An ulceration or ulcer is usually a painless sore on the bottom of the foot or top of toes which results from excessive pressure at that site. Trauma in the form of heat, cold, shoe pressure, or penetration by a sharp object must all be suspected as potential causes. The trauma or injury that causes most of the problems for diabetics' feet doesn't happen all at once, like the injuries that we are most familiar with. Instead, they happen from repeated small injuries, happening over long periods of time; what doctors call "repetitive microinjuries".
Ulcers frequently may form under a pre-existing corn or callus which was permitted to build up too thickly. Neuropathy allows these lesions to develop because the normal warning sense of pain has been lost and they go unrecognized. This would be called a Neuropathic ulcer. Continued pressure or walking on the injured skin creates even further damage and the ulcer will worsen. The open sore will frequently become infected and may even penetrate to bone. Poor circulation can also be a predisposing factor for ulcerations, since the skin is often unable to heal minor cuts or blisters.
Instead of healing normally, these minor irritations can also worsen into full thickness ulcers in the skin. Ischemic ulcers, as these might be called, are usually quite painful, unless neuropathy is also present at the same time. In the latter instance, such ominous lesions would be called Neuro-ischemic ulcers.
Treatment relies heavily on early recognition of the ulceration, avoidance of weight bearing (walking), and early intervention by your foot doctor. Debridement, or trimming away callus and dead tissue, is an essential part of ulcer treatment. In fact, frequent debridement has been shown to lead to higher rates of healing than when such frequent care was not given. Recently, new agents such as topical growth factors or tissue replacements have become available, which can also speed the rate of wound healing when blood supply and good wound care is practiced. Aside from local wound care, dressings, and antibiotics, a variety of other measures may be necessary to adequately relieve pressure from the area. When crutches, wheelchair, or bedrest are not feasible, plaster casts, braces, healing sandals, special shoe inserts or padding may be used to protect the foot while it heals. If circulation is inadequate to allow healing, your podiatrist may recommend that you consult a vascular surgeon for appropriate evaluation and possible vascular reconstructive surgery. Multidisciplinary management is more the rule than the exception for diabetic foot ulcers, because no one specialist can adequately treat all aspects of the disease and its complications. Other health professionals on the team usually include your internist or endocrinologist, cardiologist, orthopedist, neurologist, nurse, diabetes educator, therapist, and pedorthist.
Once your wound is healed, it is extremely important to see your foot doctor regularly for check ups and foot care. Special footwear and inserts will be recommended to protect your feet and prevent new or recurrent lesions from developing.