammation is present, patients are recommended to reduce their activity.
4) Regularly check feet for any signs of damage
Early detection of new lesions is critically important for reducing complications. These early lesions include blistering, calluses, and hemorrhage (signs of bleeding).
5) Address peripheral vascular disease
Many diabetics also suffer from peripheral vascular disease (this is a condition where your blood vessels narrow or become blocked, resulting in problems in blood circulation). Since problems in blood circulation is a contributing factor to ulcer development, it is vital that peripheral vascular disease managed to prevent ulcer recurrence.
In the cases where the above strategies have not been successful and there is a consistent recurrence of ulcers in the patient, a surgical response may have to be provided.