Wound Care


Although diabetes is a well-known cause of foot ulcerations—dialysis, end-stage renal disease (ESRD) and chronic kidney disease (CKD) have proven to be independent risk factors in the development and course of diabetic foot ulcerations.  There are five stages in the spectrum of the diabetic foot. They are: Stage one, a normal foot. Stage two, a high risk foot. Stage three, an ulcerated foot. Stage four, an infected foot, and, Stage 5, a necrotic foot.

Aggressive management of diabetic foot ulceration reduces advancing to infection and necrosis.

The goal in effective wound care for the diabetic foot is to reduce amputations.

Podiatrists advice people with type II diabetes to be vigilant about foot care. 

  Iron repletion commonly used in End-Stage Renal Disease (ESRD) patients to optimize erythropoiesis may inadvertently impair wound-healing.

Diabetic Wounds 

If you have type 2 diabetes, even a small cut or scrape can turn into a serious problem. 

The reason: If your blood sugar levels are too high, your arteries can become stiff and your blood vessels can become narrowed. That, in turn, hinders your blood flow and cuts off some of the oxygen and crucial nutrients that are needed to help your wound heal.

About 15 percent of people with diabetes will develop a wound over the course of the disease, according to the American Diabetes Association. However, if you take preventive steps and get the proper treatment, you can avoid a serious infection.

How to Treat Foot Wounds

  • Quit smoking. It’s a risk factor for poor circulation, which increases your susceptibility for wounds and poor healing.
  • Wear well-fitting shoes. One of the best ways to ward off a foot injury is to wear protective shoes that fit well. Avoid shoes that are too thin, flat, or high, and use custom insoles to reduce pressure. If you have neuropathy, it’s best to avoid walking around barefoot, even in your house.
  • Keep your feet clean and your toe nails trimmed. Wash your feet with soap and water every day and apply lotion to the entire foot to avoid cracked skin. Trimming your nails can help prevent an ingrown toenail, but patients with neuropathy should see a podiatrist for nail trimming.
  • Do a daily foot check. Inspect the skin on your feet, including the area between your toes. If you can’t see your entire foot, use a mirror or take pictures at several angles with your cell phone. Serious problems can happen as quickly as overnight.
  • Learn to spot the warning signs. Callouses are often the first sign that you’re putting pressure on certain areas of your feet, which can lead to an ulcer. Look for callouses and see your podiatrist if they become red and painful. Also look for cuts, blood, tenderness, a foul-smelling discharge, swelling, or black or blue skin. If you notice any of these changes, see your doctor right away. Also, if you can’t walk because of pain or tenderness, that’s a sign that you may have a wound that’s getting worse.
  • Treat a wound immediately. If you find a wound, clean it with gentle soap and water, apply an antibiotic ointment, and cover it with a bandage. Repeat this process twice a day and keep it covered in the bath or shower. If there’s any swelling, pus, or drainage; or it looks, feels, or smells bad, get it checked out. Typically, superficial wounds heal within 5 to 7 days, but if it doesn’t, be sure to see your podiatrist.

    Open Wounds Do's and Don'ts

    Do: Clean the Wound Immediately with Mild Solutions

    Flush the wound surface and interior with a mild solution. A saline solution made from a small amount of salt diluted in water works well since it mimics your body’s internal pH. You can also use mild or diluted soap in water or some purified water, then wipe the surface with clean gauze.

    Take notice of any debris that may be lodged in the wound and remove it with sterile tweezers if possible. If the debris is deep or dispersed, you should seek emergency care.

    Don't: Use Strong Antiseptics to Wash Wounds

    Conventional wisdom suggests using disinfectants and antiseptics like hydrogen peroxide, rubbing alcohol, or iodine to clean open wounds. Most of these substances are better suited for disinfecting household surfaces and are far too harsh for use on human tissue. They are more likely to damage tissue than help it heal.

    Do: Applying Pressure

    Cover the wound with absorbent material like sterile gauze pads or a clean, dry cloth. Maintain pressure for one to five minutes. If the bleeding does not slow or continues to persist, you will need medical treatment to close the wound.

    Don't: Ignore Wounds That Do Not Heal

    Most open wound treatments for minor injuries reach the proliferation stage within a period of one to three weeks, meaning the wound is actively healing if being managed through periodic cleanings and dressing changes.

      If your wound is not healing at a steady rate, it could be infected or complicated by another health condition. Do not ignore the signs; visit a medical professional as soon as possible.


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