Ulcers are slow-healing wounds on the skin.
Diabetic foot ulcers occur on the feet of people with
type 2 diabetes. Diabetic foot ulcers usually occur on the bottom of the foot.
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Diabetes can damage the nerves of the legs and feet. This may make it difficult to feel a
or sore. If you don't care for a sore it may become larger and infected.
Diabetes also can cause problems with blood flow. Poor blood flow can make it difficult to heal.
The ulcer itself is usually caused by:
Repetitive trauma or pressure on the footPuncture wound on the footObjects in the shoe that can damage the skin, such as a small rock
Factors that may increase your chance of diabetic foot ulcers include:
Neuropathy—numbness, tingling, or burning sensation in your feetPeripheral artery disease (PAD)—poor circulation in your legsImproperly fitted shoesA foot deformityDiabetes for more than 10 yearsPoor diabetes control (HbA1c > 9%
Not wearing shoes
A history of
Symptoms may include:
Sores, ulcers, or blisters on the foot or lower legPainDifficulty walkingDiscoloration in feet: black, blue, or redFever, skin redness, swelling, or other signs of infection
You will be asked about your symptoms and medical history. A physical exam will be done. Your primary doctor may refer you to a foot specialist.
Your bodily fluids and tissues may be tested. This can be done with: Blood testsWound culture Ankle-brachial pressure
Images may be taken of your bodily structures. This can be done with: Doppler or arteriographic ultrasoundX-rayCT scanMRI scan
The sooner a diabetic foot ulcer is treated, the better the outcome. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Good wound care is important to help the ulcer heal and prevent infection. Follow your doctor's instructions for wound care. Make sure to clean the wound regularly. Change the dressings often to prevent infection.
Constant pressure on the ulcer can make it difficult to heal. Your doctor may ask you to take some pressure off of the ulcer area. You may be given a special cast or boot. These will take the pressure off of your foot, but still allow you to walk.
Infected ulcers can raise high blood glucose levels. High blood glucose levels can then lower the body's ability to fight infections. The high level also keeps the wound from healing.
Improved blood glucose control will help you fight any infections and heal your wounds. This control is often done with adjustments in your diet or medications. Sometimes insulin shots are needed in the short-term until you are healthy again.
If you smoke, talk to your doctor about ways to quit. Smoking can slow healing.
Wear proper footwear. Make sure it fits well.
Some large skin ulcers may have a hard time fully healing even with the treatments above. They may need a patch of skin to help close the wound. This process is called a skin graft.
or human skin graft may be used.
If the ulcer is infected, your doctor may advise antibiotics. You may need to take the medication for 4-6 weeks. Do not skip doses. Finish the medication as directed.
Your doctor may also recommend a medication to place on the ulcer. The medication may help speed healing.
Dead tissue can build up inside and around the wound. This tissue will slow or prevent healing. You may need surgery to remove the dead tissue and clean the wound. This surgery is called
Bypass surgery may be needed to improve blood flow to the legs. This surgery uses healthy blood vessels to carry blood past areas of unhealthy blood vessels. The improved blood flow may help with wound healing.
Sometimes an infection is too severe or does not respond to treatment. As a last resort, amputation surgery may be needed. This is the removal of a body part to stop the infection from spreading to the rest of the body.
Hyperbaric oxygen therapy
may help with healing. This therapy is delivered in a chamber. Pure oxygen is pumped into the chamber. This helps to increase the amount of oxygen in the blood. The extra oxygen can improve healing.
Another option to help speed healing is using negative pressure wound therapy. A vacuum device and dressing are used to create negative pressure on the wound. This can help the wound heal faster.
To help reduce your chance of diabetic foot ulcers: Clean your feet daily. Dry them thoroughly, especially between the toes, before putting shoes and socks on.Do not wear garters and tight stockings around the legs.You may want to use petroleum jelly or an unscented lotion to moisturize dry, leathery feet. Do not put lotion between the toes. The extra moisture may attract bacteria.Inspect your feet daily. Look for sores that you may not be able to feel. Use a mirror or the assistance of another person to see all parts of your feet.Your doctor should look at your feet and test the feeling in them at least once a year. If you find a sore at any time, make an appointment to see your doctor right away.People with diabetes may have toenails that are brittle and difficult to cut. You may also want to have a foot specialist trim your toenails regularly.Buy properly fitted shoes. Some insurance companies will pay for custom-made shoes with inserts. A doctor can give you a prescription for the shoes.Avoid smoking.Talk to your doctor about exercise. Daily exercise will help to improve blood flow and blood glucose levels.Calluses
can increase the pressure on the foot and lead to foot ulcers. Have your foot doctor remove any calluses. This could reduce the risk of developing a foot ulcer.
Ask your doctor if you should use a special infrared thermometer. It can check the temperature of your feet.Improved control of your diabetes may reduce the risk of ulcers.
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Last reviewed September 2016 by Kim Carmichael, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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