• Debridement. This treatment consists of physically removing dead tissue and foreign bodies from the wound until only healthy tissue is present. It decreases the risk of infection and can aid in healing.

 

• Wound Dressing. After debridement, the wound is usually irrigated with saline or cleanser, and a wound dressing is applied.

 

• Antibiotics. Some DFUs may be infected. Most mild to moderate infections can be treated on an outpatient basis with antibiotics. These antibiotics can be taken orally or administered in the wound dressing itself. If you have an infection, your wound care specialist will select the therapy that is most appropriate for you. Patients that have severe infections may need to be hospitalized and treated with intravenous antibiotics.

 

• Offloading. Your wound care specialist may instruct you to wear special shoes, a removable boot, or to use other offloading devices to reduce the amount of weight on your foot in order to help heal your wound. You may be told to use a wheelchair or crutches to completely halt weight bearing on the affected foot. If your special shoe or offloading device does not seem comfortable to use, does not fit properly, becomes worn out, or if you have any problems with it, let your wound care specialist know immediately. If your wound care specialist has asked you to use an aid or offloading device, be sure to use it according to instructions. Proper offloading is very important to ensure optimal healing.

 

• Advanced Therapies. If your wound care specialist is unable to heal your diabetic foot ulcer with traditional therapies, he or she may decide to try advanced therapies. Examples of advanced therapies include negative pressure wound therapy, hyperbaric oxygen, and bioengineered skin substitutes.

 

• After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.

 
A DFU may be serious, and you may feel overwhelmed. But if you follow your wound care specialist’s instructions and continue to manage your diabetes—you may prevent a DFU from occurring again.
 
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• Know your A1c, your target A1c and what your doctor recommends to achieve it.
• Take your diabetes medications as prescribed and follow your doctor’s recommendations for maintaining a healthy lifestyle.
• Exercise and eat a healthful diet.
• Keep all appointments with your healthcare team.

 
2. Include a “foot check” in your daily routine. ⁷

• Look for cuts, sores, red spots, swelling and infected toenails—you may have a problem but not be able to see it.
• Use a mirror so you can see all parts of your feet.
• Call your doctor if any of these wounds do not heal in a few weeks.
• Be sure to have your doctor check your feet at each visit.

 
3. Remember these three W’s. ⁷

• Wash your feet daily in warm (not hot) water—always dry them well and keep your feet moisturized by using lotion, cream or petroleum jelly on the tops and bottoms.
• Wear socks and shoes that are breathable, provide cushioning, and fit well—always take care to protect your feet and avoid blisters. You may want to ask your doctor about Medicare and private insurance coverage for special shoes.
• Wiggle your toes and ankles several times per day to improve blood flow. Put your feet up while sitting and don’t cross your legs or wear constrictive items around your legs and ankles, which restricts blood flow.

• Get informed and connected. There is a huge amount of information and support available to those living with diabetes. Make connections within the diabetes and health communities and don’t be afraid to ask for help.

 

• You are what you eat. Making healthy choices when it comes to food is one of the most important things you can do to improve blood sugar control. Focus on eating more fruits, vegetables, beans, and whole grains. Stay away from foods made with a lot of salt and fat.

 

• A good rule of thumb is to shop in the outer aisles of the grocery store—where all the fresh produce and good lean meats are available. Avoid the inner aisles, and processed foods.

 

• Get physical. Try to exercise or be active at least thirty minutes each day. Incorporating physical activity and exercise into your daily routine goes a long way to helping maintain a better blood sugar level. Studies show that the best approach is to combine aerobic exercises (like walking or dancing) with resistance training (like weight lifting or yoga) if you want to control you blood sugar more effectively.

 

• Get the whole family involved! Walks after dinner, low impact sports and bike rides that everyone can enjoy will keep the whole family fit and motivate you to stick to your exercise program!

 

• Keep a calendar of how often you get exercise and get an exercise buddy. This will keep you from saying, “oh, I will go to the gym tomorrow.”

 

• Keep all your healthcare appointments. In addition to regular diabetes checkups, make sure to keep your other checkup appointments. You should still be getting physicals and eye exams, which will help screen you for diabetes-related complications like retinal damage or neuropathy.

 

• Watch your step (and your feet)! Keep a close eye on your feet for any irregularities like sores, cuts, redness, or blisters. If you notice foot problems that are not healing, don’t hesitate to call your doctor.

 

• Stop smoking! Tobacco use heightens your risk for a whole host of diabetic complications from nerve damage to heart disease. Quitting smoking isn’t easy, so make sure to enlist the help of your doctor or other smoking cessation experts.

 

• Manage your stress. Taking care of your diabetes and your other life commitments can be overwhelming. When you are feeling overburdened it is easy to forgo important parts of your diabetes management, which can have negative effects on your health. Stress also produces hormones that can interfere with insulin production/action and compound the problem. You can help manage stress by getting an adequate amount of sleep, eating healthfully, prioritizing your tasks, and learning relaxation techniques. One of the best stress relievers available is exercise. If you feel overwhelmed — ask your health care provider if it is OK to go for a jog or a brisk walk (just make sure your shoes fit well!). If you need help, don’t be afraid to reach out to friends and family, as well as your healthcare community.

 
See the Difference
 
When you take the right steps to managing your diabetes, you’re promoting your health by leaps and bounds. ^2,17
 

• Reducing A1c (a measure of blood sugar control) by one percentage point can reduce the risk of eye, kidney, and nerve diseases by 40%.
• Controlling blood pressure can reduce the risk of heart disease and stroke by 33%–50% and the risk of eye, kidney, and nerve diseases by approximately 33%.
• Improving control of your ‘bad’ or low-density lipoprotein (LDL) cholesterol can reduce cardiovascular complications by 20%–50%.
• Treating diabetic eye disease with laser therapy can reduce the risk of loss of eyesight by 50%–60%.
• Accessing comprehensive foot care programs can reduce amputation rates by 45%–85%.

• What are my goal blood sugar, blood pressure, and cholesterol numbers?
• What is the target range? When should I be worried?
• What can I do to reach my goal numbers?
• Am I at risk for a diabetic foot ulcer?
• What are my steps if I find a cut, blister or any type of infection on my feet?
• What kind of exercise is safe for me to start doing?
• What kind of tools can tell me how many calories or how much sugar is in each food item I want to eat?
• How often should I get check-ups?
• What other symptoms should prompt me to make a doctor’s appointment?

 
The A1c goal for many people is below 7%. However, people who experience frequent episodes of low blood sugar levels, or who are at risk for a heart attack, may need a higher target A1c. Everyone is different, so check with your healthcare provider. ^5,6

• Keep your medical appointments so your doctor can monitor your progress and make any treatment adjustments. If you have a wound, discuss the need to see a wound care specialist.
• Follow your treatment plan and the advice of your health care provider.
• Keep weight off the wound to relieve pressure around the ulcer.
• Take your diabetes medications to keep your blood sugar within target range.
• Cover the wound when bathing to keep the wound and dressing dry.
• Watch for signs of infection (pain, redness, swelling or discharge) and call your doctor if you notice any changes in the wound.
• Lead a diabetes-friendly lifestyle including well-balanced, portion-conscious meals, an appropriate physical activity program and no smoking.

 
I’ve been treated for a DFU for over a month but it has not healed yet.
Is this an emergency?
 
If your wound has not healed within four weeks, talk to your doctor about consulting with a wound care specialist. These professionals evaluate and treat diabetic foot ulcers.¹⁶
 
The American Diabetes Association found that any diabetic foot wound that remains unhealed after 4 weeks is associated with worse outcomes.¹⁶ Do not delay in getting to your doctor or a wound care specialist.
 
If traditional wound care treatment is not working, ask your doctor if seeing a wound care specialist with access to advanced therapy may be right for you.
 
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• Keep your blood sugar levels in your target range.
• Protect your feet! Always wear properly fitting socks and shoes to prevent blisters and other injuries. Ask your doctor about special footwear to prevent any rubbing or pressure caused by foot deformities like bunions or hammertoes.
• Improve circulation by wiggling your toes and ankles several times a day.
• Exercise and eat a healthful diet.
• Wash your feet daily in warm (not hot) water—always dry them well and keep your feet properly moisturized to prevent cracking.
• Check your feet daily for any abnormalities such as cuts, bruises, spots, blisters, or fungus. Use a mirror so you can see all parts of your feet.
• Do not try to treat abnormalities on your own! Let your doctor or wound care specialist help you with corns, calluses, or cuts that don’t heal.
• Have your feet professionally checked—just like your eyes and kidneys—at least once a year.

• Peripheral neuropathy
• Peripheral arterial disease (PAD)
• Foot deformity
• Past history of foot ulcer
• Previous amputation
• Poor control of blood sugar
• Diabetic nephropathy (especially patients on dialysis)
• Visual impairment
• Cigarette smoking

 
Are you at risk?