People with diabetes may develop foot ulcers. According to statistics, the lifetime risk of this complication is between 19 and 34 percent, and these figures have increased in recent years. Foot ulcers caused by diabetes can lead to many complications, the most important being amputation of the lower limbs such as the foot and, in some cases, death.

Proper foot care can greatly help prevent this condition. Treatment of diabetic foot ulcers varies depending on their cause, and in this article we cover this and many other topics about foot ulcers in people with diabetes.

What Is a Diabetic Foot Ulcer?

Foot ulcers are one of the main and most common complications of diabetes, and they cannot be cured with methods such as exercise, diet or insulin therapy. They occur when the skin breaks down and the underlying layers are exposed. Diabetic foot ulcers are mostly found under the big toe and on the ankle, and they can spread to the bones.

The Main Causes of Diabetic Foot Ulcers

Several factors cause foot ulcers in people with diabetes; 3 causes are described below:

Nerve damage

You may have met a diabetic person who feels no pain in their feet. This is caused by nerve damage and loss of sensation in the feet; these people usually feel pins and needles in their feet. Nerve damage in the feet not only reduces sensitivity to pain but also leads to painless wounds.

High blood glucose

Another factor that causes wounds on the feet of people with diabetes is high blood glucose. This slows wound healing. People with type 2 diabetes are therefore advised to take managing their blood sugar very seriously.

Poor circulation

One factor that contributes to foot ulcers is poor circulation, a type of vascular disease. Poor circulation keeps blood from flowing properly through the feet and makes wound healing difficult.

What Are the Symptoms of Diabetic Foot Ulcers?

Foot ulcers in people with diabetes usually come with signs that make them easy to recognize. One of the most important signs is discharge from the foot that can stain your socks and shoes. Unusual odors from one or both feet, redness and unusual swelling are other signs of foot ulcers in people with diabetes.

As mentioned in the previous section, poor circulation is one cause of diabetic foot ulcers, and it usually shows up as black tissue around the wound, called eschar. Tissue death due to infection (gangrene) can also occur around foot ulcers, with symptoms such as numbness, pain and foul-smelling discharge.

One thing people with diabetes should note is that foot ulcers may have no symptoms. Sometimes the wound only shows symptoms when it becomes infected. So if you notice any change in your skin color (such as blackening of the tissue around the wound, wound blackening) or feel pain around an irritated or callused area, talk to your doctor.

Types of Diabetic Foot Ulcers

The severity of diabetic foot ulcers is assessed with the Wagner wound classification system, which ranges from 0 to 5:

• Zero: the wound may have healed and has no break.
• 1: The wound is superficial and has not penetrated the deeper layers of skin.
• 2: The wound has deepened and penetrated underlying layers such as tendon or bone.
• 3: The wound has deepened further, causing bone infection (osteomyelitis) and tendon inflammation (tendonitis).
• 4: Gangrene in the forefoot or heel
• 5: Gangrene spreading to a large part of the foot

What Factors Affect Diabetic Foot Ulcers?

People with diabetes may develop foot ulcers. Some factors increase the risk of this complication, including:

• Being overweight
• Trimming toenails improperly
• Drinking alcohol and smoking
• Wearing ill-fitting, uncomfortable shoes
• Heart, kidney and eye diseases caused by diabetes
• Not following hygiene advice. People with diabetes are advised to wash their feet regularly and thoroughly and dry them completely.

How to Treat Foot Ulcers in Diabetic Patients

One of the most important recommendations for treating and healing foot ulcers in people with diabetes is to wear suitable shoes. Today there are shoes designed specifically for people with diabetes. These people should also take pressure off their feet, because pressure makes the wound worse and helps it spread.

A foot ulcer may become infected, which must be treated immediately. The methods used to treat wound infection vary with its severity and condition. Medication and surgery are usually used to heal foot ulcer infections. Measures such as regularly washing and disinfecting the feet and covering them with advanced calcium alginate dressings can also help prevent foot ulcer infection.

Caring for Diabetic Foot Ulcers

Nursing care for diabetic foot ulcers can greatly help prevent this complication; some measures are listed below:

• Cut your toenails straight across.
• If you smoke, quit.
• Avoid walking barefoot.
• Wear loose socks made of natural fibers and change them every day.
• Wear comfortable, suitable shoes that let your feet breathe.
• Avoid crossing your legs as much as possible. Doing so reduces blood flow.
• Protect your feet from heat and cold. Avoid hot water bottles, and check the water temperature twice with your hand or elbow before putting your foot in.
• Check your feet for any cuts or sores. Look for dry, cracked skin, redness, warmth or tenderness. If you find any of these, tell your doctor. Also, if you notice corns or calluses, do not treat them yourself.
• Wash, dry and moisturize your feet. Make sure the water is not too hot, and dry your feet thoroughly afterward. Lotion can be used on dry skin, but avoid the areas between your toes, as this can lead to excess moisture.

Diabetic Foot Ulcers: From Understanding to Treatment

In this article, we introduced foot ulcers in people with diabetes and described the steps needed to treat them. If diagnosed early, this complication can be treated. But if ignored, the risk of infection increases and it may lead to amputation. If your blood sugar is high, wound healing takes longer. A suitable diet not only helps control your blood sugar but also plays an important role in losing weight and taking pressure off the wound.