Diabetic

Diabetes is a complex medical condition predisposing people to diabetic ulcers in three ways:

• Peripheral neuropathy impairs normal protective mechanisms by reduction or elimination of pain sensation from minor traumas.
• Impaired circulation due to large vessel atherosclerosis and microcirculatory (capillary) abnormalities limits oxygen, nutrients and immune responses.
• In addition, poor glycemic control impairs immune response and regeneration of healthy new tissue.

Note that although not all diabetic ulcers appear on the feet or lower extremities, those locations are most common for diabetic ulcers.

Effective intervention and prevention of diabetic wounds requires a coordinated, multidisciplinary care approach.  This is likely to include primary care practitioners, and may also include other external resources such as surgical specialists with expertise in diabetic ulcer management, endocrinologists, podiatrists, orthotists and other specialists as necessary. 

Resources internal to the long term care facility that should be consulted include nurses, dieticians, physical and occupational therapists, wound care team, and nursing assistants.  Finally, since footwear is such an integral part of prevention and care, social workers and family members should also play an important role in assuring safe and comfortable footwear.

Although diabetics can have other types of leg ulcers (arterial, venous), the typical diabetic foot ulcer is a result of repetitive pressure and/or trauma that may not be recognized due to neuropathy.

A classic or typical diabetic foot ulcer is a callus formation, fissures or abrasions that progresses to open areas, abscesses and associated cellulitis.  They are usually found in weight bearing locations or in areas where the foot is in contact with footwear. 

Staging of diabetic wounds is not the appropriate way to describe a diabetic wound.  Multiple methodologies for the description of diabetic wounds have been identified.  AHS has chosen a descriptive approach reflective of the experience common to its clients.  Those descriptive Categories can be accessed using the links at right.