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Health Information Center

Diabetic Foot Ulcer

Authors:
  • Diane Voyatzis Norwood, MS, RD, CDE
Publication Type:

Condition

Diabetic Foot Ulcer

Definition

Ulcers are slow-healing wounds on the skin. Diabetic foot ulcers occur on the feet of people with type 1 and type 2 diabetes. Diabetic foot ulcers usually occur on the bottom of the foot. They can lead to serious complications.

Foot Ulcer.

Foot Ulcershttp://services.epnet.com/getimage.aspx?imageiid=75167516si1734.jpgsi1734.jpgNULLjpgsi1734.jpgNULL\\hgfiler01a\intellect\images\si1734.jpgNULL15NULL2008-12-102553907516_102704236362Copyright © Nucleus Medical Media, Inc.

Causes

Diabetes can cause problems with blood flow in feet and nerve damage. Poor blood flow will make it harder for damaged skin to heal. Damage to the nerves can make it hard to feel pressure, blisters, or other injury to the feet. This makes it hard to prevent sores and can lead to larger sores.

The ulcer itself is usually caused by:

  • Repetitive trauma or pressure on the foot
  • A puncture wound on the foot
  • Objects in the shoe that can damage the skin, such as a small rock

Risk Factors

The risk of diabetic foot ulcers is higher in those with:

  • Neuropathy—numbness, tingling, or burning sensation in the feet
  • Peripheral artery disease (PAD)—poor blood flow in the legs
  • Improperly fitted shoes
  • A foot deformity, such a bunion
  • Diabetes for more than 10 years
  • Poor diabetes control (HbA1c > 9% )
  • Not wearing shoes
  • A history of smoking

Symptoms

Symptoms of a diabetic foot ulcer may include:

  • Sores, ulcers, or blisters on the foot or lower leg
  • Pain
  • Problems walking
  • Discoloration in feet: black, blue, or red
  • Fever, skin redness, swelling, or other signs of infection

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. A foot specialist may be needed. Fluid from the wound and blood tests may be done to look for signs of infection. Other tests may include:

Treatment

Early treatment can prevent more problems. The goals are to:

  • Heal the ulcer
  • Prevent infection
  • Prevent future foot ulcers
  • Avoid having to surgically remove all or part of the foot

Treatment options include the following:

Prevention

Steps that can help keep feet healthy:

  • Daily care including washing, drying well, and using socks
  • Daily inspection of feet to look for injuries or sores
  • Regular medical care for diabetes
  • Use properly fitting shoes and socks
  • Stop or avoid smoking
  • Physical activity on most days of the week
  • Proper care for calluses or toenails that are hard to trim

Wound Care

Good wound care is important to help the ulcer heal and prevent infection. It will include keeping area clean and bandaged. Special bandages can help the wound heal faster. Other steps that can help during recovery include:

  • A special cast or boot may be needed to ease pressure on the ulcer.
  • Good blood glucose control can help the area heal. High blood glucose can slow healing and increase the risk of infections. Infected ulcers can also raise blood glucose levels. Changes to blood glucose care plan may be needed.
  • Quit smoking. Smoking can slow healing.
  • Proper footwear can decrease further injury.
  • Antibiotics may be needed if there is an infection.
RESOURCES:

CANADIAN RESOURCES:

CANADIAN RESOURCES:

References

  • Diabetic foot ulcer. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/diabetic-foot-ulcer.
  • Foot and toe ulcers. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/17169-foot-and-toe-ulcers.
  • Schaper NC, van Netten JJ, et al. Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3266.

Contributors

  • April Scott, NP
Last Updated:
2023-06-01

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.