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Diabetes and Foot Ulcers

Medical expert Dr. Mohan S. Palaniswami answers common questions about diabetes:

Q: What are the risks of developing foot ulcers due to diabetes?

Q: What are the risks of developing foot ulcers due to diabetes?

A: Foot ulcers occur in diabetics due to repetitive stress on the foot. Ulcers develop after calluses form on areas of increased pressure, such as the ball and heel of the foot, or on abnormal bony prominences.

The increased pressure seen in the diabetic foot is often due to decreased ankle motion at the Achilles tendon. This tendon becomes stiff because consistently high blood sugar levels lead to the deposition of sugar elements on the tendon.

Often, long-term elevated blood sugar levels, seen in those with poorly controlled diabetes, lead to circulation and nerve problems. The nerve problems lead to decreased sensation in the foot. The patient often doesn't even know that a sore is present. The circulation problems cause the wound to heal poorly.

Infection is a common and major complication of diabetic foot wounds. Infection leads to tissue death and progressive gangrene. Massive infection is the most common factor leading to amputation.

A large number of diabetics with persistent and untreated foot ulcers will have their lower limb amputated, so this is a very serious condition! In fact, in the U.S, diabetes is responsible for about 60% of leg amputations that are not caused by accidents. In 2002, about 82,000 lower limb amputations were done in people with diabetes.

Progressive debridement (removal of dead/infected tissue) or surgery to reconnect the blood supply can sometimes help ulcers heal. But the best way to avoid this problem is to prevent it from happening in the first place.

To help prevent diabetic foot ulcers, monitor your blood sugar levels closely with the assistance of your physician and pay close attention to the health of your feet. This includes wearing protective footwear at all times, watching closely for sores or cracks in the skin on your feet, and getting treatment right away for sores that don't seem to heal.