Looking After Your Diabetic Foot Ulcer

Contents

• Introduction
• Podiatry treatment
• Antibiotic treatment
• How to care for your diabetic foot ulcer
• Surgery
• Prevention

Introduction

Diabetes is a lifelong condition which can cause foot problems. Some of these problems can occur because the nerves and blood vessels supplying your feet are damaged. This can affect:

• the feeling in your feet (called ‘peripheral neuropathy’)
• the circulation in your feet (called ‘peripheral vascular disease’ or ‘ischaemia’).

These changes can be very gradual and you may not notice them. This is why it is very important that you check your feet regularly, especially when on holiday as you may be more active than usual. It is also essential that you have your feet screened every year.

If you have a diabetic foot ulcer, this means that an area of skin on your foot has broken down and the tissue under it is now exposed.

In some people with diabetes the skin does not heal very well and is likely to develop an ulcer or infection after only a minor injury. About one in ten people with diabetes will develop a foot ulcer at some stage.

A foot ulcer can become infected and the infection may become severe. It is important that you look after your foot ulcer to prevent the infection from coming back.

If you have a diabetic foot ulcer, you will need regular podiatry treatment. Your podiatrist will draw up a treatment plan for you tailored to your particular needs.

Podiatry treatment

A diabetic foot ulcer may be hidden beneath hard skin and can gather dead tissue around it. The podiatrist will need to remove this to help your ulcer to heal. This can cause the ulcer to bleed a little but this is completely normal. Do not try to treat the ulcer yourself.

Antibiotic treatment

You will be given antibiotics if there are signs of infection in the wound or in the nearby tissue. Report any problems you have with the antibiotics (for example, if they bring you out in a rash, or if you experience nausea or diarrhoea) to the person who prescribed them for you. If this person is not available, contact your GP immediately. Do not stop taking your antibiotics unless the person treating you, or your GP, tells you to do so. Make sure you have enough antibiotics to finish the course so your treatment isn't interrupted.

If the infection is spreading, you may need to go to hospital where you will be given antibiotics straight into your bloodstream to treat the infection quickly. This happens only rarely.

How to care for your diabetic foot ulcer

Dressings

Do not touch the dressing unless you have been properly shown how to remove and replace it and you have suitable dressings to replace the one you are changing.

It is very important that you do not get the dressing wet. This may prevent healing or allow bacteria to enter the ulcer, which will cause more problems. Your podiatrist may be able to supply you with a dressing protector to keep the dressing dry, or they may give you a form to take to your GP to allow you to get a dressing protector on prescription. The dressing protector will allow you to have a bath or shower safely while keeping your dressing dry. 

Check your feet

You should continue to check your feet every day for any other problem areas. You should pay close attention to any of the following danger signs when checking your feet:

• Is there any new pain or throbbing?
• Does your foot feel hotter than usual?
• Are there any new areas of redness, inflammation or swelling?
• Is there any discharge?
• Is there a new smell from your foot?
• Do you have any flu-like symptoms?

Moisturise the surrounding area of your feet

If your skin is dry, apply a moisturising cream every day, avoiding areas of broken skin and the areas between your toes.

Do not stand or walk on the affected foot

Avoid any unnecessary standing or walking. A wound cannot heal if it is constantly under pressure. Rest as much as possible and keep your foot up to help it to heal. Use anything your podiatrist recommends or gives you to relieve pressure on your foot. 

Footwear

You may be asked to wear a cast, a device to relieve pressure or a special shoe until your ulcer has healed. You should not wear any other footwear until your podiatrist tells you that you can wear your own shoes again.

Podiatry appointments

Always attend your appointments to have your ulcer treated. You may need regular appointments until the wound has healed. Your appointment may be with a district nurse, a treatment room nurse or your podiatrist.

Surgery

If an infection becomes severe, you may need a small operation to clean out the wound.

If an infection is very severe, an amputation may be needed to save the healthy parts of the foot.

If your circulation is reduced, you may need a small operation to increase the blood supply to the ulcerated area.

If you discover any more problems, or if you are concerned about the treatment of your foot ulcer, contact your local podiatry department or GP immediately for advice.

Prevention

Controlling your diabetes, cholesterol and blood pressure levels, as well as having your feet screened and assessed every year by a podiatrist, will help to reduce future problems with your feet.

If you smoke, you are strongly advised to stop. Smoking affects your circulation and can lead to amputation.