Patient/caregiver were instructed on the findings of diabetic foot ulcers to watch for and report to the physician as follows:
- Due to neuropathy in poorly managed diabetics, individuals with diabetic foot ulcers can have poor sensation at the ulcer site, which contributes to the painless nature of the wound. Patients, secondary to poorly controlled neuropathy, can as well present with burning, altered/tingling sensation, or numbness in the feet. Individuals with active or history of diabetic foot ulcers should closely inspect their feet every day, especially the undersurface of the feet, and report to the physician regarding any & every event of risk for skin integrity, such as, development of new calluses, open wound sites, any accidental injury to the feet, worsening altered sensations in the feet, and so on. Individuals needing caregiver assistance to perform this task should seek appropriate assistance from available and willing caregivers.
- Poorly controlled neuropathy in the foot during later stages can also result in compromised nerve supply to the numerous small intrinsic muscles in the foot, which control the action of toes and maintain the shape & arches of the foot. Poor nerve supply to the intrinsic muscles of the foot leads to progressive atrophy of these muscles, resulting in stiffness & contractures of the toes and compromised arches of the foot. Stiffness & contractures of the toes and compromised foot arches in individuals with active or history of diabetic foot ulcers can alter the gait pattern, impair balance during ambulation, and increase dependence on assistive device, thus contributing towards increased risk for falls and accidents. Any new or worsening stiffness in the toes, development of altered foot arches, changes in gait pattern, worsening of ambulatory balance, and any incidents of falls & accidents must be closely followed and reported to the physician for further investigation.
- Progressive worsening of the diabetic wound with development of repeated & uncontrolled infections could result in spread of bacteria to deeper tissues, such as, muscle and bone. This can result in worsening of wound status to deeper and complicated wound. Involvement of deeper intrinsic muscles of feet with infection can result in swelling and tightness in the feet, with poorly controlled pain. Involvement of bone along the path of infection can result in inflammation of bone, bone pain, and osteomyelitis. Poorly controlled bone infection in later stages could lead to demineralization & weakening of bones, risk for easy fractures, necrosis & gangrene of the bone tissue. An attempt at saving the uninvolved healthy bone could necessitate an amputation of the limb to the extent involved. Individuals with active or history of diabetic foot ulcers should closely follow and report to the physician for further investigation regarding any acutely increased uncontrolled pain in the feet, gross swelling & tightness in the feet, and sudden onset or increase of any bone pain.
