Overview
Diabetic foot ulcer (DFU) is a complication of diabetes. It occurs as a slow-healing skin sore on the foot. It is a common cause of hospitalization for diabetic patients and may take a few weeks or even months for the ulcers to heal.
The ulcers appear as minor trauma, a blister, or nerve damage and can gradually progress into an open ulcer. Without proper treatment, diabetic foot ulcers can lead to necrosis or gangrene and need an emergency amputation.
Proper and timely diabetic foot ulcer treatment and foot care can prevent them and minimize the risks of severe complications like gangrene.
What causes diabetic foot ulcers?
The main cause of diabetic foot ulcers is high blood sugar. Diabetes can lead to nerve damage and numbness. Nerve damage can cause the development of painless ulcers.
High blood sugar can cause poor blood circulation and cause peripheral artery disease. This can lead to the formation of ulcers and reduces the body’s ability to heal the ulcers or fight infections.
Diabetic foot ulcer causes include:
- High levels of blood sugar (hyperglycemia)
- Poor blood circulation
- Peripheral neuropathy (damage of the peripheral nerves)
- Wounds in the feet
- Feet irritation
Other risk factors that can cause diabetic foot ulcers are:
- Old age
- Obesity
- Long-term diabetes
- Hypertension
- Alteration in the white blood cell count
- Smoking
- Poor foot hygiene
- Diabetes-induce eye diseases
- Heart diseases
- Increased use of tobacco or alcohol
What are the types of diabetic foot ulcers?
Diabetic foot ulcers can be classified into three types.
Neuropathic ulcers
They occur due to nerve damage (neuropathy) for chronic and long-term diabetes. They occur on the pressure areas on the foot mainly due to trauma and go undetected due to loss of sensation. They appear as thick, round ulcers with calluses formation in the surrounding skin. They mainly develop under the big toe, sides of the heel or the foot, tips of the toe, etc.
Ischemic ulcers
These types of ulcers occur mainly due to insufficient blood flow in certain body parts like the legs and feet. Due to poor blood flow, the tissues and cells in these areas gradually die.
Insufficient blood flow can occur due to several reasons like the narrowing down of the arteries or peripheral artery disease (PAD).
The ulcers appear as pink lesions and turn black when they are dried up. They mostly develop in the heels, toes, and feet.
Neuroischemic ulcers
People suffering from peripheral neuropathy and ischemia can develop these ulcers. They need immediate medical intervention and have a high risk of infection that may lead to amputation.
They appear as pale, yellowish wounds. They develop on the tips of the toes and the foot.
Is it okay to walk with a diabetic foot ulcer?
To promote healing, it is important to put the least pressure on the bottom of the foot. To reduce pressure and irritation to the affected area, use a crutch, wheelchair, specialized footwear, or castings.
Avoid repeated pressure on the feet. If you have nerve damage on the feet, limit prolonged walking, or stay away from weight-bearing exercises. Choose exercises that do not stress the feet and the wound site.
Consult with your podiatrist physician regarding recommended guidelines, foot care, and treatment.
Stop your suffering NOW
Don't just jump into a surgery because your doctor is advising you to go for it. Consult our doctors to know if you need a surgery at all. Rest assured, we WON'T recommend you surgery unless it's the last resort.
What are the stages of diabetic foot ulcers?
Diabetic foot ulcer stages are categorized from stage 1 to stage 6.
Stages of diabetic foot ulcers include:
Stage 1 – normal foot
The foot appears normal and there are no risk factors. The physician may encourage you to use specialized footwear and take proper care of the foot.
Stage 2 – high-risk foot
In this stage, there is some evidence of poor blood flow or nerve damage. There may be calluses formation.
Stage 3 – ulcerated foot
In stage 3, the ulcer has been diagnosed. Your podiatrist or foot specialist will ask you to put less pressure on the feet, wear castings, use a wheelchair, and recommend bed rest. Proper advice will be given regarding foot care, treatment, and prevention of an infection.
Stage 4 – infected foot ulcer
The wound has been infected and may require hospitalization. The physician will ask for further tests and culture for diagnosis. Treatment includes antibiotics or surgery to drain and remove the infected tissues.
Stage 5 – gangrene
At this stage, gangrene or necrosis has started. The tissue is starting to die due to infection and poor blood flow. You will need hospitalization. Surgical intervention will depend on the symptoms.
Stage 6 – amputation
This is the final stage where the infection is severe and the foot requires amputation. There is also a risk of developing pressure ulcers after surgery due to immobilization.
What are the symptoms of diabetic foot ulcers?
Sometimes the early signs of foot ulcers may be hard to detect. They are noticeable only when the ulcer is infected.
Early signs of diabetic foot ulcers include:
- Drainage from the foot that stains or dampens the socks or leaks out in the shoes
- Swelling or redness
- Irritation
- Odour from one or both feet
Serious diabetic foot ulcers will have visible symptoms such as:
- Black tissue formation (eschar) in the surrounding area of the ulcer
- Tissue death resulting in gangrene
- Pus drainage
- Pain or numbness
- Skin discolouration
- Skin hardening
