Over the last three weeks we’ve been discussing the most common complications to affect the diabetic patient in the lower extremity. Diabetic neuropathy with circulatory compromise and increased plantar foot pressures all contribute towards an increased risk of diabetic ulceration in such patients.
I’ve given you many helpful tips for decreasing your risk of developing each of those three complications, and again I’ll reiterate that prevention is your best option! However, despite your best efforts, if you do develop a “neuropathic ulcer,” you will be facing an uphill battle in getting that ulceration to heal. This week I hope to help you identify signs and symptoms of an ulceration that needs immediate treatment, increasing your chances of healing that area quickly.
First and foremost, you should understand what I mean when I say “neuropathic ulcer:” this is an ulceration found in an area of the foot where you lack sensation such that the causative agent (whether a foreign object or friction) went undetected by you. Treatment begins with recognition of the ulceration at home during your daily foot checks. Once you’ve identified a break in the skin or ulcerative area, you should immediately call your Podiatric Physician for an appointment. This last step is very important, no matter how large or small the area of ulceration may be, because these wounds have a history of quickly deteriorating.
Now, if the area in question is discovered on a Friday after your Podiatrist’s office has already closed for the weekend, there are some signs and symptoms you need to be on the lookout for. These signs/symptoms will help you determine if you need to seek immediate treatment at an Emergency Room, or if you are able to wait it out until Monday. In deciding this, think ROD: Redness, Odor, Drainage.
R = Redness: If the skin surrounding the ulceration is extremely red, hot and swollen, this is a cause for concern. Even more emergent is recognition of red “streaking” from the area of ulceration up towards the core of the body. Streaking is a sign of infection that is penetrating the lymph system and needs immediate attention. As an aside, if you are having any symptoms of a systemic infection, such as fever, chills, nausea or vomiting, you are also in need of immediate treatment.
O = Odor: If the area smells fruity or has an unbearable odor associated with it, this may be an indication of local infection across the base of the wound. If this is the only symptom, what you should do is clean the area with warm soap and water, dry it completely and place a clean dry bandage over the area, to be changed each day until you’re able to see your Podiatrist. If this odor is associated with systemic symptoms, excessive redness or streaking and alarming drainage, you are in need of immediate treatment.
D = Drainage: If there is green or thick yellow drainage coming from the area, typically associated with an odor, you need to be seen immediately. This is a definite sign of local infection, and one that may spread quickly, so it’s important to seek medical attention.
As a disclaimer, if you are unsure that your wound meets any of these criteria, my advice would be this: go to the Emergency Room. It’s better to be reassured that everything is okay than to miss an ulceration that’s quickly deteriorating. In addition, if the ulceration seems to be changing for the worse and digressing quickly, you should also seek immediate treatment.