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Diabetic foot ulcers

Approximately 25 to 30 percent of patients with diabetes develop a foot sore, or ulcer. Though foot ulcers can be anywhere on the foot, most occur on the ball of the foot or on the bottom of the big toe.

There are several reasons why people with diabetes have foot problems, but the most common reason is that many diabetic people suffer from nerve damage called neuropathy, which causes loss of sensation in the feet. Additionally, people with diabetes also suffer from poor circulation, which can make the foot less able to fight infection and heal. Poor circulation can also change the shape of feet or toes, which also causes problems. Other factors that contribute to the risk of developing foot problems include:

  • Elevated blood sugars.
  • Obesity.
  • Alcoholism.
  • Hypothyroidism.
  • Hypertension.
  • Smoking.

Once you develop an ulcer, it may take weeks or even several months for it to heal. Foot ulcers are the most common reason for hospital stays for people with diabetes. Left untreated, a foot ulcer can become infected and in turn lead to the loss of a limb. In fact, research has shown that diabetic foot ulcers precede approximately 84 percent of all lower leg amputations.

Diabetic ulcers are often painless, so special care must be given to taking care of your feet.

Caring for your feet

  • Check your feet daily. Look for blisters, cuts and scratches. Use a long-handled mirror or place a mirror on the floor to see the bottom of your feet. Always check between your toes.
  • Keep your feet clean. Wash daily, dry carefully—especially between the toes.
  • Moisturize your feet. Apply a moisturizer as recommended by your physician, but never apply it between toes, as that can lead to a fungal infection.
  • Do not walk barefoot. That includes on sandy beaches and pool/patio areas.
  • Wear properly fitted shoes. Shoes should be comfortable when purchased. Do not wear narrow, pointed toe or high-heeled shoes.
  • Inspect the inside of your shoes daily. Check for foreign objects, tears or rough areas on the inside of the shoe.
  • Do not wear shoes without socks or stockings. Wear clean, properly fitted socks. Cotton or cotton-blend socks are recommended.
  • Avoid temperature extremes. Test water temperature with your hand or elbow prior to bathing. Do not soak your feet in hot water or apply a hot water bottle. If your feet feel cold at night; wear socks.
  • Trim your toenails regularly. Always cut your nails straight across.
  • Do not use over-the-counter remedies for corns. See a podiatrist to have these evaluated.
  • Avoid crossing your legs. This causes pressure on the nerves and blood vessels, resulting in less blood flow to your feet.

The most important thing you can do to lower your risk of developing a foot ulcer is to manage your diabetes.

With proper self-care, most symptoms can be reduced and foot ulcers minimized. Early recognition of an ulcer and immediate care under your physician's direction can prevent complications.

Symptoms

You may be at risk for a foot ulcer if you have one or more of the following signs:

  • Lack of sensation (feeling) in your feet.
  • Feeling of "pins and needles" in your feet.
  • Feet hurt while walking or resting.
  • Sores don't heal.
  • Skin on your feet becomes thick, dry or scaly.
  • Calluses develop easily on the soles of your feet.

Treatment and care

After a thorough evaluation, which may include diagnostic testing, your physician will discuss a treatment plan with you. Treatments vary based on individuals, but may include:

  • Special dressings to absorb drainage.
  • Prevention and treatment of infection.
  • Appropriate off-loading device (e.g., a special shoe, cast, wheelchair, etc.).
  • Hyperbaric oxygen (HBO) therapy.

Until your foot ulcer is healed, your activity will be limited. Walking on an ulcer can cause it to get larger and force the infection deeper into your foot. It is important you follow your physician's recommendations.

Your physician will also encourage you to eat healthy. Foods high in protein, vitamins and minerals are important to healing and maintaining healthy skin.

The good news is early intervention, proper treatment and a multi-disciplinary team approach increases your chances of healing and reduces the rate of amputation by as much as 85 percent.

Your compliance with the plan of care is the single most important factor in your healing.

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