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Diabetic foot ulcers are sores or
wounds on the feet that occur in people with
diabetes, a condition where blood sugar levels are
abnormally high. If a foot ulcer goes untreated and does not heal, it may
become infected. Because this may result in the foot needing to be
amputated, preventing ulcers is very important. The January 12, 2004,
issue of JAMA includes an article about
preventing diabetic foot ulcers.
What causes diabetic foot ulcers?
In people with diabetes, prolonged high blood sugar
levels are linked with damage to the nerves in the feet. Nerve damage can
cause loss of sensation as well as deformities of the feet. This nerve
problem is called peripheral neuropathy.
Foot problems such as calluses and hammertoes can cause
high pressures on the soles of the feet.
People can hurt their feet by repetitive minor trauma
(such as prolonged walking) or a single major trauma (like scraping their
skin, stepping on objects, immersing their feet in hot water, cutting their
toenails inappropriately, or wearing ill-fitting shoes). Because of
peripheral neuropathy, they may not notice such injuries, which can then
lead to a diabetic foot ulcer.
Poor blood flow to the feet is also common in people
with diabetes, and this slows the wound healing process and increases the
risk of infection and amputation.
Diabetic foot ulcers can often be prevented by careful
control of diabetes and proper foot care. It is important to control blood
sugar levels in order to prevent peripheral neuropathy or to stop it from
People with diabetes should check their feet,
including the areas between the toes, daily for sores and cuts. They should
see a doctor immediately if a foot problem develops. Those who cannot see
their feet can use a mirror on the floor or a long-handled mirror.
The feet, including the areas between the toes, should
be kept clean and dry.
People with diabetes should check the bath temperature
with their hand.
Toenails should be carefully trimmed with the contour
of the toe, and sharp nail edges should be filed smooth. People with
peripheral neuropathy should not cut their own nails, and a clinician, such
as a podiatrist (doctor specializing in foot
care), should evaluate them regularly.
Footwear should fit properly to avoid friction or
pressure. People with peripheral neuropathy should avoid walking barefoot
and should check their footwear for foreign objects before putting them
Seek appropriate professional care at the first sign of
a foot problem.
Avoid putting any pressure on the foot wound.
Keep the ulcer clean and change the dressings
regularly, as instructed by your doctor.
For more information
National Diabetes Information Clearinghouse
American Podiatric Medical Association
American Diabetes Association
To find this and other JAMA Patient Pages, go to the Patient Page
link on JAMA's Web site at
http://www.jama.com. Many are available in English and Spanish.
A Patient Page on managing type 2 diabetes was published in the January 12,
2000, issue, and one on type 1 diabetes was published in the October 22/29,
Sources: National Institute of Diabetes and
Digestive and Kidney Diseases, American Diabetes Association, Centers for
Disease Control and Prevention
The JAMA Patient Page is a public service of JAMA. The information and recommendations
appearing on this page are appropriate in most instances, but they
are not a substitute for medical diagnosis. For specific information
concerning your personal medical condition, JAMA
suggests that you consult your physician. This page may be photocopied
noncommercially by physicians and other health care professionals to share
with patients. Any other print or online reproduction is subject to AMA
approval. To purchase bulk reprints, call 718/946-7424.
Parmet S, Glass TJ, Glass RM. Diabetic Foot Ulcers. JAMA. 2005;293(2):260. doi:10.1001/jama.293.2.260
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