Wound Care for People With Diabetes and Foot Ulcers

A diabetic foot ulcer is an open sore or wound on the foot that can develop in people with diabetes. It often appears on the bottom of the foot or over a pressure point, and it may heal slowly.

Diabetes can affect the nerves, which may reduce feeling in the feet, and it can affect circulation. When a person cannot feel a blister, cut or pressure spot, it may go unnoticed. Reduced blood flow can also make it harder for the body to repair skin.

Because slow-healing wounds can become infected, foot ulcers are taken seriously by clinicians. Early professional evaluation is a common theme in diabetic foot care, which is why many people look for a podiatrist or wound care specialist.

Diabetic foot ulcers have traditionally been managed by a care team that may include a podiatrist, a wound care physician or nurse, a primary care clinician, an endocrinologist, and sometimes a vascular or infectious disease specialist.

Common elements of traditional wound care include a clinician examining the wound and the foot, checking circulation and sensation, removing unhealthy tissue (debridement), choosing dressings, and using ways to reduce pressure on the area, such as specialized footwear or offloading devices.

Other approaches that clinicians may consider, depending on the individual, include negative pressure wound therapy, which is well established, as well as skin substitutes or amniotic and placental grafts, which vary in FDA status and insurance coverage. Hyperbaric oxygen therapy is FDA-cleared only for certain indications, including certain diabetic foot ulcers. Whether any of these is appropriate is a decision for a licensed clinician after an evaluation.

The right wound care specialist may help by looking at the whole picture: the wound itself, the foot's shape and pressure points, blood flow, nerve sensation, and how well blood sugar is being managed with your broader care team. A visit generally starts with a history and a careful exam of both feet.

The specialist may explain what they see, how the wound is classified or staged, and what options exist. They may also coordinate with other providers and talk with you about footwear, daily foot checks and what warning signs should prompt a call. Any plan is individualized and made by the clinician, never by a web page.

Questions you might ask a licensed provider include: What is causing my wound? How is it staged? What are my treatment options and the reasons for each? How long might healing take? Which signs of infection should I watch for? Is my circulation being checked? What will my insurance cover, including any advanced products? Ask about amniotic products in particular, since coverage and regulatory status vary; amnioticdoctors.com offers further reading on that topic only.