• You should ask for help (the same day) from your doctor, hospital or diabetic foot service
• Clean the ulcer with saline
• Cover the ulcer with a sterile dressing held in place with a light bandage
• Ask for help dressing the ulcer from your community nurse if you or your family have difficulty with this
• Keep right off the ulcer. Use crutches or a wheelchair and try not to put your foot to the ground
• Keep your foot up on a stool and cushion, sofa or bed
• Stay home from work or work from home if possible
• Do not go away on holiday with an open ulcer
• If you are offered special shoes or plaster cast treatment, remember that these heal ulcers very successfully. Remember that a few days off work can heal an ulcer and prevent months of misery and long stays at home or in hospital.
If ulcers are healed quickly there will be less scarring and you will be far less likely to develop another ulcer in the future.
What other treatment will my ulcer need?
Ulcers are often surrounded or covered with dead tissue, callus and debris. If these are allowed to gather around the ulcer they will prevent it from healing and may make the ulcer get worse. The ulcer should be cleaned by cutting away all the unwanted tissue. It may be necessary to clean up the edges until they bleed. This sounds drastic and frightening but it is usually quite painless and is essential treatment if you want your ulcer to heal quickly. This treatment is called 'debridement'. Never try to debride your ulcer yourself: ask your podiatrist or doctor for help.
Another aspect of ulcer treatment is preventing pressure on the ulcer. This can be achieved by resting and elevating the foot, by using crutches or a wheelchair, or by wearing special footwear or casts as advised by the foot clinic.
How long do ulcers take to heal?
In a patient who attends a well-organized, multidis-ciplinary diabetic foot clinic and follows advice, diabetic foot ulcers should heal within 3 months.
What should I do if my ulcer fails to heal?
• Tell the foot clinic you are concerned and ask them why they think the ulcer is not healing
• Ask them if a second opinion might help
• Ensure you are being treated by an experienced multi-disciplinary team
• Follow their advice explicitly
• If any aspects of their advice are impossible for you to follow, tell them and ask for advice. There may be an alternative approach which will suit you better.
What short-term lifestyle changes would help?
• Ask your family or friends for help. People like to rally round in times of trouble, and you can repay them later. If you live alone you can ask your doctor or nurse to organize help
• Let your usual high standards slip a bit: do less
• Prioritize! Leave the housework and let the dust gather or get help with cleaning: it'll all be the same in a hundred years!
• Don't run around helping other people: they should be looking after you
• Don't stand at the stove: use quick and easy recipes or use ready-cooked or take-away food. Cooking can be hard on the feet. Make the family do the washing up or use disposable plates
• Fight the boredom factor: think about things you can do while you are sitting or lying down and ways of getting out and about without overloading your foot. Get your friends to come to you instead of going to them— and ask them to bring the refreshments with them! Get a wheelchair so that you can still go out without putting pressure on your foot ulcer
• Don't feel guilty. You are keeping off your feet in order to avoid future problems. Be sure that everyone knows that. If anyone criticizes you for being lazy ask him to talk to the diabetic foot service
• Keep your foot clinic appointments without fail. If you miss one, ask for another without delay.
What should I do if my foot ulcers keep coming back?
If you get recurrent ulcers, the following long-term lifestyle changes would help:
• Try to avoid jobs which involve long hours of walking or standing
• Work as close to home as possible: long journeys are bad for feet
• Get your car adapted to hand controls instead of foot pedals. Use an automatic.
Should I drive with an ulcer?
Driving with an ulcer is better than walking, but not so good as resting.
What should I do if it is essential to drive?
If you need to drive you should:
• Stop frequently to rest and elevate the feet
• Avoid emergency stops!
• Consider having hand controls fitted to your car
• Enquire about a different design of foot pedal which will not pressurize the ulcerated area
• Always wear your hospital shoes for driving. (If shoes are large and bulky, the control pedals of the car may need to be adjusted or changed.)
What else should I be doing to help my foot heal and stay healed?
• If you enjoy sports, try to choose something like swimming which off-loads your feet
• Avoid situations where you are out of control. For example, if you go on holiday after your ulcer has healed then allow plenty of time at the airport, and organize a wheelchair if you have a history of recurring ulceration. If you go on a guided tour, ensure it will not involve long walks over rough ground
• Walk as little as possible
• Try to lose weight if you are overweight
• Be on the lookout for potential problems that have caused ulcers in the past or might cause a future problem.
Radiators or hot pipes by the bed can bum your feet, worn-out shoes can rub sores and walking barefoot can injure you. Try to remember the hidden dangers in day-to-day life and think hard about how to avoid them
• Every time you injure yourself and cause an ulcer, try to work out the reason and take steps to prevent it in future. It sounds boring, but it isn't nearly as tedious as having foot ulcers
• Be prepared to drop everything and come to the foot clinic at the first sign of a foot problem.
Can I go on holiday with an ulcer?
Ideally you should not go on holiday until
• The ulcer has healed and remained healed for at least a month
• Your footwear is adjusted
• Your footwear has been worn in and is trouble free
• You have received holiday foot care advice
• You know what to do and where to go if you get a foot problem on holiday.
What should I do if my own doctor or nurse wants to change the treatment?
Always ask them to discuss your treatment with the diabetic foot service.
Fig. 4.22 Bulla secondary to severe cardiac failure.
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