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Patient Instructions

If you have diabetes, you may have an increased risk for developing foot ulcers, or sores. Foot ulcers are the most common reason for hospital stays for people with diabetes. It may take weeks or even several months for your foot ulcers to heal. Diabetic ulcers are often painless.

See also Diabetes - taking care of your feet

Debridement is the process to remove dead skin and tissue. Your doctor or nurse will need to do this to be able to see your foot ulcer. There are many ways to do this.

One way is to use a scalpel and special scissors.

• The skin surrounding the wound is cleaned and disinfected.
• The wound is probed with a metal instrument to determine how deep it is and to see if there is any foreign material or object in the ulcer.
• The doctor cuts away the dead tissue, then washes out any unattached tissue.
• Your sore may seem bigger and deeper after the doctor or nurse debrides it. The ulcer should be red or pink in color and look like fresh meat.

Other ways to remove dead or infected tissue are to:

• Put your foot in a whirlpool bath.
• Use a syringe and catheter (tube).
• Apply wet to dry dressings to the area.
• Put special chemicals, called enzymes, on your ulcer. These dissolve dead tissue from the wound.

Foot ulcers are partly caused by increased pressure on your foot. Be sure to wear shoes that do not put a lot of pressure on your foot, especially where the ulcer is.

Your doctor may ask you to wear special shoes, or a brace or a special cast. You may need to use a wheelchair or crutches for awhile. These devices will reduce the pressure and irritation to the ulcer area, and that will help speed up the healing process.

The type of shoes you wear when you have diabetes is important:

• Wear shoes made out of canvas, leather, or suede. Do not wear shoes made out of plastic, or other material that does not breathe.
• Wear shoes you can adjust easily. They should have laces, Velcro, or buckles.
• Wear shoes that fit properly and have plenty of room in them. You may need a special shoe made to fit your foot.
• Do not wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.

You will need to do these things to care for your wound:

• Keep your blood sugar levels under tight control. This can help you heal faster.
• Keep the ulcer clean and bandaged.
• Cleanse the wound daily, using a wound dressing or bandage.
• Try to take fewer steps around your house.
• Do not walk barefoot unless your doctor tells you it is OK.

Your doctor or nurse may use different kinds of dressings to treat your ulcer.

Wet-to-dry dressings are often used first. This process involves applying a wet dressing to your wound. As the dressing dries, it absorbs wound material. When the dressing is removed, some of the tissue comes off with it.

• Your doctor or nurse will tell you how often you need to change the dressing.
• You may be able to change your own dressing, or family members may be able to help.
• A visiting nurse may also help you.

See also: Wet to dry dressing changes

Other types of dressings are:

• Dressing that contain calcium alginates or growth factors
• Skin substitutes

Keep your dressing and the skin around it dry. Try not to get healthy tissue around your wound too wet from your dressings. This can soften the healthy tissue and cause more foot problems.

Call your doctor if you have any of these signs and symptoms of infection:

• Redness, increased warmth, or swelling around the wound
• Extra drainage
• Pus
• Odor
• Fever or chills
• Increased pain
• Increased firmness around the wound

Also call your doctor if your foot ulcer is very white, blue, or black.

Debridement of skin ulcers

American Diabetes Association. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008 Jan;31 Suppl 1:S12-54.

Inzuchhi SE and Sherwin RS. Type 2 diabetes mellitus. In: Goldman L and Ausiello D, eds. Cecil Medicine. 23rd ed. Saunders; 2007:chap 248.

In the clinic. Type 2 diabetes. Ann Intern Med. 2007 Jan 2;146(1):ITC1-15.

Hunt D. Foot ulcers and amputations in diabetes. Clin Evid. 2006;(15):576-584.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.