What if I develop a foot ulcer? What care can I expect if I am admitted to hospital with a diabetic foot problem?

Seek medical help if your foot infection doesn't improve in a day or two, or becomes significantly worse.You should tell your doctor straightaway if you suspect an ulcer has formed.  

If you have a diabetic foot problem, you will be able to get most of the treatment you need from your treating physician.

However, there are some problems which may require you to go into hospital for treatment. You should expect to be treated by a team which deals especially with people who have diabetic foot problems. This team usually includes:

• ·       A specialist in diabetes.
• ·       A surgeon who deals with diabetic foot problems.
• ·       A person qualified to diagnose and treat foot disorders (a podiatrist - previously called a chiropodist).
• ·       A diabetes nurse specialist.
• ·       A tissue viability nurse (who assesses whether the skin and underlying tissues of your feet have been affected by circulation changes due to diabetes).

You should be given information about your foot condition.

Aim of treatment:Treatment aims

• ·       to dress and protect the ulcer,
• ·       to prevent or treat any infection and
• ·       also to help your skin to heal.

• You will have your diabetes assessed and checks will be made to make sure you have not developed complications such as kidney disease (or if you have already developed complications, to make sure they are not becoming any worse).
• You will have an examination of both feet to check for ulcers, cuts and abrasions to the feet, signs of poor circulation, areas of numbness and the development of Charcot's arthropathy. This is a condition in which the sensation of pain is reduced because of the diabetes, resulting in damage to bones, such as tiny fractures.
• You will have a general examination to make sure you do not have a high temperature (fever) or any other signs of a severe generalised infection.
• If you have an ulcer, this will be checked for infection; baseline measurements of the size and depth will be taken.
• You may be asked to have an X-ray or scan of your foot to make sure the bones have not been affected by your condition.
• The ulcer is usually covered with a protective dressing. A nurse or podiatrist will normally examine, clean and re-dress the ulcer regularly.A podiatrist may need to remove any hard skin that prevents the ulcer from healing. Also, depending on the site and size of the ulcer, they may protect it from further injury by using padding to take the pressure off the area.You may also be advised to wear special shoes or have a cast made for your foot to keep the pressure off the ulcer. Antibiotics will be advised if the ulcer or nearby tissue becomes infected. Sometimes a small operation is needed to drain pus and clear dead tissue if infection becomes more severe.In some cases, the arteries in the legs are very narrow and greatly reduce the blood flow to the feet. In these cases an operation to bypass or widen the arteries may be advised. Many foot ulcers will heal with the above measures. However, they can take a long time to heal. In some cases, the ulcer worsens, becomes badly infected and does not heal. Sometimes infection spreads to nearby bones or joints, which can be difficult to clear, even with a long course of antibiotics. Occasionally, the tissue in parts of the foot cannot survive and the only solution then is to surgically remove (amputate) the affected part.