5 things you can do to reduce the risk of your ulcer moving to amputation

5 things you can do to reduce the risk of your ulcer moving to amputation

I have been diagnosed with a chronic diabetic foot ulcer and I’m terrified it will get worse.  What are the most important things I can do to prevent amputation?

Test blood flow

If you are one of the approximately 30 million people in the United States with diabetes, then hopefully you are aware of the term “diabetic foot ulcer”.   Why do diabetics often develop ulcers, which are non-healing wounds on their feet?  Once present, will these wounds result in amputation?

First, here are some staggering statistics that reveal how vast this problem is, and why if you are struggling with this condition, you should understand you are hardly alone in the struggle.

  • As of 2015, 30.3 million Americans (9.4%) of the U.S population have diabetes. These numbers are increasing, and the number of actual diabetics is likely much higher, with many individuals undiagnosed, and others considered “pre-diabetic”.   According to the CDC, more than 100 million adults are now living with diabetes or pre-diabetes. ¹
  • DFUs are common complications of diabetes with an annual incidence of 1-4% with a lifetime risk of 15-25% and a recurrence rate within 5 years of 50-70%! 2,3   They are a leading cause of hospitalization, osteomyelitis (bone infection), and amputation in patients with diabetes. 1,3,4
  • Every 7 minutes, a lower limb amputation occurred among patients with diabetes. 2,a
  • 15% of DFUs result in lower extremity amputation. ³
  • Greater than 80% of leg amputations in patients with diabetes are preceded by a diabetic foot ulcer.4,5,6,7

If you have experienced a simple blister, cut or open area on your foot that has not healed in a timely fashion, an evaluation in a wound center is a good first step.

If you are currently being managed by a wound specialist and your diabetic foot ulcer is not healing, there may be issues that are slowing your progress.   A key point is that many wounds can heal, but the longer they remain open and do not improve, the greater the risk of developing infection, amputation, and even death.

What can you do to reduce the risk of your ulcer moving to amputation?

Here are 5 suggestions to promote healing of your ulcer and prevent a potential amputation:

  1. Do not miss appointments with your wound specialist.
  2. Report any concerns or symptoms to your specialist should they occur between visits.  Do not wait until your next appointment if something doesn’t feel right, or if you develop increased pain, odor, fever, chills, night sweats, nausea, vomiting or diarrhea.
  3. Make sure your circulation has been properly tested.  Many diabetics have decreased blood flow to their feet and toes. This can lead to not only delayed or non-healing but may also lead to ischemic or “dry” gangrene.  Ask your Provider to order a skin perfusion test, or segmental arterial doppler studies at the least.
  4. Do not walk barefooted, especially outdoors during the summer months.  Beaches and hot pavement have caused countless burns and wounds in persons who have lost protective sensation and feeling in their feet.  A bandage covering a wound is not going to protect the foot from additional damage, so never go barefooted!
  5. Do not soak your feet, especially in ocean, lake or even pool water.  An open wound is the portal of entry for bacteria to enter the body.  While sterile saline solution is often used to clean wounds, the saltwater in sea or gulf waters is full of organisms, which may include the flesh- eating type.  Diabetics should never soak their feet, regardless of whether a wound is present or not.

References:

  1. National Diabetes Statistics Report, 2017. Est1mates of Diabetes and Its Burden in the United States  http://www.cdc.gov/diabetes
  2. National Diabetes statistics Reports 2014 http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed July 14, 2016. 2. Singh  N, et al. JAMA. 2005;293:217-228.  3. Boulton AJM, et al. Lancet. 2005;366:1719-1724; 4. Snyder RJ, et al. Ostomy Wound Manage. 2010;56(suppl 4):S1-S24.
  3. Based on 2010 US CDC data.
  4. Snyder RJ, et al. Ostomy Wound Manage. 2010;56(suppl 4):S1-S24.
  5. Singh N, et al. JAMA. 2005;293:217-228;
  6. Driver VR, et al. J Am Podiatry Med Assoc. 2010;100:335-341.
  7. Armstrong DG, et al. Int Wound J. 2007;4(4):286-287.

Author: Dr. Desmond Bell - Chief Medical Officer at Omeza