The purpose of this video is to help you understand the importance of offloading, the use of special
footwear, and helping your foot ulcer heal as quickly as possible. Healing quickly can
reduce your risk of developing serious complications. Key elements of successful healing are: rest,
eat a balanced diet and maintain your blood sugars in a controlled range, wear the device
your doctor tells you to wear at all times, and refraining from smoking. Foot ulcers need
rest in order to heal. If you were to break your leg, your doctor would tell you not to
walk on it. It is the same with your foot ulcer. We rest ulcers by taking off the load,
or offloading the ulcer using special casts, boots, or shoes.
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The possible complications from a foot ulcer that
fails to heal are: development of an infection, infection spreading to the rest of the body,
resulting in hospitalization, amputation at the foot or leg, or even death. Foot ulcers
put you at considerable risk for amputation. Amputation of part of your foot or leg can
lead to changes in your ability to do activities that are part of your everyday life. It can
lead to a decrease in activity, which can weaken your heart and body, making it difficult
to control your diabetes. It can also change the way you walk or move, potentially causing
damage to your other foot and leg. Most importantly, the challenge of having an amputation can
lead to depression and sadness, affecting how you are able to enjoy your family, friends,
and hobbies. Normally, your body’s response to pain is a sharp reflex that allows you
to recoil and prevent further injury. Diabetes causes changes to the nerves in your feet,
and the ability to feel or sense pain. It robs your body of the protective gift of pain,
or the ability to protect itself. This condition is called neuropathy. People with neuropathy
can walk with a stone in their shoe and not notice it. This could cause an ulcer or blister
on their foot. A person with neuropathy does not know that they have a sore or blister
on their foot because they cannot feel it. By the time you notice the ulcer, it can become
very serious. This is why it is important to check your feet every day for problems.
Diabetes can cause the skin on your feet to become very dry, creating cracks that later
become sores or infections. Ask a doctor to recommend a good moisturizer for your feet
and heels. People with diabetes can also have changes in their leg and foot circulation.
This reduces the oxygen, nutrients, and blood supply to your leg, increasing your risk of
getting an ulcer and slowing your ability to heal. Your doctor may order a test to examine
your circulation. Because of these factors, simple everyday activities such as walking
or standing on your injured foot can be harmful to your healing ulcers. It could worsen the
condition or cause infection. If you smoke, it is important that you talk to your doctor
about treatments to stop smoking. Smoking is a large reason why people develop circulation
problems in their legs and feet. Continuing smoking will slow healing to your ulcer and
likely make your circulation worse. The best way to heal your diabetic ulcers is to take
off the load by using special casts, boots, or shoes. It is important to wear these all
the time, even if you are only taking a few steps. The best way to heal a diabetic foot
ulcer is to use a special cast called a total contact cast. Research shows that more people
treated with total contact casts heal than with other treatments. These include bioengineered
tissues, such as growth factors or synthetic skin substitutes, and negative pressure wound
therapy. They also heal faster than with many of the newer advanced wound-healing technologies.
People treated with total contact casts heal in an average of 42 days.
>> DOCTOR: Next I’m going to make this irremovable by adding on a layer of cohesive bandages.
Doctors can also adapt your diabetic walking
boot so that you cannot take it off. This has been shown to be just as effective as
a total contact cast. Your doctor may use a combination of wound and offloading treatments
to best heal your ulcer. It may be scary to think of an ulcer being in a cast where you
can’t see it, but the cast helps even out your weight so the pressure is not just on
one part of the foot. Your doctor will change the cast every few days and even up to once
a week if your ulcer is healing well. When a person breaks their leg, they don’t tell
the doctor that the cast is awkward and ugly or ask for another way to heal their leg.
They know that wearing a cast and resting the bone is the best way to heal it. Likewise,
it is important to take the pressure off your ulcer so that it can heal. Wearing your offloading
device for every step will give you the best chance to heal your ulcer quickly. Your foot
ulcer heals at the rate of about one millimeter per day, or about the width of a dime. Going
barefoot is another way to seriously risk further injury and complications. In the comfort
of their own homes, patients either forget or choose not to wear the offloading device
or protective footwear for a few quick steps around the house or across the room. Don’t
do it. Every unprotected step is a day of healing lost. Going barefoot will slow your
healing and make your foot ulcer worse. You may think that one step here or there without
the offloading device will not harm the ulcer. You may think that it is all right not to
wear it for a couple of steps when you get up to go to the bathroom. What you may not
realize is that every step you take without your offloading device is a day of healing
lost. You need to wear your offloading device all the time. You don’t want to go backwards.
You want your ulcer to heal as fast as possible to avoid or help prevent complications. Proper
offloading, using prescribed slippers or shoes with proper orthopedic inserts, greatly reduces
high pressures on the bottom of your foot that can result in loss of healing, re-ulceration,
and complications such as infection. Once you have had one ulcer, you are at a higher
risk for another ulcer. So once your ulcer has healed, you need to protect the new skin
so that it becomes strong, and you need to protect your foot from new ulcers. Once your
ulcer has healed, you may think it is all right to start wearing regular shoes again
or even go barefoot. Unfortunately, even though your ulcer has healed, you should still never
walk barefoot, even at home. By wearing your diabetic footwear, you protect your foot from
high pressures and the danger of injury due to neuropathy. Injury can result in another
ulcer and possible infection, with all the complications that go with it. Your doctor
may prescribe specially fitted shoes or orthotic inserts to continue to offload your foot and
protect it. Remember, diabetes can change the bones in your foot and create spots of
high pressure while you walk. These high pressures continue to exist even after your ulcer is
healed. Continued proper offloading greatly reduces these pressures on your feet that
can cause reinjury. Ask your doctor about shoes or inserts that are specially fitted
to your feet. Insurance will often cover the cost. Improper choices of footwear to events
outside the home environment are a major cause of foot ulcers reoccurring. Fragile, newly
healed skin is not accustomed or equipped to handle the demands of a social event. It
is very tempting to put on those dress shoes for just a few hours. Don’t do it. Plan
to use and wear your diabetic footwear for all of your activities, including social events.
If you have a question about what you can’t or shouldn’t wear, ask your doctor. Remember,
important factors that help heal your ulcer are: keeping your diabetes in good control,
eating a balanced diet, stopping smoking, rest, and wearing the device the doctor tells
you to wear at all times. It is the goal of your doctor and health care team to help your
ulcer heal as quickly as possible to minimize events such as infection, amputation, and
possibly death. To do this, your doctor has prescribed an offloading device to take off
the load from your ulcer. The good news is that healing is possible for your diabetic
foot ulcer.
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