Diabetes mellitus is a chronic disease that affects the lives of about 16 million people in the United States, 25% will develop foot problems related to the disease. The disease is marked by the inability to manufacture or properly use insulin and impairs the body's ability to convert sugars, starches, and other foods into energy. The long term effects of elevated blood sugars (hyperglycemia) can cause to damage the eyes, heart, feet, kidneys, nerves, and blood vessels.
A diabetic ulcer is caused by stress of the body's weight and the impact of the foot striking the ground. The ball of the foot, big toe, and the heel are at greatest risk. Force or friction against the bottom of your feet causes the skin to thicken, forming a callus. If the skin keeps thickening, the callus presses up into the foot and kills healthy tissue causing pain. You may not notice the pain if you have diabetic neuropathy, a nerve disorder that limits your ability to detect pain. As healthy skin dies, an ulcer forms that may become infected. Also, peripheral vascular disease (poor circulation) contributes to diabetic ulcers by reducing the amount of oxygen and nutrition supplied to the skin and other tissues, causing ulcers to heal poorly.
As a podiatrist and a wound care specialist the treatment of the diabetic ulcer can involve topical wound care products, bioengineer living skin, diabetic shoes and inserts, contact casting, antibiotics, and surgery if need be. This should be a team approach working with your physician and other specialists. For more information: American Academy of Wound Management