Transcription:
Help for Diabetic Foot Ulcers

 Melanie Cole (Host):  There is help for people who have chronic problems with foot sores. It’s important to seek help and not wait until the wound is severe. Diabetic foot sores can quickly become infected and lead to partial or total foot amputation. My guest today is Lindsey Graff. She is a wound care specialist with Aspirus Health System. Welcome to the show, Lindsey. Tell us about the issue that diabetics have with their feet and why this can rapidly become something very severe.   

Lindsey Graff (Guest):  Good morning. Diabetics, unfortunately, just because of the disease process of diabetes there are multiple factors that make them more at risk for getting infections and having those infections quickly get out of control. Some of this has to do with the affect that diabetes has on their blood vessels. The other main concern is that oftentimes diabetes affects the sensations of the patient’s foot and the patient is not aware that there has been an injury to the foot. These injuries can go unnoticed and untreated for some time before they are noticed and treated and, unfortunately, then we are usually in a very emergent situation.

Melanie:  Many of these people these develop these foot ulcers, they don’t feel it down there. So, even when they are wearing shoes, it’s not like when you have a blister, right? You’re not feeling this wound that may be getting worse.

Lindsey:  Correct. It is always very important that diabetics where protective footwear to help prevent trauma. Even ill-fitting or incorrectly fitting shoes can cause trauma and can perpetuate an ulcer.

Melanie:  What is causing the ulcer itself? You said shoes, or they are not keeping good track of their health and their blood sugar. They get, what? A wound down there, like a sore?   

Lindsey:  Yes, correct. Sometimes what happens is it’s a callous and the callous becomes a sore.     

Melanie:  What would you like diabetics to know? Should they be checking their feet every night? Should they go see a podiatrist? What do you want them to do?  

Lindsey:  Both of those are great suggestions. It’s very important for a diabetic--even if they have good control of their blood sugars or even if they have sensation of their feet--to have good preventative care provided by a podiatrist. A podiatrist can also help them have appropriate fitting footwear to help avoid any injuries that footwear can cause. Important nutrition and maintaining good blood sugar control is also important to help prevent sores or wounds from becoming infected and getting out of control quickly.  The most important thing is if a person who is diabetic were to notice any kind of skin breakdown on their foot, they need to seek care sooner than the average healthy person would because they are so much more susceptible to the effects of the disease process.

Melanie:  What do you do for them if you have determined that they have a foot ulcer? Maybe they knew about it, maybe they didn’t, and they come to see you. What do you do for them?    

Lindsey:  We provide comprehensive care here at Aspirus Wound and Hyperbaric Center. We treat the wound and try to minimize any complicating factors such as infection or devitalized tissue that may interfere with the normal healing process. We also look at nutrition and how to support patients with their nutrition and helping them get their blood sugar under control. We also do vascular studies to make sure that they are getting appropriate blood flow to that wound so that they can get the nutrition and oxygen that that wound needs to heal.

Melanie:  We were recently talking about hyperbaric oxygen and the doctor mentioned that for diabetic foot ulcers. The person goes in with their whole body and that helps with their feet as well.

Lindsey:   Correct. That is one of the advanced modalities that we have available to us here at the Wound and Hyperbaric Center that we can utilize to help diabetics heal their ulcers and heal them faster which minimizes the risk of complications, including worsening infections and amputations. There are a lot of statistics out there that show that people who have diabetes and develop an ulcer on their foot, if there has not been a significant amount of healing within the first four weeks statistically their risk of having an amputation skyrockets at that point. So, that’s where early, aggressive care is so important to help minimize those complications including amputation.

Melanie:  Speak about prevention a little bit, Lindsey. What would you like people to know about hopefully preventing this in the first place if they do know that they’ve got poor circulation? Are there ways to keep your feet healthy? What are your best tips?

Lindsey:   Again, it goes back to looking at your feet every day by visually inspecting and not depending on the sensation of knowing there is a wound that may be developing. Two, if you are diabetic working with your primary care provider and/or a podiatrist to have frequent foot checks and foot care. Sometimes this means seeing somebody who is certified in nail and foot care to do callus removals and nail trimmings so that way you don’t accidently remove too much of the callus or the nail and unintentionally give a wound that could start the process of a non-healing diabetic foot ulcer. 

Melanie:  Is there a limit on such things like pedicures and things that people might do on a normal basis for people with diabetes? Do you have tips for them about that?

Lindsey:  Again, the best thing is to seek care with somebody who is certified in foot care who understands the nature of diabetes and how it affects the vasculature of the foot; like I’ve said before, working with a podiatrist.  

Melanie:  What about shoe wear, Lindsey? Are there certain types of shoes you would tell somebody who is more at risk for this situation like “don’t wear sandals” or “don’t wear high heels”? Are there any footwear recommendations you can give?

Lindsey:  Typically, you want an enclosed shoe--something that is going to protect the toes and the heel. It is important that the shoes are the correct size. This means that if you are not working with a podiatrist or with somebody who specializes in fitting your shoes that you are even utilizing an outline of your foot and making sure that it fits in the shoe appropriately. Oftentimes, very pointed toes or narrowing over the toe portion are not appropriate because you can have a lot of trauma to the fourth and fifth toe. That’s where a lot of times these ulcerations can begin. Fully enclosed foot wear is always the best bet.

Melanie:  It’s so interesting that podiatrists are now such a big part of diabetic care. In just the last few minutes, Lindsey, give your best advice for people with diabetes in taking the best care of their feet and why they should come to Aspirus for their care.

Lindsey:  Thank you. Again, there is a huge risk for anybody who has diabetes, whether it is uncontrolled or controlled, to suffering very significant complications if they were to develop any kind of wound or sore on their foot. It may start out as something that seems innocuous, something that as a young person they would have healed fine on their own but, unfortunately, due to the chronic effects of diabetes, they are at increased risk for a more significant reaction if there is an infection than somebody who does not have diabetes. I think that the thing that we do very well here at Aspirus is we have many disciplines that work closely together to have collaborative practice to help people with prevention. If they were to develop a wound, then to act quickly to try to minimize the risk of complications. That includes working with the Aspirus podiatrists and other podiatrists in the area with our vascular team, with the nutritionists that are available as well as the endocrinologist and diabetic educators. That is something that we are able to do well here at Aspirus because we have so many of these specialists available to us and we all work very closely together.

Melanie:  Thank you, Lindsey, for being with us today.  You’re listening to Aspirus HealthTalk and for more information you can go to Aspirus.org. That’s Aspirus.org. This is Melanie Cole. Thanks so much for listening.