How to Recognize, Prevent and Treat Diabetic Ulcers with Dr. Brad Backoff

If you have diabetes, you’re at risk for developing a diabetic wound. Podiatric physicians at Ankle & Foot Care Centers urge people with diabetes to stay on top of their foot health to avoid complications such as ulcers, which could develop into worse conditions if left untreated.

Dr. Bradley Backoff, a podiatric physician at Ankle & Foot Care Centers, says between 10 and 20 percent of diabetics experience a diabetic ulcer.

Dr. Backoff discusses what diabetic ulcers are, how they’re formed, how to recognize them early on and how to prevent and treat them.

What are diabetic ulcers?

A diabetic foot ulcer is an acute or chronic wound, which is a result of abnormal pressure and shear forces, generally found on the boney prominences of the foot.

“In addition to these forces, poor blood flow and neuropathy, a loss of feeling or sensation in the limbs, are thought to play a major role in decreasing the body’s ability to repair itself, contributing to the formation of an ulcer,” explains Dr. Backoff.

What are the risk factors, signs and symptoms?

In addition to diabetes, some common risk factors include decreased blood flow to the feet, neuropathy, abnormal foot structure, poor shoe selection, kidney problems, edema, which is the swelling of the legs and feet, and smoking.

A diabetic ulcer typically starts out as a callous, which forms as a result of a pressure point.

“Any diabetic with a callous, blister, or wound on the foot or leg should have it examined as soon as possible,” says Dr. Backoff. “Some other common symptoms individuals may notice are an increase in pain when they previously lacked sensation, a foul odor, or drainage in the socks or shoes.”

When left untreated, ulcers can lead to other complications, such as infection or the formation of an abscess, which is the collection of bacteria that requires surgical drainage. Another serious condition that can result is osteomyelitis, an infection of the bone. In the most serious cases, ulcers can lead to gangrene and the need for amputation of the lower extremities.

“Around 80 percent of amputations in the diabetic foot result from the presence of, or complications from an ulcer,” explains Dr. Backoff.

How do you prevent and treat ulcers?

Ulcers may be prevented by maintaining good control of blood sugars, wearing proper footwear, performing daily foot inspections and visiting a primary care physician and podiatrist on a regular basis.

“Diabetics should have a comprehensive diabetic foot exam to assess their foot health and determine their risk level,” says Dr. Backoff.

“Generally speaking, diabetic patients should see a podiatrist at least once a year, but patients who have a foot deformity, neuropathy, or peripheral vascular disease are at risk for ulcers, and should be seen more often.”

Ulcers are treated with a combination of local wound care and offloading, which refers to taking weight off the pressure points by placing an individual in a special shoe, boot, cast or bandage.

Vascular surgery may be necessary if the blood flow is poor and prevents the ulcers from healing. If there is an active infection, antibiotics, or in severe cases, amputation, may be necessary.

“Staying informed and aware of one’s health and seeking out treatment is the best thing anyone can do, but especially diabetics who are at risk for ulcers and other serious complications. Awareness is crucial for prevention of conditions associated with diabetes.”

Early Treatment Can Limit Impact of Peripheral Arterial Disease

April marks Foot Health Awareness Month and Ankle & Foot Care Centers is spreading awareness of peripheral arterial disease (PAD), which affects more than 18 million people in the United States.

PAD is a vascular disease caused by plaque build-up and the hardening of arteries, limiting blood flow to the legs and feet.

Dr. Mark S. Smesko, a podiatric physician with Ankle & Foot Care Centers, warns his patients to be aware of some common symptoms of PAD because it is crucial to seek early treatment and implement a prevention plan.

Symptoms of PAD

 “Patients with PAD can experience pain, numbness, burning in the legs and feet, cold toes and feet, loss of hair growth on the lower legs and feet as well as wounds on the lower limbs that won’t heal,” Dr. Smesko says. “People with PAD may also experience a condition called intermittent claudication, which is when they get extreme cramping in their legs and feet with activity, forcing them to have to sit down. They can get this from walking just a short distance.”

In more progressive cases of PAD, patients who experience intermittent claudication might also have rest pain.

“Patients can experience rest pain at night, due to a lack of blood flow while laying down,” Dr. Smesko explains. “They have to sit up, stand up and move around to improve blood flow back to the extremity. Rest pain is a sign of more severe disease than intermittent claudication.”

Common Risk Factors

 Individuals with diabetes are more at risk to experience PAD, Dr. Smesko warns.

“One in three patients who have diabetes and are over age 50 are likely to have PAD,” says Dr. Smesko. “A patient with both diabetes and PAD has a ten times greater risk for amputation.”

Other risk factors include smoking, hypertension, kidney disease and increased age.

Prevention and Treatment

Dr. Smesko recommends those at risk to manage their diabetes, get annual foot exams, stop smoking, keep blood pressure under control and stay active.

“If a patient has clinical signs of PAD, I order an arterial exam. This is a noninvasive test that detects blood pressures and wave forms at various levels of the leg, ankle and feet,” says Dr. Smesko. “If that comes back abnormal, I refer the patient to a vascular surgeon for evaluation and treatment.

“Sometimes patients with PAD may end up finding out they also have cardiac issues. About 60 percent of patients with PAD also have coronary artery disease. Therefore, it is crucial for individuals to seek treatment early, as soon as they experience any symptoms.”

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Peripheral Arterial Disease Questionnaire

If you answer Yes to the questions below, you may be at risk for vascular disease. If you or someone you know may be at risk for PAD, contact one of our 20 locations today and make an appointment with a podiatric physician.

Do you experience any pain while at rest in your lower leg(s) or feet?

Yes   No

Do you have foot, calf, buttock, hip, or thigh discomfort (aching, fatigue, tingling, cramping or pain) when you walk, which is relieved by rest?

Yes   No

Do you have an infection, skin wound, or ulcer on your feet or toes that is slow to heal (8-12 weeks)?

Yes   No

Do you have high cholesterol level or other blood lipid problem, or do you take medication to lower your cholesterol?

Yes   No

Do you have high blood pressure or take medication for high blood pressure?

Yes   No

Do you have diabetes?

Yes   No

Have you ever smoked?

Yes   No

Have you previously had a stroke?

Yes   No

Do you have heart disease?

Yes   No

Do your legs hurt at night?

Yes   No

To stop the pain, do you hang your legs over the side of the bed?

Yes   No

Do you raise your legs to stop them from hurting?

Yes   No


Simple Steps Help People with Diabetes Keep Feet Healthy


When people with diabetes watch their feet carefully, they can prevent some of the most severe risks of diabetes, including lower-limb amputations, says Dr. Robert Debiec, a podiatric physician with Ankle & Foot Care Centers.

People ages 20 and older who are living with diabetes account for about 60 percent of non-traumatic lower-limb amputations, according to the Centers for Disease Control and Prevention’s 2014 National Diabetes Statistics Report.

“The CDC says diabetes-related foot and lower-leg amputations have decreased by 65 percent since 1996,” Dr. Debiec points out. “Still, many more amputations can be prevented by closer attention to the health of one’s feet.”

People with diabetes may be less aware of cuts or wounds on their feet due to the nerve damage related to their disease, Dr. Debiec says.

Dr. Debiec and the American Podiatric Medical Association offer this advice to help people with diabetes protect their foot health:

  • Inspect your feet daily. Check the entire foot and all 10 toes for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration. Treat wounds immediately and see your podiatrist if a problem persists or infection is apparent.
  • Exercise by walking. This can help you maintain a healthy weight and improve circulation. Be sure to wear athletic shoes appropriate for the type of exercise you’re doing.
  • Wear shoes that fit. When you buy new shoes, have them properly measured and fitted. Foot size and shape can change over time, and ill-fitting shoes are a leading cause of foot pain and lesions. Certain types of shoes, socks, and custom orthotics are available for people with diabetes, and they may be covered under Medicare (learn more here).
  • Keep your feet covered. Never go barefoot, even at home. The risk of cuts and infection is too great.
  • Rely on a professional. See a licensed podiatrist to remove calluses, corns, or warts — don’t tackle them yourself, and don’t ask an unlicensed nonprofessional to do it. Over-the-counter products can burn your skin and injure your foot. Podiatrists are specially trained to address all aspects of foot health for people with diabetes.
  • Get checkups twice a year. An exam by your podiatrist is the best way to ensure your feet stay healthy.

“For people with diabetes, taking charge of your own foot health can help you avoid foot-related complications like amputation,” Dr. Debiec says. “Working with your podiatrist will help you safeguard your foot health.”

For a free booklet on diabetic neuropathy, visit this page.

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2 Easy Steps Can Discourage Wounds, Save Feet

gronerAs a wound care specialist, Dr. Thomas Groner sees dozens of debilitating foot wounds every week and knows that many of them could have been prevented by one of two very easy actions.

“First, it’s very important to look carefully at your feet and let your foot doctor know if you notice anything unusual,” said Dr. Groner, clinical director of the podiatric residency program at the Alliance Community Hospital Wound Care Center.

“Second, it’s important to wear shoes that fit right,” he said.

Although those seem like simple preventive measures, they are often overlooked.

In many cases, that’s because diabetes can blunt the feeling in one’s feet. If a person suffering from such numbness doesn’t physically look closely at his or her feet, warning signs may be missed and poorly fitting shoes could rapidly turn a small wound into a dangerous one.

In other cases, patients may feel the pain of a new wound but conclude it’s too minor to justify a doctor’s appointment, then grow complacent as the wound gets worse.

“There are people who have lost their legs, and it could have been prevented,” Dr. Groner said.

These conditions -- (from top) a heel ulcer, a neurotropic ulcer and dry gangrene -- can often be prevented but can also lead to amputation. (Images courtesy of American Podiatrict Medical Association.)
These conditions — (from top) a heel ulcer, a neurotrophic ulcer and dry gangrene — can often be prevented but can also lead to amputation. (Images courtesy of American Podiatric Medical Association.)

“It’s not uncommon for someone who has lost feeling to wear loose-fitting shoes and get a blister,” he said. “If they don’t notice, that blister can turn into a wound before they see it.

“For people with diabetes, the risk of not feeling a wound is complicated by the greater likelihood that they might step on a sharp object and develop a serious infection without realizing it.”

The APMA has published some compelling statistics about the dangers of wounds. A landmark study in the 1980s found that some 85 percent of amputations in people with diabetes are preceded by a foot ulcer. Other research suggests that more than 80 percent of diabetic lower extremity amputations are preventable (read more here).

Dr. Groner has some suggestions for those who may have lost feeling in their feet:

  • Ask a caretaker or relative to regularly check your feet for you, especially the bottoms of feet where forerunners to serious wounds often start and may go unnoticed for days or weeks.
  • Look into custom-fitted diabetic shoes, which are often covered by insurance. They’re wider and deeper and have a custom insert that’s molded specifically to the patient’s foot. Some insurance plans cover new diabetic shoes every year.

“Since it’s been established that wounds so frequently lead to amputations, I tell my patients that it is important to prevent wounds as opposed to treating them after they occur,” Dr. Groner said.

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Hispanics Face Greater Risk of Diabetes

According to recent statistics, Hispanics are increasingly facing foot problems as a result of diabetes. In the latest research linking Hispanics and diabetes, about 12 percent of Hispanics have diabetes, and almost two-thirds of those with diabetes have some sort of foot problem.

With diabetes can come a myriad of foot problems, ranging from ulcers to lower limb amputations. The good news is that foot and ankle specialists, like those at Ankle & Foot Care Centers, can treat these ailments before they become serious.

Dr. Christian Carbonell, a podiatric physician at Ankle & Foot Care, with 18 offices in the Mahoning Valley, presented a free bilingual seminar titled “Diabetes and Your Feet,” about diabetes and Hispanics’ increased risk to getting the disease. The presentation was at the Youngstown Orginizacion Civica y Cultural Hispana Americana, Inc. (OCCHA) facility as part of the practice’s community outreach efforts.

More than 40 attendees there learned how Hispanics are more at risk for diabetes and how it can result in foot ulcers and lower limb amputations.

In addition to explaining the symptoms and treatments for those experiencing foot problems as a result of diabetes, Dr. Carbonell recommended these dos and don’ts for preventing major foot problems.


  • Examine your feet daily
  • Keep the area between the toes dry
  • Moisturize dry skin
  • Wear comfortable shoes
  • Visit a podiatrist regularly


  • Don’t tear at loose skin
  • Don’t soak your feet in hot water
  • Don’t walk barefoot
  • Don’t smoke
  • Don’t use chemical callus removers

If you need further advice on how to care for your feet, the expert staff at Ankle & Foot Care Centers can help. To schedule an appointment at a location near you, call 330-758-6226.

Diabetes & its Effect on the Feet

Those who suffer from diabetes face a number of challenges, and among them is maintaining proper foot health. Diabetes can have many different negative effects on the feet and ankles, such as:

  • Neuropathy, wherein patients lose sensation in their feet
  • Susceptibility to foot sores and ulcers
  • Dryness in the skin of the feet
  • Poor circulation in the lower extremities
  • Risk of necessary amputation

If you suffer from diabetes, you must be more vigilant than others about taking proper care of your feet, ankles and legs. These consequences of diabetes can be prevented with good foot care habits, however. Diabetics can take many strides to ensure their feet remain health, including:

  • Checking the feet daily for sores, inflammation, and more.
  • Keeping toenails trimmed neatly.
  • Making sure the feet remain cool and dry.
  • Wearing socks and shoes to protect from foreign objects.
  • Being active to increase and improve circulation.

If you are one of the many Americans who suffer from diabetes, you and your podiatrist can develop a foot care routine that will protect your feet for years to come. To find an expert foot and ankle specialist inOhioand schedule an appointment, please visit Ankle & Foot Care Centers on the web or visit one of our 19 convenient locations.