Diabetic Foot Ulcer

What is a diabetic foot ulcer?

A diabetic foot ulcer is an open sore that can develop anywhere on your foot or toes. The ulcers usually develop on the bottom of the foot. You may first notice drainage on your sock. Drainage is fluid that may be yellow, brown, or red. The fluid may also contain pus or blood.

What increases my risk for a diabetic foot ulcer?

• Blood sugar levels that are not controlled
• Nerve damage and numbness in your feet
• Poor blood flow
• A foot deformity, such as a bunion or hammertoe
• Calluses or corns on your feet or toes
• A decrease in vision that keeps you from seeing your feet clearly
• Being overweight
• Cigarette smoking or alcohol use

What can you do to prevent diabetic foot ulcers?

Good foot care may help prevent ulcers, or keep them from getting worse. Ask someone to help you if you are not able to check or care for your feet. The following can help you prevent diabetic foot ulcers:

• Keep your blood sugar levels under control. Continue the plan for your diabetes that you and your healthcare provider have discussed. Healthy food choices and taking your medicines as directed may help control blood sugars. Contact your healthcare provider if your blood sugar levels are higher than directed.
• Wash your feet each day with soap and warm water. Do not use hot water, because this can injure your foot. Dry your feet gently with a towel after you wash them. Dry between and under your toes. Put lotion or moisturizer on your feet. Do not put lotion or moisturizer between your toes.
• Check your feet each day. Look at your whole foot, including the bottom, and between and under your toes. Check for wounds, corns, and calluses. Feel your feet by running your hands along the tops, bottoms, sides, and between your toes. Use a nonbreakable mirror to check your feet if you have trouble seeing the bottoms. Do not try to remove corns or calluses yourself. File or cut your toenails straight across.
• Protect your feet. Do not walk barefoot or wear your shoes without socks. Check your shoes for rocks or other objects that can hurt your feet. Wear cotton socks to help keep your feet dry. Wear socks without toe seams, or wear them with the seams inside out. Change your socks each day. Do not wear socks that are dirty or damp.
• Wear shoes that fit well. Wear shoes that do not rub against any area of your feet. Your shoes should be ½ to ¾ inch (1 to 2 centimeters) longer than your feet. Your shoes should also have extra space around the widest part of your feet. Walking or athletic shoes with laces or straps that adjust are best. Ask your healthcare provider for help to choose the right shoes for you. Ask him if you need to wear an insert, orthotic, or bandage on your feet.
• Do not smoke. Nicotine can damage your blood vessels and increase your risk for foot ulcers. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your healthcare provider for information if you currently smoke and need help quitting.
• Do not drink alcohol. Alcohol increases your blood sugar levels and make your diabetes more difficult to manage. Ask your healthcare provider for information if you need help to quit drinking alcohol.
• Maintain a healthy weight. Ask your healthcare provider how much you should weigh. A healthy weight can help you control your diabetes. Ask him to help you create a weight loss plan if you are overweight. Even a 10 to 15 pound weight loss can help you manage your blood sugar level.

How is a diabetic foot ulcer diagnosed and treated?

Your healthcare provider will ask about your symptoms and examine your foot and the ulcer. He may check your shoes. He may also send you to a podiatrist (foot doctor) for treatment. The goal of treatment is to start healing your foot ulcer as soon as possible. The risk for infection decreases with faster healing. Do the following to help your ulcer heal:

• Prevent or treat an infection. A bandage will be put on your ulcer. Your healthcare provider will give you instructions on changing your bandage. You may need to clean the wound and change the bandage daily. The bandage may contain medicines to help your ulcer heal. You may be asked to put medicine on your foot ulcer before you put on the bandage. The medicine may also prevent growth of tissue that is not healthy. If you have an infection, your healthcare provider will give you antibiotics to treat it.
• Have any dead tissue debrided (removed). The removal of dead skin and tissue around your foot ulcer can help with healing.
• Manage your blood sugar levels and other health problems. Your blood sugar, blood pressure, and cholesterol levels need to be controlled to help your foot ulcer heal. Your healthcare provider can help you make a plan to manage your health problems.
• Offload (take the pressure off) the foot ulcer. You may need special shoes with insoles, cushions, or braces. You may be asked to use a wheelchair or crutches until your foot ulcer heals. These items will help keep pressure and irritation off the area of your foot ulcer. Your foot ulcer can heal faster without pressure and irritation.
• Have blood flow to your foot increased. Your healthcare provider may use hyperbaric oxygen therapy or negative pressure wound therapy to increase blood flow. Ask for more information about these therapies.
• Go to specialists as directed. Your healthcare provider may recommend you see a podiatrist, or an orthopedic or vascular surgeon. These healthcare providers can help manage your treatment.

When should you contact your provider?

• You see new drainage on your sock.
• Your foot becomes red, warm, and swollen.
• Your foot ulcer has a bad smell or is draining pus.
• You feel pain in a foot that used to have little or no feeling.
• You see black or dead tissue in or around your ulcer.
• Your ulcer becomes bigger, deeper, or does not heal.
• You have questions or concerns about your condition or care.

When should you seek immediate care?

• You have a fever with chills.
• You begin vomiting.
• You feel faint or become confused.