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Living with Your Diabetic Foot Ulcer

A Guide for Patients and Caregivers

This guide is for you, our patient, and any caregivers who may be involved in your care.

This guide explains how we can help you to help your Diabetic Foot Ulcer. It is full of information to help you to understand what it going on with yoru body when you have a wound and what your body needs to heal the wound or, if it can't heal, to feel better. 

What is a Diabetic Foot Ulcer?

Your doctor or nurse has determined that the wound on your foot is a diabetic foot ulcer which is also known as a DFU. This is a wound that has difficulty healing due to diabetes.

How Did I Get This Diabetic Foot Ulcer?

A DFU is usually caused by trauma related to tight fitting shoes or an injury you may not have felt, which could be due to neuropathy.

NEUROPATHY

Neuropathy is when people with diabetes may have damage to their nerves. This leads to trouble in three areas.

Feeling Pain: Your ability to feel pain in your hands and feet may have decreased. If you don’t feel pain, you cannot avoid the activity that is hurting you.

Your nurse will have performed a test called a Monofilament Test where they test the sensation in your feet with a small filament like a piece of fishing line. The nurse will have recorded the areas of your feet that have decreased sensation. If this was not done, ask your nurse about it.

Decreased Ability to Sweat: You may have decreased or absent ability to sweat on your feet and legs, leaving them very dry and your heels may get hard and cracked. If you have cracks in your heels your risk of infection increases as germs can get in to your body through the cracks.

Brittle Bones in Your Feet: The bones in your feet can become brittle. This means that you can actually break a bone in your foot and not know it because you didn’t feel it. This causes your feet to change shape and to possibly not fit into your shoes anymore.

You can also develop a loosening of the tendons that hold up the arch in your foot, making your foot flat and change shape. The changed areas can become pressure points leading to injury. You may hear this called a “Charcot foot.”

CIRCULATION

People with diabetes may also have trouble with blood circulation and are at increased risk for infection. The combination of nerve damage, increased risk for pressure and trauma to your feet, and poor circulation significantly increases your risk for a DFU.

• If you have adequate blood flow to your foot and toes, your chances of healing your wound improve and your risk for infection decreases.
• If you do not have adequate blood flow to your foot and toes, chances of healing are less, and your risk for infection is more.
• Your doctor may send you to a vascular surgeon to see if you need surgery to improve your blood flow or your doctor or nurse may perform tests called an Ankle Brachial Pressure Index and/or a Toe Brachial Pressure Index to determine the blood flow to your foot and or toes.

CALLUS FORMATION

You are at higher risk for calluses on your feet than people who don’t have diabetes because of your neuropathies.

• A callus acts like a stone each time you put your foot down. But because you may not feel the pain, you don’t stop stepping on the callus! In time, the pressure from the hard callus causes a wound under it.
• The wound may appear to “pop” open, and you will see drainage, or the area may swell and become infected.
• You will need to have your doctor or nurse pare the calluses on your feet regularly to prevent wounds from forming underneath the callus.

TRAUMA TO THE FOOT

• When you have a DFU on the bottom of your foot, each step you take puts pressure on the area. This increases the damage and stops the healing. You must not walk on your wound - ever!
• Even when your wound is healed, you must never walk bare foot!
• Always wear shoes or slippers, even if just getting up to the bathroom at night. If you have neuropathy, you can injure yourself without knowing it.
• Your doctor or nurse will help you to learn how to offload your DFU. This means that you will have shoes or devices that allow you to walk without putting any pressure on the wounded area.

Things I Can Do To Help My Diabetic Foot Ulcer Get Better

Manage My Blood Sugars

• When my blood sugar is high I am more at risk of infection and poor healing. I will check and record my blood sugar____ times a day.

• My diet impacts my blood sugars. I will follow my diabetic diet plan provided by my Diabetes Educator or Dietitian.

• Exercise helps my circulation and helps control my blood sugars. I will discuss which exercises would be okay for me with my doctor, nurse or Diabetes Educator.

• If okay with my doctor or nurse, I will start a regular exercise program ____ times per week for _____ minutes each day.

• My medication helps control my blood sugar. I will take my medication as prescribed.

Take Care Of My Feet

• My DFU was caused by a trauma to my foot that I did not feel because I have damaged nerves (diabetic neuropathy). I must remove the pressure from my ulcer. I will talk to my doctor about how to remove the pressure from my feet and especially the ulcer area.
• My feet are always at risk of new wounds. Each day I will wash and inspect my feet for wounds and dry well between my toes to prevent fungus.
• My feet are dry because of my diabetes. Every day, after I wash my feet, I will apply appropriate moisturizers to my feet and heels, but not between my toes.
• Nail care is really important to prevent wounds. I will cut my nails straight across, then file the edges smooth. (If I can’t see my nails well I won’t cut them myself).
• I could get a burn on my feet because I can’t feel if the water is too hot. I will always test hot water with my elbow and be careful with heating pads, heaters, etc.

• I could get frostbite without knowing it. I will protect my feet from cold and check them when I come inside.

Sock and Shoes

• My shoes and slippers protect my feet. I will never go barefoot (not even at night when I go to the bathroom).
• If I get a cut, it might bleed or drain. I will wear loose and light coloured socks (with no irritating seams) so that I can see blood right away.
• Since I cannot feel my feet, I won’t know if something is in my shoe. I will check my shoes before putting them on for wear and tear or foreign objects.
• I will be careful to buy the right size shoe. Since my feet swell, I will buy my new shoes at the end of the day so I buy shoes big enough.
• If my foot shape has changed, I will consider buying special orthopedic shoes to help prevent a wound.
• My doctor needs to see the shoes I normally wear. I will always take the shoes I normally wear to my doctor’s appointments.