Diabetes - foot ulcers

Diabetes can damage the nerves and blood vessels in your feet. This damage can cause numbness and reduce feeling in your feet. As a result, your feet are more likely to get injured and may not heal well if they are injured. If you get a blister, you may not notice and it may get worse.

If you have developed an ulcer, follow your health care provider's instructions on how to treat the ulcer. Also follow instructions on how to take care of your feet to prevent ulcers in the future. Use the information below as a reminder.

One way to treat an ulcer is debridement. This treatment removes dead skin and tissue. You should never try to do this yourself. A provider, such as a podiatrist, will need to do this to make sure the debridement is done correctly and does not make the injury worse.

• The skin surrounding the wound is cleaned and disinfected.
• The wound is probed with a metal instrument to see how deep it is and to see if there is any foreign material or object in the ulcer.
• The provider cuts away the dead tissue, then washes out the ulcer.
• Afterward, the sore may seem bigger and deeper. The ulcer should be red or pink. Wounds that are pale or purple/black are less likely to heal.

Other methods the provider may use to remove dead or infected tissue are:

• Put your foot in a whirlpool bath.
• Use a syringe and catheter (tube) to wash away dead tissue.
• Apply wet to dry dressings to the area to pull off dead tissue.
• Put special chemicals, called enzymes, on your ulcer. These dissolve dead tissue from the wound.
• Order hyperbaric oxygen therapy (helps deliver more oxygen to the wound).

Foot ulcers are partly caused by too much pressure on one part of your foot.

Your provider may ask you to wear special shoes, a brace, or a special cast. You may need to use a wheelchair or crutches until the ulcer has healed. These devices will take the pressure off of the ulcer area. This will help speed healing.

Sometimes putting pressure on the healing ulcer for even a few minutes can reverse the healing that happened the whole rest of the day.

Be sure to wear shoes that do not put a lot of pressure on only one part of your foot.

• Wear shoes made of canvas, leather, or suede. Don't wear shoes made of plastic or other materials that don't allow air to pass in and out of the shoe.
• Wear shoes you can adjust easily. They should have laces, Velcro, or buckles.
• Wear shoes that fit properly and are not too tight. You may need a special shoe made to fit your foot.
• Don't wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.

Care for your wound as instructed by your provider. Other instructions may include:

• Keep your blood sugar level under good control. This helps you heal faster and helps your body fight infections.
• Keep the ulcer clean and bandaged.
• Cleanse the wound daily, using a wound dressing or bandage.
• Try to reduce pressure on the healing ulcer.
• Do not walk barefoot unless your provider tells you it is OK.
• Good blood pressure control, controlling high cholesterol, and stopping smoking are also important.

Your provider may use different kinds of dressings to treat your ulcer.

Wet-to-dry dressings are often used first. This process involves applying a wet dressing to your wound. As the dressing dries, it absorbs wound material. When the dressing is removed, some of the tissue comes off with it.

• Your provider will tell you how often you need to change the dressing.
• You may be able to change your own dressing, or family members may be able to help.
• A visiting nurse may also help you.

Other types of dressings are:

• Dressing that contains medicine
• Skin substitutes

Keep your dressing and the skin around it dry. Try not to get healthy tissue around your ulcer too wet from your dressings. This can soften the healthy tissue and cause more foot problems.

Regular exams with your provider are the best way to determine if you are at higher risk of foot ulcers due to your diabetes. Your provider should check your sensation with a tool called a monofilament. Your foot pulses will also be checked.

Contact your provider if you have any of these signs and symptoms of infection:

• Redness, increased warmth, or swelling around the wound
• Extra drainage
• Pus
• Odor
• Fever or chills
• Increased pain
• Increased firmness around the wound

Also contact your provider if your foot ulcer is very white, blue, or black.

Diabetic foot ulcer; Ulcer - foot

American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S231-S243. PMID: 38078577 pubmed.ncbi.nlm.nih.gov/38078577/.

Brownlee M, Aiello LP, Sun JK, et al. Complications of diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Dhatariya KK, Umpierrez GE, Crandall JP. Diabetes. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 210.

National Institute of Diabetes and Digestive and Kidney Disease website. Diabetes and foot problems. www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems. Updated January 2017. Accessed May 28, 2024.

Updated by: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.