What is a Diabetic Foot Ulcer? Diabetic ulcer occurs in diabetic people and is a medical term for an open sore. Ulcers of the foot are serious conditions that take a very long time to heal (weeks to months). When not treated and cared for properly, these ulcers can deteriorate and lead to severe infection, gangrene causing an alarming need for amputation. What causes a Diabetic Foot Ulcer?

• High Blood Glucose levels
• Poor Foot Hygiene
• Dry and Cracked skin
• Increased tendency to walk barefoot
• Tight Footwear (Not according to foot size)
• Injuries to foot
• Pre-existing foot deformity
• Nerve Damage (Diabetic Neuropathy)

What Tests are needed for me if I have a Diabetic Foot Ulcer? One of the common tests taken from an actively infected ulcer will be a swab or tissue sample from it. This is done under a clean and sterile technique to help identify the bacteria causing the infection. This will aid in making sure target specific antibiotics are given to help fight the infection.
Other tests taken will include

1. Laboratory blood tests (White Cell Count, CRP, ESR levels) are taken to identify infection and severity
2. Circulation tests on your legs and feet
3. X ray or scan are also done to help determine if infection is in the bone.

When do I need to start Antibiotics and for How Long? Antibiotics are usually started when your ulcer is infected (as confirmed by your doctor). The duration of antibiotics can range from 7 days to several months depending on how deep the infection is. You need to take your antibiotics regularly and complete the course to avoid complete treatment and future resistance. If you develop any additional symptoms such as diarrhoea and vomiting, make sure to immediately inform your doctor. What do I need to look out for?

1. Do you notice any skin changes? Redness or Bluish marks around your dressing area?
2. Are you having a fever, tired and unwell lately?
3. Did you notice any new blisters or ulcers?
4. Do you experience any swelling over your foot?
5. Do you notice your show becoming tight recently?
6. Do you notice any pus, watery or bleeding from the dressing? Was the dressing dry previously?
7. Do you feel any pain or throbbing around the area of the ulcer?
8. Do you notice any unpleasant smell around the dressing of your foot?

If the answer to any question is YES, do seek medical attention immediately on THE SAME DAY. Inform your treating doctor that you have diabetes and what are changes that you have noticed above.

How is Diabetic Foot Ulcer Treated?

1. Debridement when needed
• Debridement is a term used to describe the removal of hard skin, or dead or infected tissue. Debridement is not normally painful. Research shows that debridement helps foot ulcers to heal faster.
Benefits of debridement:
• It will show the full size and nature of the ulcer
• It will reduce the pressure on the edge of the ulcer
• It will reduce the risk of trapped infection.
It is normal to understand that following a debridement procedure, your ulcer may appear bigger and may bleed. However, it is a cleaner ulcer which reduces the risks of infection and further complications.
2. Pressure Relief
This is an important part of the treatment plan. Any kind of pressure exerted onto the ulcer from the walking or from the type of footwear used will slow down the healing process and further complicate the ulcer. Talk to your doctor on what will be the best way to reduce or relief pressure from your ulcer.
3. Get Regular Dressing
Regular dressing is needed to ensure the ulcer is always kept clean to avoid it from forming a suitable medium for any kind of bacterial infections.

What do I need to do after the wound has Healed? Although your ulcer has healed well, you will still need to take good care of the affected area as well as the whole foot to prevent another ulcer from forming.

• Check your feet every day. If you notice any areas of cracked skin, apply a sterile dressing holding it in place with tape or bandage.
• Make sure the bandage is not too tight.
• Do not put tape on fragile skin or wrap tape around toes.
• If you have been given special footwear or insoles, wearing them as much as possible (including in the home) will help to prevent further ulcers.

What is my Do’s and Don’ts MY DO’s

• Ensure you rest your foot well; minimize walking and doing vigorous activities
• Try to keep your leg elevated when resting
• Monitor proper blood sugar control as it is essential for healing to take place
• Be compliant to your diabetic medication daily
• Try not to adjust the dressing too frequently
• Keep the dressing as dry as possible at all times
• Be compliant to use any special foot ware or insoles that has been recommended for your use.

MY DON’TS

• Do not sit in one stationary position for a long time
• DO NOT Smoke
• Do not miss taking your antibiotics or medication unless told by your doctor.