Types of Chronic Wounds
 Diabetic Foot Ulcers
A diabetic foot ulcer refers to any break in the top layer of the skin (epidermis) on the foot of a person who has diabetes. Ulceration may be caused by a loss of sensation (neuropathy) and/or inadequate blood flow (ischemia). For example, pressure or a cut from poorly fitted shoes can lead to a diabetic foot ulcer. A callus should be considered an ulcer. Infection is likely to arise if a wound does not receive early treatment. Since people with diabetes are less able to fight infection, early treatment is beneficial.
People with diabetes are at increased risk for neuropathy, or nerve damage affecting the motor, sensory, and autonomic nerves. Motor neuropathy can cause muscle weakness, reduction of muscle, and paralysis. Sensory neuropathy can lead to a loss of the protective sensations of pain, pressure, and heat. Autonomic neuropathy can cause the blood vessels to swell, impairing the ability to sweat and resulting in warm, overly dry feet with the skin at risk of breaking down.
The loss of sensation associated with neuropathy can make a person with diabetes unaware of the constant trauma to the feet caused by poorly fitting shoes, improper weight bearing, hard objects such as pebbles in the shoes, or infections such as athlete's foot. By preventing the detection of pain and pressure, neuropathy can make individuals with diabetes unable to adjust their gait to avoid walking on an area of the foot where pressure is causing trauma to cells and tissue.
Testing & Treatment
The goal of offloading is to relieve pressure on foot ulcers through specialized shoes or other type of foot or leg orthotics. Every person with diabetes who comes to the wound center will be given a consultation with a pedorthist, who will create personalized orthotics. Because of constant foot problems and the risk of ulcers, people with diabetes should wear shoes that have been fitted correctly. Specially designed shoes have been demonstrated to be effective in preventing relapses in people with previous ulcerations. In addition, appropriate foot coverings should be used to keep the feet warm and dry, which also helps to prevent new wounds from developing.
The two major signs of infection are cellulitis (redness) or drainage. If a wound does appear, topical dressings may decrease the rate of infection and promote a moist environment, which stimulates healing.
Oral and IV antibiotics are specifically chosen based on the patient's medical condition and the type of bacteria growing in and around the wound. (Bacteria are identified through deep cultures or tissue samples.) To prevent the bacteria from becoming resistant, antibiotics are used selectively for finite periods of time. Used correctly, antibiotics will stimulate wound healing.
Debridement is a surgical procedure used to accomplish three goals:
- Stimulate wound healing
- Remove non-living tissue
- Remove infected tissue
Once non-living and infected tissue has been removed, the wound is stimulated to contract and heal. Learn more about debridement.
In addition, the FDA (Food and Drug Administration) has approved the following therapies to help heal diabetic foot ulcers:
- Apligraf®, consists of human keratinocytes and fibroblasts
- Regranex®, a prescription drug containing a growth factor to help ulcers heal
- Dermograft® (which is not currently available)
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