Diabetes Awareness Month

Diabetes is a complex chronic condition that extends its reach far beyond blood sugar levels, impacting nearly every system in the body. From cardiovascular health to nerve function and wound healing, diabetes can create a cascade of complications if not carefully managed.

One often-overlooked yet critical complication is the development of diabetic foot ulcers—open sores or wounds on the feet that can lead to severe infections, amputations, and diminished quality of life. Understanding how diabetes disrupts circulation, sensation, and the body’s ability to repair itself is essential for preventing these ulcers and safeguarding overall health.

Latisha Smith-Chase, MD, Would & Hyperbarics Specialist at Fort HealthCare’s Hyperbarics, Wound & Edema Center, offers important advice surrounding diabetic foot ulcers and what individuals need to be aware of to protect themselves.

What Is a Diabetic Foot Ulcer?

Diabetic foot ulcers are open wounds on the foot or ankle that can develop due to minor trauma or even without any obvious injury. These ulcers arise from multiple factors, including poor circulation caused by high blood sugar, which hardens the arteries and weakens the skin. Additionally, changes in foot shape from peripheral neuropathy and excessive skin dryness increase vulnerability to skin breakdown.

“Once it happens, there’s a long process to getting a foot ulcer healed,” cautions Dr. Smith-Chase. “The skin breaks down and then you have no defense against the environment. Infection is very common and can get into not just the skin but in the muscles and bones below the skin. That’s when you have deep tissue infection, and it becomes extremely difficult to treat.”

Early Detection Is Key

Patients living with diabetes should have their feet thoroughly checked over two to three times per year by their primary care provider. This helps ensure early detection of a potential issue.

“It’s essential to look for deformity and early skin breakdown. An area might be discolored but not actually an ulcer yet,” explains Dr. Smith-Chase. “Early detection is key. We don’t want to wait until something is ulcerated to say there may be a problem. It’s a much easier wound to treat before it gets to be a deep, infected ulcer.”

Treatment Protocols for Diabetic Foot Ulcers

In the early stages of wound care for diabetic foot ulcers, a comprehensive assessment is critical. The process begins with checking blood flow to the feet, as proper circulation is essential for healing. If pulses in the foot and ankle are not palpable, an ultrasound may be needed to evaluate blood flow. For the wound itself, the clinic typically performs a culture to check for infection, removes dead or non-viable tissue through a process called debridement, and applies a wound dressing designed to keep the area warm and moist conditions that promote effective healing.

Dr. Smith-Chase notes that she attempts to stimulate healing with conservative wound care first. Yet, if that doesn’t prove effective, she must get more aggressive with the treatment protocol. This involves patients undergoing anesthesia for a deep debridement and subsequent hyperbaric oxygen therapy (HBOT).

“If you think of a bottle of Coke, when you take the cap off, it fizzes up. My hyperbaric chamber does the opposite. I put the cap on, and I supersaturate you with 100% oxygen. That gets healing down into those tissues that are not well-oxygenated due to poor circulation,” she states.

What Is Involved in Hyperbaric Oxygen Therapy?

Patients go through 30-40 HBOT treatments, once a day for approximately 90 minutes each session. The most common side effect of these treatments is a popping of the ears, similar to the sensation some people experience when flying on an airplane. Ear, nose, and throat specialists can help ease this effect by inserting tubes into eardrum. Per Dr. Smith-Chase, this slight side effect is well worth the results HBOT can generate. She also shares how fortunate the wound clinic is to be able to offer this type of treatment in the community.

“Hyperbaric oxygen therapy has been shown to heal diabetic foot ulcers that have not been able to heal by other means, and it will avoid amputation in some patients. That’s really important because once we get to amputation, it can become a downhill spiral. Having hyperbaric oxygen is critical to the patient’s overall well-being and length of life.”

Prevention Strategies

Diabetes arises from the body’s inability to regulate blood sugar, making lifestyle choices crucial for prevention and management. Eating a balanced diet, staying active—such as taking regular walks—and attending regular checkups can help identify and address prediabetes early. While diabetes may not always be avoidable, these habits can improve control of blood sugar. For those with diabetes, simple practices like regularly checking your feet can play a significant role in preventing complications like foot ulcers.

“Most ulcers occur in patients who have no feeling in their feet. So, if you don’t have feeling in your feet, you can’t feel there’s a problem. So, you have to visually check your feet every day. It takes about 10 seconds to do that, but it takes about 10 to 12 weeks to heal an ulcer once it forms,” warns Dr. Smith-Chase. “Whether you have numbness in your feet or not, please do not go barefooted. Many people like to go barefooted in their homes. Things in your home are just as dangerous to your feet as things outside your home. Wear shoes all the time if you’re a patient with diabetes.”