What Are DFUs?

Diabetic foot ulcers (DFUs) are sores or wounds on the feet that occur in people with diabetes, a condition in which blood sugar levels are abnormally high. About 15% of people with diabetes will develop DFUs in their lifetime. If left untreated, DFUs may not heal and may become infected and lead to serious complications. However, DFUs can often be easily treated if caught early.

What causes a DFU?

For people with diabetes, prolonged high blood sugar levels can lead to damaged nerves in their feet. This condition, called peripheral neuropathy, can cause you to lose sensation in your feet and may prevent you from noticing injuries, including:

• Sores caused by repetitive minor trauma (such as long walks)
• Wounds caused by a single major trauma (like scraping your foot, stepping on rocks, putting your feet in hot water, cutting your toenails incorrectly, wearing shoes that don’t fit properly)
• Foot problems such as calluses and hammertoes

If left untreated, these injuries can turn into DFUs. Additionally, people with diabetes may have poor blood flow to the feet, which slows the wound healing process and increases risk of infection and lead to serious complications.

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Risk Factors

You may be at risk of developing a DFU if:

• Your blood sugar levels are too high
• You have nerve damage that causes a loss of feeling in your feet
• You experience changes in the shape of your feet

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Prevention

If you have diabetes, it is important to monitor for any injuries to your feet that you might not feel. See your wound care specialist regularly and have your feet professionally checked – just like your eyes and your kidneys – at least once a year. Following these important steps can help keep you healthier and your feet in better shape.

1) Take care of your diabetes

• Know your A1C, what it means, and what your doctor recommends for your target number.
• Take your diabetes medications as prescribed and follow your doctor’s recommendations for maintaining a healthy lifestyle.
• Keep all appointments with your healthcare team.

2) Make a daily feet check part of your routine

• Look for cuts, sores, red spots, swelling, and infected toenails – you may have a problem but not be able to see it.
• Use a mirror so you can see all parts of your feet.
• Call your wound care specialist if any of these problems do not heal after one day.
• Be sure to have your wound care specialist check your feet at each visit.

3) Follow the “3-Ws” foot care plan

• Wash your feet daily in warm (not hot) water – always dry them well and keep your feet moisturized by using lotion, cream, or petroleum jelly on the tops and bottoms.
• Wear socks and shoes that are breathable, provide cushioning, and fit well. Always take care to protect your feet and avoid blisters. You may want to ask your wound care specialist about Medicare and private insurance coverage for special shoes.
• Wiggle your toes and ankles several times per day to improve blood flow. Put your feet up while sitting and don’t cross your legs or wear constrictive items around your feet.

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Self-Examination

DFUs often begin as relatively minor sores or cuts that get worse because of low blood flow and/or infection. Regular foot examinations can help diagnose any problems early on.
Keep on the lookout for:

• Cuts
• Scrapes
• Calluses
• Blisters
• Sores
• Redness and red spots
• Swelling
• Toenail infections

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Patient Resources

The following links are provided for your convenience. They offer additional information about diabetes, diabetic foot ulcers, or related topics.

American Diabetes Association (ADA)
www.diabetes.org
The ADA is the nation’s leading non-profit health organization offering information on diabetes education, research, and patient advocacy.

American Podiatric Medical Association (APMA)
www.apma.org/diabetes
The APMA is the premier professional organization representing the nation’s doctors of podiatric medicine (podiatrists). The APMA advances and advocates for the profession of podiatric medicine and surgery for the benefit of its members and the public.

American Association of Diabetes Educators (AADE)
www.diabeteseducator.org
AADE is a professional association dedicated to promoting the expertise of the diabetes educator, ensuring the delivery of quality diabetes self-management training to the patient, and contributing to the future direction of the profession.

United States Food and Drug Administration (FDA)
www.fda.gov/diabetes
The FDA is an agency within the US Department of Health and Human Services that is responsible for, among other things, protecting the public health by assuring the safety, effectiveness, and security of drugs, vaccines, other biological products, and medical devices. This comprehensive site from the FDA provides information on a wide variety of diseases, including information to help patients manage their diabetes and live healthy lives. You’ll also find information on medical products for treating diabetes, including glucose meters, insulin pumps, diabetes medicines, and insulin. New research findings, product approvals, upcoming panel meetings, and other current information about diabetes care are also available.

Department of Health and Human Services (HHS) & Centers for Disease Control and Prevention (CDC)
www.hhs.gov and www.cdc.gov
The CDC is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans, and for providing essential human services, especially for those people who are least able to help themselves. Information on diabetes is available through both organizations’ websites.

National Diabetes Information Clearinghouse (NDIC)
www.diabetes.niddk.nih.gov
The National Diabetes Information Clearinghouse (NDIC) is an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NDIC was established in 1978 to increase knowledge and understanding about diabetes among patients, healthcare professionals, and the general public.

Diabetes.com
www.diabetes.com
This website was developed by GlaxoSmithKline and offers educational information about diabetes. This information is not a substitute for your doctor’s medical advice, nor is your doctor responsible for its content.

Advanced BioHealing, Inc. (ABH)
www.abh.com
ABH is a leader in regenerative medicine focused on the development and marketing of cell-based and tissue-engineered products, including Dermagraft®, a human fibroblast-derived dermal substitute used in the treatment of diabetic foot ulcers.

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