Between 30-50% of patients with diabetes have peripheral neuropathy. This is a nerve injury that prevents you from protecting your own skin by losing feeling. In addition, the nerve damage interferes with your muscles leading to deformities and difficulty walking. Pressure increases over these prominent areas leading to callus formation from repeated injury. Damage from the callus or injury leads to open sores or ulceration.
Your wound care treatment has included some form of “off-loading” by padding or casting. This is how we remove pressure from the open sore to allow the body to heal. Under the care of Dr. Geller you also had to remain in this cast or padding 4 weeks after healing to allow the scar to mature. To prevent return of the ulceration you will need protection from pressure on prominent areas.
You should be very proud of yourself. You have accomplished what more than 90,000 Americans failed to do this year. You saved your leg from amputation due from diabetic ulcer.
More than 90,000 people lost a major part of their foot or the entire leg to complications beginning as a wound on their foot. Some of these were not avoidable, but it is estimated that 64% of these could have been prevented with advanced wound care such as you have done.
Now our focus switches to prevention. You and your physician do not want you to experience anything like this ever again. You have most likely been treated using some form of cast or padding to keep the pressure off your foot and swelling down. Since this was necessary to heal the wound it should be no surprise that something will be needed to keep the wound healed.
Prescription shoes with custom-made inserts are used to cushion and protect the feet. You will have to wear these shoes with inserts everyday for quite some time. Every year your insurance will pay for new shoes. You should receive three pairs of inserts for these shoes to be changed every four months. The longer you stay healed and the better you control the callus formation the more flexible your shoe selection will become.
In some patients surgery was performed to correct deformity and decrease pressure. Even these patients have to wear the prescription shoes with insoles.
Dr. Stephen Geller, AZ Podiatrist