Diabetic Foot Ulcers
What is a diabetic foot ulcer?
An ulcer is an open wound or sore. People with diabetes are at higher risk for developing ulcers on their feet due to a higher risk for poor circulation or sensation, high blood sugar levels, nerve damage, and infection. Adequate blood circulation is necessary for foot health because fresh blood helps keep all the tissues in the area alive and working like they’re supposed to. Sufficient sensation is also necessary for foot health.
Imagine that your foot is numb. If you step on something sharp, you wouldn’t activate the reflex to pull your foot back so the sharp object doesn’t penetrate your foot deeper than it already has. You wouldn’t feel blisters forming on your feet that tell you it’s time to change your shoes or rest your feet. You might stub your toe and not realize that you tore the skin for a week, at which point you might have an infection or have made the injury worse by not taking care of it. This is NOT to say that everyone with diabetes and diminished sensation in their foot can’t feel anything at all. Not being able to feel hot, cold, pain, pressure, light touch, or dull or sharp objects just makes the individual more likely to suffer an injury and more likely to not notice it immediately.
There is also a grading system for diabetic foot ulcers, with 0 being the most mild (no ulcer) and stage 5 being the most severe (and most likely to need amputation).
Photo by Kindel Media: https://www.pexels.com/photo/people-s-feet-7294248/
How do physical therapists help?
First and foremost is the PT favorite treatment for everything: some kind of exercise! If you’re having issues with a diabetic foot ulcer, a PT can help you find the safest and most effective exercise program that will improve your symptoms. This will likely be focused on improving circulation and blood flow to the feet while preventing new ulcers or worsening existing ones. If your foot ulcer is too severe to stand on, your PT may guide you in sitting exercises that get the foot and calf muscle moving. (The calf muscle can act like a pump to help move blood along and improve circulation.) Later exercises can vary a lot since they depend on your preferences, but don’t be surprised if it involves aerobic activity!
Physical therapists are also trained in debridement (removing dead tissue), wound cleaning, choosing and applying the appropriate dressings, applying compression, and properly documenting ulcer characteristics and healing. You may need to find a wound management specialist PT for this, as many outpatient clinics don’t keep the necessary equipment on hand for regular wound care treatment.
Your PT may also provide education to you, your caregivers, or family members about caring for diabetic foot ulcers, how your exercises help, the healing process, and any lifestyle modifications that may be beneficial. Physical therapists can also recommend changes to footwear, bed setup, or seat setup that may be helpful.
If you’d like to know more about this topic, try one of these sites:
(Or call a wound care PT because there’s not a ton of info easily available to the public yet!)
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