Diabetes-related foot ulcers are often associated with numbness in the feet. According to patients, the fact that these ulcers can also cause severe and unpredictable pain does not receive sufficient attention within the healthcare system, according to a doctoral thesis from the University of Gothenburg.
Hard-to-heal foot ulcers in people with diabetes typically occur in areas of the foot subject to pressure, such as the toes, the forefoot, and the heel. Foot ulcers can develop in both type 1 and type 2 diabetes, with underlying causes including impaired blood circulation and nerve damage.
The thesis is based on surveys and interviews with patients suffering from diabetic foot ulcers, a condition where pain can occur despite reduced sensation. The intensity varies significantly, ranging from a mild, dull ache to the sensation of being cut with a knife on the sole of the foot; furthermore, the pain can be unpredictable.
"Patients live with the reality that intense pain can strike suddenly, at any time of day or night. They cannot predict when the pain will occur, which leads to sleep disturbances and makes it difficult for them to plan their daily lives and social activities," says Anneli Ringblom, district nurse who holds a PhD in nursing science and health.
Constant vigilance in daily life
Can I work in the garden? Can I go to the party? Do I have enough pain relief? Planning daily life becomes difficult, while at the same time, patients feel that their pain issues are not being addressed within the healthcare system. To a large extent, they are left to manage the pain on their own.
“In general, patients appreciate the healthcare staff who treat them – doctors, nurses, and foot therapists receive positive feedback in the surveys – yet they also report that their pain is not always acknowledged. They explain that healthcare staff do not always ask about pain, and that they themselves hesitate to bring it up so as not to burden the staff,” says Anneli Ringblom.
Some patients describe the pain as so severe and persistent that amputation can sometimes seem like a way out, a means to escape the suffering, even though amputation is simultaneously one of the most feared consequences of unhealed foot ulcers.
Pressure and responsibility
Anneli Ringblom emphasizes that the studies in her thesis focus on the patient perspective. While she did not investigate the specific clinical events that took place, she argues that the findings nonetheless point to a need for greater attention and clearer strategies regarding the assessment and alleviation of pain associated with diabetes-related foot ulcers.
“Diabetes-related foot ulcers are extremely limiting. Patients describe a shift in their relationship with their own bodies, a sense that they can no longer trust them. Some say they no longer have the energy to go for a walk; the preparation involved – applying ointments, bandaging, and checking for things like a wrinkle in a sock or a grain of sand in a shoe – is too demanding, especially since even minor foot injuries can have serious consequences. They face immense pressure and a heavy, perceived personal responsibility to ensure that nothing goes wrong,” she concludes.