What is a Diabetic Foot Ulcer?
One of the most common vascular issues treated by Vascular Surgeons is diabetic foot ulcers (DFUs). Up to 25% of diabetic patients will have a foot ulcer during their lifetime. Diabetic foot ulcers are wounds of the lower extremities that develop because of poor blood circulation. These ulcers most commonly occur on the feet and toes, sometimes on the ankles. There are usually several factors that contribute to the development of these wounds — including poorly fitting shoes, neuropathy, and disease of the arteries. DFUs are often missed and must be carefully sought after on physical examination. It is important for diabetic patients to regularly check their feet for development of ulcers.
Is a DFU a serious condition?
Diabetic patients often develop calcified plaques in their arteries, which can lead to narrowing or blocking of the artery (this is called ‘arterial disease’.) This can lead to decreased or complete absence of blood flow to the foot. The arteries commonly involved are the arteries below the knee.
I distinctly remember caring for a young diabetic woman during my vascular surgery fellowship, who had a small lesion on her foot. Unfortunately, she missed a couple of appointments and returned 2 weeks later with a severe infection of her toe. I performed an angiogram and found a blockage in one of the arteries of her leg. I treated the blockage with ballooning and stent in order to restore blood flow to her foot. Luckily, with ongoing wound care and close follow up, the ulcer healed completely. I feel fortunate that we were able to avoid needing to amputate part of her foot.
Some patients may have what we call ‘multi-segment arterial disease,’ which means that there is narrowing or blockages in the arteries of the thigh or, even higher up, in the pelvis. Blood brings oxygen and nutrients needed for the DFUs to heal. When DFUs don’t heal they can lead to uncontrolled deeper infection (sometimes involving the bone). Sometimes a procedure is needed to restore blood flow so that DFUs can heal properly.
How are DFUs Treated?
Simple vascular tests can be performed to diagnose and treat arterial disease. These tests can often be done in the same office visit, and allow planning for the next step in treatment.
An angiogram is often the next step to diagnose and treat arterial disease. An angiogram is a minimally invasive procedure performed either in the hospital or the office. The procedure involves a small needle puncture, usually in one of the arteries in the groin, and injecting dye or contrast. This allows the Vascular Surgeon to see exactly where the narrowing and blockages are located. Often these can be treated during the same procedure with ballooning and/or placement of stent.
Angiography is often the next step in diagnosing the type and location of the arterial disease more accurately. One advantage of an angiogram is that it can be both diagnostic and therapeutic. Meaning, most blockages or narrowing in arteries could potentially be treated with ballooning and/or stenting at the same time. Angiograms are performed both in an outpatient and inpatient settings.
Appropriate testing and proper diagnosis of DFUs can save limbs, not to mention lives. Many of the above mentioned procedures are performed in our office locations. If you or someone you love is a diabetic and suffers from foot pain, call The Vascular Experts for an appointment today.
Please contact Dr. Shahmohammadi at email@example.com with any additional questions.
Kaveh Shahmohammadi MD
Kaveh Shahmohammadi MD is a board eligible vascular surgeon at Southern Connecticut Vascular Center (The Vascular Experts). His areas of interest include doctor-patient relationship and communication, arterial and venous ulcers, aortic disease, carotid disease, and peripheral vascular disease. Read more»