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Diabetic Foot Ulcers


What is a diabetic foot ulcer?

A diabetic foot ulcer is a serious wound that develops from a cut or scratch on your foot. You may not be able to feel a cut or scratch because of nerve and blood vessel damage. This damage is caused by long-term high blood sugar levels.

Foot Ulcers

What increases my risk for a diabetic foot ulcer?

Your risk increases if you have had diabetes for 10 years or longer. Any of the following can increase your risk:

  • Nerve damage and numbness in your feet
  • Poor blood flow
  • Crooked or curved toes, or changes in your walk
  • A decrease in vision that keeps you from seeing your feet clearly
  • Shoes that are too tight or do not fit well
  • A blister, scratch, bite, burn, or injury from a sharp object
  • Certain medicines, such as steroids
  • Smoking
  • Being overweight or obese
  • Poor nutrition

What are the signs and symptoms of a diabetic foot ulcer?

  • Bad odor or pus coming from your foot
  • Shiny, tight skin on your foot that turns dark, cold, or pale
  • Fever and chills
  • A weak foot or trouble moving your foot
  • Muscle pain or cramps that occur with activity and go away with rest
  • Pain in your foot that had little or no feeling before
  • Redness and warmth, or swelling in your foot
  • Thick, yellow toenails

How is a diabetic foot ulcer diagnosed?

Your healthcare provider will ask about your symptoms and examine your foot and the ulcer. He may also check your shoes. You may need any of the following:

  • Blood tests may show an infection.
  • An ankle brachial index test may show how well blood flows to your feet.
  • A monofilament test may show nerve damage in your feet. A healthcare provider presses a small wire against the bottoms of your feet.
  • A tissue, drainage, or bone sample may be taken from your ulcer to check for infection. These samples help healthcare providers find the best treatment for your foot ulcer.
  • An x-ray, ultrasound, CT, or MRI may show the infection and how deep it is. You may be given contrast liquid to help your foot show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

How is a diabetic foot ulcer treated?

Diabetic foot ulcers are hard to treat because they heal slowly. Follow your diabetes treatment plan. You may need any of the following:

  • Medicines:
    • Antibiotics help treat or prevent a bacterial infection.
    • Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
    • Growth factors help increase cell repair so you can heal. Growth factor may be a gel that is put directly on your ulcer.
    • Vasodilators help widen your blood vessels and improve blood flow.
    • Prescription pain medicine may be given. Ask how to take this medicine safely.
  • Bandages help keep your wound area moist and free from infection. The bandages may contain medicines to help your ulcer heal and prevent growth of unhealthy tissue.
  • Electrical stimulation uses a low-level electrical current on your ulcer to improve healing.
  • Hyperbaric oxygen therapy increases the oxygen supply to the area of your ulcer. The increased oxygen may decrease swelling, and help your ulcer to heal faster.
  • Negative pressure wound therapy uses a machine to pull fluid out to decrease swelling, improve blood flow, and help your ulcer heal.
  • Offloading devices , such as insoles, cushions, braces, or custom foot wear may be needed. These devices help decrease the amount of weight and pressure placed on your foot.
  • Surgery may help improve blood flow and wound healing. Infected or dead tissue may need to be removed from your ulcer.

How do I care for my feet?

Good foot care may help prevent ulcers, or keep them from getting worse. You may need to do any of the following:

  • Care for your wound as directed. Keep your wound clean and cover it with a nonstick bandage. You may need to cover your wound with a plastic bag while you bathe. Ask your healthcare provider for instructions on bathing until your foot heals.
  • Check your feet each day. Look at your whole foot, including the bottom, and between and under your toes. Check for wounds, corns, and calluses. The skin on your feet may be shiny, tight, or darker than normal. Your feet may also be cold and pale. Feel your feet by running your hands along the tops, bottoms, sides, and between your toes. Redness, swelling, and warmth are signs of blood flow problems that can lead to a foot ulcer. Do not try to remove corns or calluses yourself.

  • Wash your feet each day with soap and warm water. Do not use hot water, because this can injure your foot. Dry your feet gently with a towel after you wash them. Dry between and under your toes.
  • Apply lotion or a moisturizer on your dry feet. Ask your healthcare provider what lotions are best to use. Do not put lotion or moisturizer between your toes.
  • Cut your toenails correctly. File or cut your toenails straight across. Use a soft brush to clean around your toenails. If your toenails are very thick, you may need to have a healthcare provider or specialist cut them.
  • Protect your feet. Do not walk barefoot or wear your shoes without socks. Check your shoes for rocks or other objects that can hurt your feet. Wear cotton socks to help keep your feet dry. Wear socks without toe seams, or wear them with the seams inside out. Change your socks each day. Do not wear socks that are dirty or damp.
  • Wear shoes that fit well. Wear shoes that do not rub against any area of your feet. Your shoes should be ½ to ¾ inch (1 to 2 centimeters) longer than your feet. Your shoes should also have extra space around the widest part of your feet. Walking or athletic shoes with laces or straps that adjust are best. Ask your healthcare provider for help to choose shoes that fit you best. Ask him if you need to wear an insert, orthotic, or bandage on your feet.
  • Go to your follow-up visits. Your healthcare provider will do a foot exam at least once a year. You may need a foot exam more often if you have nerve damage, foot deformities, or ulcers. He will check for nerve damage and how well you can feel your feet. He will check your shoes to see if they fit well.

When should I contact my healthcare provider?

  • You can see bone through your ulcer.
  • You see black or dead tissue in or around your ulcer.
  • Your foot ulcer has a bad smell or is draining pus.
  • Your foot becomes red, warm, and swollen.
  • Your ulcer becomes bigger, deeper, or does not heal.
  • Your feet become numb, weak, or hard to move.
  • You feel pain in a foot that used to have little or no feeling.
  • You have a fever or chills.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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