Diabetic foot ulcers – Symptoms, Causes, Risk factors, and Prevention

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What is Diabetic foot ulcers?

Improper management of Diabetes through methods like diet, exercise and insulin treatment leads to a disorder called Diabetic foot ulcers. It is a general complication of Diabetes. Ulcers are caused due to breaking down of skin tissues over a period that exposes the underneath layers of skin. Diabetic foot ulcers are commonly seen under and beneath the big toes. 

This disease can penetrate the bottom layer of the skin and damage your foot bones. Treatment for Diabetic foot ulcers may vary for every individual. If you are infected with any foot disorder, consult your doctor immediately to avoid further effects.

What are the symptoms of Diabetic foot ulcers?

Some of the early symptoms of Diabetic foot ulcers are irritation, swelling, redness and odours. But, one of the first signs of a foot ulcer is sweating from your foot that may stain or produce a musty smell in your shoes.

Stages of Diabetic Foot Ulcer

The obvious sign of a severe foot ulcer is black tissue (also known as eschar). This is caused due to the absence of healthy blood flow around the corners of ulcers. In this case, tissue death appears around the corners of the ulcer.

Signs of foot ulcers remain unclear most of the time and can be confirmed only after infection. Sometimes, you may not be able to figure out these ulcer problems. Always keep in touch with your doctor so that you can stay away from the symptoms of Diabetic ulcers and skin discolouration.

What are the common causes of Diabetic foot ulcers?

Diabetic foot ulcers are caused due to underlying factors:

  • poor circulation of blood flow
  • Hyperglycemia (high blood sugar)
  • multiple nerve damages
  • wounded feet 
  • irritation in legs 

Poor blood flow is a vascular disease that affects blood flow to your feet efficiently. Poor circulation of blood aggravates wounds of ulcers. Foot ulcer becomes more adverse if blood sugar management is high and critical.

People who have severe Diabetes face difficulties during ulcers. Nerve damage can lead to pain and a loss of feeling in your feet painful. 

What are the risk factors involved in Diabetic foot ulcers?

People diagnosed with Diabetes are most likely to get affected with Diabetic foot ulcers. These ulcers can be commonly seen in older men.

Some common risk factors are so follows

  1. poor quality shoes
  2. ugly toenails
  3. over-consumption of alcohol
  4. peripheral arterial disease
  5. cigarette smoking
  6. Diabetic neuropathy
  7. heart diseases
  8. Previous foot ulcerations
  9. obesity

How to prevent Diabetic foot ulcers?

According to The University of Michigan Health approximately 15 percent of patients with Diabetes are affected by diabetic foot ulcers. Of those 15 percent, six percent of people are getting hospitalized due to complications. Hence, Diabetic patients should be very meticulous in preventing Diabetic foot ulcers. People should constantly monitor the level of stability in their blood sugar.

 You can also do the following steps to eradicate foot ulcers:

  • Clean your feet every day
  • Trim your toenails regularly
  • Always moisturize your feet
  • Change your socks regularly
  • Wear properly cleaned shoes

Diabetic foot ulcers can come again after the treatment. For this reason, try to wear shoes specially made for people with Diabetes to prevent Diabetic foot ulcers.

Treatments for Diabetic foot ulcers  

An NCBI article states that wound debridement, infection treatment, revascularisation treatments and offloading of foot ulcers are considered to be gold standard treatments for Diabetic foot ulcers.

Add-on treatments, including negative-pressure wound therapy (NPWT), hyperbaric oxygen therapy and cutting-edge wound care products, are also used in certain cases.

Prevention of infection 

Infection management is essential to stop or prevent infection occurrence since it can trigger and worsen diabetic foot ulcers. Since diabetic foot ulcers have high rates of morbidity and mortality, oral and topical antibiotics are advisable during infection. 

Taking the pressure off the area 

Off-loading is the term that refers to taking the pressure off the area. Healing of the diabetic foot ulcer is hindered by pressure. 

A device to disperse pressure more evenly across the lower leg is a crucial component of treatment. A non-removable total cast or a removable offloading device can be used. 

The fact that many patients using removable devices only wear them for 30% of the day, according to research, can have a substantial impact on the treatment’s results.

Removing dead skin and tissue 

Debridement is necessary to get rid of surface debris and necrotic tissues from all chronic wounds. It can be accomplished surgically, enzymatically, biologically or by autolysis, and it aids healing by encouraging the development of new tissue.

Scalpels are used in surgical debridement, which removes dead tissue and hyperkeratosis quickly and efficiently. 

The new healthy tissue has a red or deep pink appearance and should be protected with extra care. One of the most effective methods for managing wound healing is debridement, particularly sharp debridement, which greatly aids in healing wounds like diabetic ulcers.

Applying medication 

Dressings and topical medication usage are part of wound treatment. These range from solutions like saline to cutting-edge items like growth factors and bandages for ulcers that have been proven to be incredibly effective in treating foot ulcers.

There must be sufficient circulation to the ulcerated area for a wound to heal. A podiatrist might request diagnostic tests like noninvasive investigations, or it is preferable to seek advice from a vascular surgeon.

Managing blood glucose  

Diabetic foot ulcers can develop in patients with Diabetes due to various reasons. 

Damage to the nerves and decreased blood supply to the legs and feet are a few common causes. Optimal blood glucose control may be helpful since having high blood glucose may hinder the ability of foot ulcers to heal.

Surgery for Diabetic foot ulcers

Diabetic foot ulcers, which are difficult to manage with conservative management, require surgical intervention. Instances for preferring surgeries are listed below.

  • To release the pressure on the affected area, typically by shaving or removing the damaged bone.
  • To treat leg abnormalities such as hammertoes, bony bumps, etc.
  • To treat infections like osteomyelitis by physically removing the infected bone.

Reconstructive foot and ankle surgery encompasses a thorough musculoskeletal assessment, plain radiographs, CT scans and MRI scans to help decide on the surgical plan. It is a complex process that is carried out methodically.

  • Arthroplasty
  • Osteotomies
  • Resection
  • Arthrodesis
  • Tenotomies
  • Tendon transfer
  • Tendon lengthening 

Rebalancing the foot and forming a plantigrade foot that can distribute pressure on the leg are the objectives of the surgery. 

The doctor may use vascular reconstruction to treat diabetic foot ulcers if the blood vessels in the legs are severely damaged and the patient has arterial lesions with excruciating pain and gangrene. 

It entails replacing the blood vessels that were damaged by ulcers with artificial grafts or blood vessels taken from other parts of the body. It permits the wound to heal by restoring blood flow there.

Complications of Diabetic foot ulcers  

Skin and bone infections 

Skin infections from diabetic foot ulcers can result in swelling around the wound site, fever, chills and foul-smelling discharge. Amputation risk increases if the infection moves from the incision to the bone.


An abscess develops if the cut on the diabetic foot becomes infected. It contains an infectious substance that keeps leaking out of the abscess. In such a situation, it can be quite difficult to even wear socks or shoes.


Gangrene describes necrosis (body tissue death) due to a bacterial infection or a reduction in blood supply. 

Skin discolouration, unusual pus or drainage from the location and lack of sensation in the body portion affected are its defining features. 

The skin tissues around a diabetic foot ulcer that are not promptly treated experience a loss of oxygen due to the lack of blood supply. As a result, ischemia, a dark tissue that is one of the early warning symptoms of gangrene, may emerge.


Deformities in the feet can develop from the weakening of the bones and muscles of the feet caused by diabetic foot infections and long-term uncontrolled Diabetes. They might potentially result in Charcot foot, a severe condition that affects the soft tissues, joints, and bones of the ankle or foot. 

With ageing, the bones become brittle and begin to fracture or dislocate in response to light pressures, like walking. Foot joints may collapse if not treated at an early stage. 


Treatment must start right away if the infection in the diabetic foot ulcer spreads deep enough to affect the bones or tendons. If left untreated, this infection could enter the circulation and cause sepsis. Necrotising fasciitis can also develop due to specific types of bacteria in the illness. Even life-threatening consequences could result from either of these problems.

Charcot foot 

Charcot foot is a side effect of Neuropathy and Diabetes. A cycle of uncontrolled inflammation sets off its damaging effects on the foot and ankle. Early diagnosis and treatment can help to prevent this syndrome, which is a late stage of the disease. Around 1% of people with Diabetes with neuropathy experience Charcot foot.


One of the most harmful effects of untreated diabetic foot ulcers is foot amputation. The foot ulcer cannot heal if there are severe infections, an abscess, or gangrene present. In these situations, amputation of the infected foot is the only way to stop the infection from entering the bloodstream. So, if a person puts off getting treatment for a diabetic foot ulcer for a very long time, they run the risk of losing their foot.

When to see a doctor?

If you experience numbness in certain areas of your feet, see your doctor promptly and seek treatment before it turns into Diabetic foot ulcers. If you ignore treatments, it may result in over damage to your feet and legs. Surgery and amputation are performed in critical situations to cure ulcers.

In conclusion

Foot ulcers are treatable at an early stage. If you come across any symptoms, promptly treat a doctor. Diabetic foot ulcers can take weeks for complete healing.

It may take a longer time to heal if the patient’s blood sugar level is high. Removing pressure from the feet is the fastest way to heal foot ulcers. Consistent preventive care will help you stay away from Diabetic foot ulcers.

Can foot ulcers be cured? 

An ulcer can occasionally be healed in as early as three to six weeks in those with healthy blood circulation and access to quality medical care. It could take 12 to 20 weeks for deeper ulcers. Extreme cases require surgical management.

What is the most common cause of diabetic foot ulcers?

Poor glycemic control, calluses, foot deformities, inappropriate foot care, poorly fitting footwear, underlying peripheral Neuropathy and poor circulation and dry skin are some of the common causes of diabetic foot ulcers. The predominant aetiology, Neuropathy, affects about 60% of diabetics and finally results in a foot ulcer.

How severe are foot ulcers? 

A foot ulcer that is not treated may become deeper and larger. It becomes infected, which might lead to other foot issues that cause the feet to operate less effectively and, in rare situations, may necessitate amputation.

How do you clean a diabetic foot wound? 

Use saline or fresh tap water to thoroughly clean the wound. After cleaning, apply antibiotic ointment to keep the wound moist. To stop the bleeding and protect the wound, bandage it. Every 1-2 days, change the bandage and repeat the process.


The Information including but not limited to text, graphics, images and other material contained on this blog are intended for education and awareness only. No material on this blog is intended to be a substitute for professional medical help including diagnosis or treatment. It is always advisable to consult medical professional before relying on the content. Neither the Author nor Star Health and Allied Insurance Co. Ltd accepts any responsibility for any potential risk to any visitor/reader.

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