Non-Healing Foot Ulcers

Nerve damage to the feet (neuropathy) is a major risk factor for foot ulcers. Non-healing foot ulcers can lead to infection and amputation. A minor foot sore can become very serious for a person with diabetes. Damaged sensory nerves cause loss of feeling in the feet. When there is loss of feeling or pain, foot injuries can occur.

What causes foot ulcers? When the motor nerves are damaged, some of the foot muscles may lose their tone. This changes the normal position of the foot. It can cause hammer or clawed toes (flexed toes). The fat pads protect the bony structures of the feet. With damaged motor nerves, the pads get very thin. Walking or standing for long periods of time puts pressure on these weakened areas. This causes injury. When the autonomic (involuntary) nerves are damaged, normal sweating of the feet is decreased. This can cause dry, brittle skin that cracks easily. Cracked skin makes it easy for germs to enter. Foot ulcers are also the result of poor circulation in the legs and feet. This is known as peripheral vascular disease (PVD). Blood carries oxygen, nutrients and antibiotics to injured sites. Healing becomes difficult when blood flow to an injury or ulcer is reduced.

How can you prevent foot ulcers? A monofilament test can be done in many areas of your feet. This is done during a yearly foot check up. If you do not feel the monofilament at four or more sites, you may have loss of feeling. If you cannot feel an injury to your foot, this can lead to an ulcer. Look at your feet every day. Check for signs of pressure, blisters or small cuts. This may prevent a small problem from turning into a bigger one.

What are the treatments?

Treatment involves:

  • Keeping weight off the foot
  • Cleaning the ulcer, treating infection and removing any dead tissue
  • Wearing special shoes, insoles or socks to keep pressure off of the ulcer
  • Using a protective bandage on the ulcer
  • Having surgery to improve the blood flow to the legs and feet
  • Good nutrition, controlled blood sugar levels and quitting smoking are also important parts of the treatment. Many people can continue treatment at home. However, in some cases, you may need treatment at the hospital.

Important things to remember:

  • Practice good foot care.
  • Keep your blood sugar levels within your target range. Follow your exercise and meal plan. If you smoke, stop.
  • Check your feet daily. Look for any signs of injury, pressure spots or signs of infection. Report any problems to your doctor.
  • When wounds or ulcers develop, follow the treatment your doctor gives you.

How can your doctor help you? Talk to your doctor about any risk factors you may have. Ask if you need to make any changes to improve your blood sugar levels. At each doctor visit, remove your shoes. Ask your doctor to check your feet. If an ulcer develops, follow your doctor's treatment plan. Be certain you understand your role in the care of your foot ulcer.