Diabetic complications such as poor circulation and nerve damage can result in loss of sensation and slower wound healing in the lower extremities, which can lead to the formation of diabetic foot ulcers. Diabetics are encouraged to follow a daily foot care regimen that includes washing and inspecting the feet. Ulcers commonly form on the ball of the foot or under the big toe; ulcers on the side of the foot are generally due to improperly fitting shoes. Untreated ulcers can lead to further complications for the diabetic patient.
Infection
Left untreated, an ulcer attracts bacteria which can leads to an infection of the skin and possibly bone. Signs of infection include discolored discharge, odor from the infection site and fever. Pain is often not present because of sensory loss to the foot. A deep wound culture of the ulcer is taken to determine the type of bacteria present, and antibiotics are commonly prescribed, as well as topical wound care. Sterile wet to dry dressings are recommended by the "Cleveland Clinic Journal of Medicine." The American Diabetes Foundation recommends to stay off the feet if an ulcer is present, as walking on an infected ulcer may further drive the infection into the foot or bone.
Necrotic Tissue
Skin tissue may not receive adequate oxygenation as well as become infected, causing necrosis, or tissue death, to set in if a foot ulcer is left untreated. Signs of necrosis include brown or black coloration of the skin, numbness, foul odor and swelling. The necrotic tissue must be removed for new, healthy tissue to form. Wound debridement removes all dead tissue using a sharp instrument such as a scalpel; however, topical debriding agents are also applied to remove dead tissue. The "Cleveland Clinic Journal of Medicine" reports that most patients do not feel pain during debridement procedures due to decreased sensations in the foot. Tissue is removed until a bleeding edge is seen around the foot ulcer.
Amputation
Though most diabetic foot amputations are preventable with foot care and proper footwear, people with diabetes have the most non-trauma lower extremity amputations, reports the American Diabetes Association. As a last resort, amputations remove the foot or lower extremity to save a diabetic's life. Amputations are necessary when wounds do not heal and severe infection is present, and when treatment methods such as antibiotic therapy, wound care and debridement have been attempted with minimal results.
