Diabetes and Wounds: Caring for Sores
Avoid amputation with the prevention and early treatment of skin sores.
By Gina Shaw

WebMD FeatureReviewed by Louise Chang, MDEvery 30 seconds, somewhere in the world, someone loses a lower limb as a result of diabetes. That's because diabetes and wounds are a dangerous combination.

If you have diabetes, there's no such thing as a minor wound to the foot -- even a small foot sore can turn into an ulcer that, if not properly treated, can lead to amputation. The rate of amputation for people with diabetes is 10 times higher than for those who don't have the disease.

Most of these amputations could easily be prevented with good foot care and wound treatment. "You can't always prevent an ulcer, but you can almost always prevent an amputation," says Harold Brem, director of the Wound Healing Program at Columbia University College of Physicians and Surgeons.

Here's what you need to know about preventing foot sores and treating them in order to avoid an amputation.

Diabetes and Wounds: Prevention Matters
People with diabetes are at increased risk for complications from wound healing for several reasons. First, diabetes decreases blood flow, so injuries are slower to heal than in people who do not have the disease. Second, many people with diabetes also have neuropathy -- reduced sensation in their hands or feet -- which means they don't necessarily notice an injury right away.

Why are feet at more risk for diabetes wounds? Because feet just take more of a beating in our daily lives than hands do, and we don't look at them as often, so it's harder to spot a wound.

5 Tips for Preventing Foot Sores
The best way to prevent wound complications is to prevent the wound in the first place. You do that by taking good care of your feet. Top ways to keep your feet in good health include:

Check your feet every single day, and wash them with mild soap and water. (Be sure to check the water temperature first.) Make it part of your daily routine, just like brushing your teeth.
Dry your feet well . Moisture retained between the toes can cause skin breakdowns.
Be cautious in nail salons . Though some specialists recommend avoiding salons and having your nails cut only by a podiatrist, others simply urge caution. "You want to make sure the salon's certification is current and visible," says Brunilda Nazario, MD, a diabetes specialist and senior medical editor for WebMD.
And ask when the salon was last inspected by the state, Nazario says. Before treatment, watch to see that the tools are properly sanitized. They should be freshly unwrapped or have just been removed from heat or chemical sterilization -- if it's not clear, ask. If you choose, you could also bring your own nail files.Will you be using a foot spa? Find out whether it's been cleaned and disinfected. "These precautions aren't just for people with diabetes," Nazario says, "They apply to everyone."

Keep your feet from drying and cracking with regular applications of foot cream. You don't need a special cream -- any moisturizer available at your drugstore, like Aquaphor, Cetaphil, and Eucerin, will work.
Use an antifungal cream if you have evidence of athlete's foot (tinea pedis) or other fungal infection. Athlete's foot can make the skin crack and peel, which increases your risk for an infection. Be on the lookout for fungal nail infections, too (nails will look and feel harder, darker, and thicker). See your podiatrist or your doctor about treatment and care.

Avoid fancy footwear . This means no tight socks and, above all, no tight, pointy shoes with high heels.
"Footwear is probably one of the biggest offenders," says Jeffrey Buehrer, MD, a vascular surgeon and wound care specialist at Firelands Regional Medical Center in Sandusky, Ohio. A well-fitted pair of athletic shoes is often a safe bet, or your podiatrist can work with you to have shoes custom-fitted for your needs -- often at no charge through the Medicare therapeutic shoe program. Brem admits that these shoes may not be the most stylish, "But they will likely save your limb."

Diabetes and Wounds: Getting Timely Treatment
What if, despite your best efforts, you develop a foot sore? "Any break in the skin of the foot is an absolute emergency," declares Brem. "There's no such thing as 'just a little cut.'" Brem's recommendations:

Put a triple antibiotic cream on the foot sore immediately
Cover the wound with a light gauze and keep pressure off the area
See a local wound center within seven days at most
And calluses, which are precursors to foot ulcers in many diabetic patients, should be considered -- and treated -- just as seriously.

"Diabetic foot wounds can develop complications rapidly," explains Buehrer. "I'll see patients who tell me that they scratched their foot in the garden and everything seemed fine, and then they woke up two days later to find it horribly swollen. Early intervention is always better."

Once you go in to see the doctor about your foot sore, he or she may do several things:

Test that you have a good blood circulation to the area. This is called an ankle brachial index.
If the ankle brachial index is 0.9 or less, you should see a vascular surgeon to determine if intervention is necessary. "An ankle brachial index of 0.9 or below could point to a 50% occlusion of a major artery."

Cleaning a foot sore is a process known as debridement. The doctor can culture the area to check the type of bacteria that may be present.
"Looks can be extremely deceiving in a person who has diabetes and a foot ulcer," Brem says.

Offload your foot. This means putting it in a special custom-designed support boot -- such as the Cam Walker or Air Calf Boot. "This may be bulky, but it's absolutely necessary until you heal," says Brem. "If everyone did these steps, amputations would decrease by 90%."
Diabetes and Wounds: Putting the Specialists Out of Business
"If everyone followed these steps, I'd be out of business," says Brem. "I'm begging you -- put me out of business. Most amputations can be avoided through prevention and early treatment."

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