diabetic foot ulcer

Diabetic Foot Ulcers: Treatment, Symptoms, Care & Prevention of Diabetic Wounds

Learn about diabetic foot ulcers, it’s treatment and symptoms, as well as care and prevention of diabetic wounds.

by Lorraine Bunag, R.N.

Diabetes, a condition that affects how our bodies use sugar, can lead to various complications. It can damage the nerves and blood vessels enough to cause wounds in the feet. Left untreated, these wounds, better known as foot ulcers, can lead to a severe infection or amputation. 

From their causes and risk factors to their complications and care, here’s everything you need to know about diabetic foot ulcers. 

What is a Diabetic Foot Ulcer?

Athlete’s foot, calluses, skin dryness, blisters, and ingrown toenails – these are some of the most common foot problems anyone can experience. However, for people with diabetes, these seemingly harmless concerns can lead to infection and even loss of limb. 

For instance, blisters and calluses can progress into a diabetic foot ulcer: a break in the skin or a deep sore. Undetected and left untreated, a diabetic foot ulcer can get infected, cause tissue death, and lead to deformities or amputations. This is why diabetic foot screening is an integral part of diabetes care. 

Please note that diabetic foot ulcers are common; reports say 15% of people with diabetes develop them, and 6% of those cases would require hospitalization. 

Causes Of Diabetic Foot Ulcers

As mentioned earlier, common foot problems, like blisters and calluses, can lead to diabetic foot ulcers. Similarly, deep sores can result from minor scrapes and cuts as well as ill-fitting shoes. 

Now, there are two main reasons why these simple concerns have the potential to develop into severe diabetic foot ulcers:

Nerve Damage

Over time, diabetes can damage the nerves (diabetic neuropathy) and impair your ability to feel heat, cold, and pain. This lack of sensation may sound appealing at first, but it does more harm than good. 

You see, pain is one of the ways our bodies tell us that something is wrong. Without it, injuries may go unnoticed. For example, you may step on a tack and not feel it throughout the day or wear tight-fitting shoes and not know about it until you see bruising, blisters, or calluses! 

The wounds caused by the inability to feel pain may develop into diabetic foot ulcers. Thankfully, the risk decreases when a patient regularly undergoes diabetic foot screening. 

Impaired Blood Flow

Another contributing factor to the development of a foot ulcer is impaired circulation or reduced blood flow in the feet. 

Sufficient blood flow is crucial to any part of the body. It ensures that the cells receive the oxygen and nutrients they need to function well and heal when there is damage. 

With diabetes, you may have impaired blood flow in the feet. Should injuries, like scrapes and cuts, occur, they may not heal as expected, increasing the risk of a diabetic ulcer. 

Risk Factors in Developing a Diabetic Foot Ulcer

Now that we have a better idea of the definition and causes of a foot ulcer, let’s talk about its risk factors. 

Anyone who has diabetes can develop a diabetic foot, but their risk significantly increases when they have difficulty reaching their target glucose goals. Additional risk factors include:

  • Insulin use
  • Diabetes-related eye, kidney, and heart disease
  • Excess weight
  • Alcohol consumption
  • Tobacco smoking

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When to Seek Medical Help

The main symptom of a diabetic ulcer is the appearance of a deep sore, frequently a circular, open wound, in any part of the feet or legs. We include the legs because diabetic legs also experience reduced sensation and impaired circulation. 

If you notice a sore, regardless of size or depth, it’s best to get it checked immediately. However, you can consult a doctor long before you see an actual foot ulcer. Set an appointment if you observe the following warning signs and symptoms:

  • Diabetic foot pain, as well as tingling and burning sensation. 
  • Pain and cramping in your buttocks and lower extremities during physical activity. 
  • A notable change in the shape or appearance, color, or temperature in your feet. 
  • Loss of your ability to feel hot, cold, or pain in your legs and feet. 
  • Skin dryness in your feet. 
  • Athlete’s foot, which usually manifests as redness and flakiness on foot, particularly in between toes. 
  • Thickened, yellow toenails. 
  • Occurrence of infected corn, ingrown toenail, blister, and calluses. 

Diagnosing Diabetic Foot Ulcers

According to experts, a foot ulcer is diagnosed clinically – not bacteriologically. This means that when diagnosing, doctors mainly use the appearance of the wound rather than look into the microorganisms. This is because all skin ulcers, regardless of location, harbor some microorganisms. 

To diagnose a diabetic foot, they will observe for:

  • An ulcer or deep wound. 
  • Presence of purulent discharge (pus) in the open wound. 
  • Classic signs of inflammation, which include redness, warmth, tenderness, or pain. 
  • Suggestive symptoms of infection, such as foul odor, tissue death (necrosis), and reduced wound healing despite proper diabetic foot care. 

However, please note that there are other factors to consider. Case in point, people with significant nerve damage, may not feel pain. Likewise, patients with severely impaired circulation may not manifest redness. 

Diabetic Foot Ulcer Treatment

While the doctor’s first goal in treating a foot ulcer is to prevent complications, they also want to preserve the limb’s function, improve the patient’s quality of life, and reduce healthcare expenses. 

So, it’s not surprising for diabetes wound management to be quite aggressive. 

If you have a diabetic foot or diabetic legs, your medical team may recommend the following treatment strategies: 

Off-loading 

The first practical step in diabetes wound healing is off-loading, or the process of taking pressure off the affected area. 

This may not be an intense problem if the diabetic ulcer is somewhere on top of the feet, but as it is, many cases of foot ulcers occur at the bottom – the part that comes in contact with the floor when we walk. 

Off-loading is often achieved through assistive devices, such as specialized casts, crutches, or foot gears. The doctor may also advise using a wheelchair, at least until the diabetic ulcer has healed. 

Keep the Foot Ulcer Clean and Covered

Another crucial step in diabetic foot care is to keep the diabetes wound clean and covered. No matter how many people suggest “airing it out,” remember that medical science has since proven that wounds heal faster when they are dressed and moist. 

Cleaning the wound once daily and covering it also helps reduce the risk of infection; however, please refrain from using any dressing. In many cases, the doctor will recommend a particular product that suits your diabetic wound care needs

To date, options include: 

  • Medicated dressings
  • Skin substitutes
  • Dressings specifically made for ulcers

Apply or Take Medicines

Of course, if the doctor has ordered medicines for your diabetic foot care, you need to take or apply them as instructed. 

The types of medicines physicians prescribe depend on various factors, like the patient’s overall health, infection or tissue death, and pain scale. They can also be pills or topical creams and ointments. 

A Note on Diabetic Wound Care

A foot ulcer is not a typical wound that you can manage with strategies we use for minor cuts and scrapes. For this reason, consult a doctor as soon as you recognize the emergence of a foot problem or sore. 

If you need help in diabetic foot care, seek the guidance of a physician. Alternatively, you can consider our Home Wound Care Service, where we match you with a Homage Care Professional who will assess your wound and provide individualized care. Besides proper cleaning and dressing, they will also advise you on the warning signs to watch out for and tips to hasten healing. 

Keep Your Blood Sugar Levels Under Control

An essential part of treatment is to keep the blood sugar levels within the target range. This is because uncontrolled sugar slows down healing. 

To reach your goals, you need to work closely with your physician. They will guide you on medications, diet, physical activity, and required tests. 

If ever going to the clinic or hospital for your diabetes care is not yet an option for you and your family, consider setting an appointment with one of our Online or House Call Doctors

Surgery

The majority of non-infected wounds do not require surgery. However, there are cases when the surgical removal of certain parts (deformities, bunions, bones, etc.) is beneficial. 

Furthermore, the presence of dead tissues may also warrant surgery (debridement), although nowadays, there are topical debriding agents available. 

The last resort is amputation, where the affected part (toe, part, or entirety of foot, leg) is removed. Doctors only recommend this operation when there is extensive tissue death, and the infection is unstoppable, meaning it can spread elsewhere. 

Diabetic Foot Care to Prevent Ulcer

The good news is, you can prevent ulcers with diligent care and diabetic foot screening. If you want to maintain healthy feet, consider the following practices:

Inspect Your Feet Everyday

The first step in preventing a diabetes wound is to check your feet every day, even if you don’t suspect any injury or problems. Inspect for cuts, scrapes, blisters, corns, warts, and other issues like athlete’s foot. 

So that you wouldn’t forget, consider inspecting your feet at the same time each day, like in the evening after you remove your shoes. If you’re having trouble checking some parts of your feet, use a mirror or ask a loved one to help you. 

Wash Your Feet Daily

Wash your feet with warm (not hot) water every day, but don’t soak them as it causes skin dryness, which makes them more vulnerable to problems. You can also apply lotion on the top and bottom parts of the feet, but avoid application between toes as the moisture increases infection risk. 

Wear Well-Fitting Footwear All the Time

No matter how comfortable you are, never go barefoot. Choose well-fitting shoes or slippers and wear socks when you wear shoes. Of course, don’t forget to check your shoes and slippers for any hard objects like pebbles. This step avoids injuries. 

A great tip when you buy new shoes is to “break” them first. You can do this by wearing them for only 1 to 2 hours daily until you’re completely comfortable. 

Be Careful with Corns and Calluses

Corns and calluses are thickened skin layers, and while it’s tempting to get rid of them as soon as possible, you need to be cautious. 

If you have corn or calluses, talk to your doctor about how to take care of them. They might recommend the use of pumice stone and petroleum jelly to smooth them out. Without your doctor’s approval, never:

  • Cut the hardened skin by yourself. 
  • Use medicated patches. 
  • Use liquid corn and callus removers. 

Trim Toenails Straight Across

Trim your toenails straight across and smooth the edges carefully with a nail file. If you’re having trouble trimming your nails, ask your podiatrist to do it for you. 

Keep the Blood Flowing, But Stick to Feet-Friendly Activities

A few times each day, wiggle your toes and hold your legs up while sitting. As for activities, choose ones that are less likely to harm your feet and legs, like walking, biking, swimming, yoga, and stretching.

Also, don’t forget to protect your feet from heat and cold. Put sunscreen on top of your feet when going out, and wear shoes when you go to the beach. 

Have a Diabetic Foot Screening Regularly

And finally, have a diabetic foot screening regularly. Your attending physician can do this during each visit, but many clinics in Singapore provide this service, too. 

The goal of each diabetic foot screening is to identify foot problems early on and refer any significant findings to doctors, reducing the risk of infection and complications. 

In Singapore, diabetic foot screening is offered at selected:

  • Community Health Centers
  • Family Medicine Clinics
  • SingHealth Polyclinics
  • National Healthcare Group Polyclinics
  • National University Polyclinics

You can also refer to this list to learn more about the clinics that offer diabetic foot screening. Finally, don’t forget that a Comprehensive Diabetic Foot Assessment is also available at Singapore Diabetic Foot Centre Clinic.

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References
  1. Bader, M. S. (2008, July 1). Diabetic foot infection. AAFP American Academy of Family Physicians. https://www.aafp.org/afp/2008/0701/p71.html#:~:text=The%20diagnosis%20of%20diabetic%20foot,strongly%20preferred%20to%20wound%20swabs
  2. David G. Armstrong|Lawrence A. Lavery. (1998, March 15). Diabetic foot ulcers: Prevention, diagnosis and classification. AAFP American Academy of Family Physicians. Retrieved May 9, 2021, from https://www.aafp.org/afp/1998/0315/p1325.html#:~:text=Management%20of%20the%20diabetic%20foot,and%20peripheral%20arterial%20occlusive%20disease
  3. Diabetes and foot problems. (2017, January 21). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved May 9, 2021, from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems#how
  4. Diabetes and your feet. (2019, December 9). Centers for Disease Control and Prevention. Retrieved May 9, 2021, from https://www.cdc.gov/diabetes/library/features/healthy-feet.html
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  6. Diabetic foot. (2017, November 16). The BMJ. Retrieved May 9, 2021, from https://www.bmj.com/content/359/bmj.j5064
  7. Foot complications. (n.d.). ADA. Retrieved May 9, 2021, from https://www.diabetes.org/diabetes/complications/foot-complications
  8. Frequently asked questions: Diabetic foot ulcers. (n.d.). University of Michigan | Michigan Medicine. Retrieved May 9, 2021, from https://www.uofmhealth.org/conditions-treatments/podiatry-foot-care/frequently-asked-questions-diabetic-foot-ulcers#:~:text=A%20diabetic%20foot%20ulcer%20is,or%20other%20ulcer%2Drelated%20complication
About the Writer
Lorraine Bunag, R.N.
Lorraine is a registered nurse who spends most of her time writing informative articles on health and wellness. At the end of the day, she relaxes by reading a book or watching documentaries about unsolved mysteries.
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