Our Podiatrist In Scarborough, ME Can Help With Your Diabetic Foot Health

DIABETIC FOOT CARE

Diabetes, an autoimmune disease that affects millions of Americans, poses special risks to your feet. The condition slows your circulation and dulls your nerves, especially in feet and toes far from your head and central nervous system. This double whammy not only makes it harder for you to detect cuts, scrapes, and other injuries, but it also restricts your body’s ability to heal itself and fight infection. If unnoticed or untreated, even minor injuries develop into significant ulcers. You could even require an amputation. That’s why it’s so crucial to stay on top of this disease.

At-Home Inspection Is Important

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The most important aspect of diabetic foot care is how you take care of your feet at home. You see your feet every day—we don’t. Catching problems early, and seeking help promptly, is the best way to avoid serious complications, such as amputation of a toe or foot.

Inspect your feet carefully and thoroughly at least once per day. Use a mirror or enlist a loved one if you have any difficulty seeing the bottom of your feet. Any cuts, scrapes, blisters, swelling, or any skin or nail issues should be reported to your doctor.

Treating Your Feet Right

  • To minimize the risk of infection, keep your feet clean, dry, and protected. Wash your lower limbs gently in warm water and dry thoroughly, including between the toes. A pumice stone can be used to carefully and gently scrub calluses and dry, dead skin. Use a moisturizer (everywhere but between the toes) to keep dryness and cracking at bay.
  • Be careful when trimming nails—always cut straight across from corner to corner, and not too short. Doing so reduces the chances of developing an ingrown toenail, which can be painful and easily become infected, or lead to fungal toenails.
  • Keep your feet protected by always wearing a comfortable, supportive pair of shoes that fits you well whenever you leave home, and check the inside of your shoes before putting them on to make sure they do not contain foreign objects. Although any pair of shoes will protect you from stepping on foreign objects, shoes that don’t fit you well can lead to sores, blisters, corns, or other conditions due to painful friction.

Managing Your Condition

Taking care of yourself and managing your diabetes will keep your circulation stronger and your nerves healthier, which in turn will help protect your feet. Carefully managing your sugar levels, maintaining a good diet, refraining from smoking or alcohol abuse, and getting plenty of exercise is good for your whole body, including your lower extremities.

Get a handle on your diabetic wound care!

How Lighthouse Foot and Ankle Can Help

Our office provides a full suite of diabetic foot care, from yearly foot checks to diabetic toenail trimming, corn and callus removal, custom orthotics, wound care, and more. Whether you have an ulcer that needs debridement, or you’re just looking for tips on selecting a good pair of shoes, Dr. Michele Kurlanski and the staff at Lighthouse Foot and Ankle Center are here to help.

If you notice any problems during your regular foot checks, including swelling, itchiness, redness, blisters, or other abnormalities, call Dr. Michele Kurlanski at (207) 774-0028 today. You don’t have to manage diabetes alone—let us help you stay healthy and on your feet.


WOUND CARE - DIABETIC FOOT ULCER

There are several risk factors for developing a diabetic foot ulcer....

  • Absence of protective sensation due to peripheral neuropathy
  • Arterial insufficiency, poor circulation
  • Foot deformity (hammertoes, bunions) and callus formation resulting in focal areas of high pressure
  • Autonomic neuropathy causing decreased sweating and dry, fissured skin
  • Limited joint mobility
  • Obesity
  • Impaired vision
  • Poor glucose control leading to impaired wound healing
  • Poor footwear that causes skin breakdown or inadequately protects the skin from high pressure and shear forces
  • Kidney disease

What can you do to decrease your risk of a diabetic ulcer?

Have your feet checked yearly by your podiatrist for signs of poor circulation or peripheral neuropathy, or more frequently if you already have these symptoms.

  • Quit smoking
  • Monitor blood sugar levels
  • Exercise, stretch, lose weight
  • Wear extra depth diabetic shoes with diabetic inserts prescribed by a podiatrist
  • Hydrate skin daily with a moisturizing lotion
  • Treat athlete's foot with an over the counter antifungal
  • Check your feet daily, if you cannot reach your feet, use a hand mirror or ask a loved one to check them
  • Call your podiatrist at the first sign of an ulcer, redness, drainage, swelling, foul odor.
  • Don't be afraid to call a podiatrist if you don't have an established relationship with one.  Podiatrists consider ulcers to a "heart attack of the foot" and patients can be seen immediately.
  • The sooner an ulcer is detected the easier it is to treat and heal.

I have found over the years, I really like to treat wounds, especially diabetic wounds. There is something very satisfying about watching an ulcer transform into new skin.

There are several types of wounds.

  • Venous stasis ulcers
  • Diabetic neuropathic ulcers
  • Ulcers secondary to peripheral vascular disease
  • Traumatic ulcerations
  • Post surgical wounds
VENOUS WOUND

Small venous stasis ulcer

These ulcers are caused by blood pooling in the legs due to venous insufficiency. Treatment for venous stasis ulcers include antibiotics for infection, controlling drainage, debridement of the wounds, compression dressings or stockings and possibly grafting. These wounds can take many months to heal and can be quite frustrating. Patients with these types of wounds may benefit from laser or radiofrequency ablation of incompetent veins or sclerotherapy.  Fortunately this patient is on her way to healing.  Once the wound has healed it is important to wear compression stockings.

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Infected diabetic neuropathic ulcer

This ulceration was caused by friction and pressure in an uncontrolled diabetic. Treatment included antibiotics, debridement, wound care, offloading by taking pressure off the ulcer. The patient achieved control of his blood sugar with diet and adding insulin to his oral medication. The ulcer eventually went on to heal with an Apligraf and wound care. Prevention of future ulcers is achieved with periodic visits and extra depth diabetic shoes with diabetic inserts.

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Infected diabetic neuropathic ulcer

This ulceration was caused by friction and pressure in an uncontrolled diabetic. Treatment included antibiotics, debridement, wound care, offloading by taking pressure off the ulcer. The patient achieved control of his blood sugar with diet and adding insulin to his oral medication. The ulcer eventually went on to heal with an Apligraf and wound care. Prevention of future ulcers is achieved with periodic visits and extra depth diabetic shoes with diabetic inserts.

Neuropathic ulcer on the great toe

This ulcer was caused by lack of sensation to the feet from neuropathy without diabetes. Treatment for this ulcer is similar to those with diabetes, offloading, diabetic inserts, shoe modifications, wound care, debridement and antibiotics if necessary.

Non infected diabetic neuropathic ulcer

This patient has a non painful ulcer of the plantar surface of her foot. Unfortunately she has already lost her other leg.

Diabetic neuropathic ulcer that started out as a callus.

 

Wet gangrene

A diabetic patient with acute osteomyelitis (bone infection) of the great toe and cellulitis.  It is considered "wet" due to the active infection and black necrotic tissue.

Ischemic ulcer/gangrene fourth toe

This wound is due to loss of blood flow to the small blood vessels causing the tip to turn black. There are ischemic changes to the third toe as well. This patient has a history of tobacco abuse, high cholesterol and Raynaud's disease. Treatment includes referral to a vascular surgeon for possible revascularization, smoking cessation, amputation and antibiotics for infection. Hyperbaric oxygen can also be a treatment option.

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Traumatic Wound

Traumatic wounds can lead to infection in the bone. In this photo the end of the second toe is enlarged and swollen secondary to a chronic bone infection. Treatment includes local amputation and antibiotics. The patient went on to heal very well after removal of the end of his toe.

 

Malignant Melanoma

This may look like a diabetic wound initially but it is an aggressive form a skin cancer that must be treated quickly.  This patient had his fourth and fifth toes amputated within a few weeks of a biopsy.

Chronic Osteomyelitis First Toe 

Here is an example of chronic osteomyelitis in the great toe.  The wound bed is red and granular but centrally the wound probes to bone.   Swelling and scaling around the nail plate also suggest chronic infection.  Treatment is amputation and antibiotics. Patient is status post 2 months amputation on the right.  The patient may develop hammertoes of the lesser toes which may be treated by cutting the tendons to the bottom of the toes. 

Post Surgical Wound

This patient had a first ray amputation for acute osteomyelitis of the first metatarsal.  The wound was left open to insure that the infection had resolved and allowed to granulate by secondary intention with a VAC dressing. The wound was then treated with Apligraft after the wound became granular.

Pre-ulcerative callus in patient with diabetes and hammertoe. 

The callus is considered pre-ulcerative due to the dried blood in the callus.  The patient a percutaneous flexor tenotomy of the second toe in the office. The picture on the right show the toe one week after the procedure. 

Total contact casting for diabetic ulcers. 

Casts are applied weekly untl the wound is healed and then a final application for one week after the wound has healed.  The patient is able to walk in the cast full weight bearing. 

Non-Diabetic ulcerated callus

This patient is not a diabetic, but she is profoundly neuropathic. The first picture is her wound surrounded with blood, she is on coumadin and her INR levels were higher than normal on this day. She has been dealing with this ulcer for 4 years or more. We recently performed a percutaneous flexor tenotomy on the second toe. The toe is now completely healed. (Updated picture to follow)

Diabetic Foot Ulcer

This patient presented with a new diabetic foot ulcer. This was created from wearing new shoes. It is very important to know the proper break in for new shoes and to always check your feet when removing your shoes. This patient was put into a total contact cast to offload the area. She has healed nicely.

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Cavus Deformity of the foot, diabetic

This patient has a major deformity of the foot that causes him to walk on the outside of his foot. This, along with diabetes has caused him to ulcerate due to the added pressure. He is having a skin graft done soon to help him heal, and possible reconstructive surgery to correct the deformity.