Patient education: Diabetic foot ulcer (The Basics)

What is a foot ulcer? — A foot ulcer is an open wound or sore on the foot (picture 1 and picture 2). People with diabetes have a higher risk of foot ulcers. When this happens, doctors sometimes use the term "diabetic foot ulcer."

People with diabetes can have problems if their blood sugar is not well managed. These include:

●Nerve damage – The medical term for this is "diabetic neuropathy." If you have problems with the nerves in your feet, you might not be able to feel a blister, cut, or sore on your foot.

●Damage to the blood vessels – The medical term for this is "peripheral artery disease." This can decrease blood flow to your feet. When this happens, it can weaken your skin and wounds can take longer to heal.

These things can increase the risk of foot ulcers. For this reason, people with diabetes need to take special care of their feet.

If you notice any signs of a foot ulcer, tell your doctor and get treatment right away. The earlier you get treatment, the less likely you will get an infection or other complications.

What are the symptoms of a foot ulcer? — Symptoms might include:

●Irritated skin – The skin might look red.

●Pain

●Bleeding from the area – You might also notice blood on your sock or on the floor.

●A bad smell from the area

●Swelling

●Skin that looks dead or discolored

●Pus draining from the area

Should I see a doctor or nurse? — Yes. See your doctor or nurse if you notice:

●Broken skin

●Ulcers

●Blisters

●Areas of increased warmth or redness

●Any changes in the shape of your toes or bottoms of your feet

Will I need tests? — Yes. Your doctor will do an exam and ask you about your symptoms. If you have signs of poor circulation, you might also need tests.

Your doctor might do a lab test called a "culture" if they think that your ulcer might be infected. For a culture, your doctor or nurse uses a swab to collect some of the fluid from your ulcer. Then, the swab is tested in a lab to see if there are bacteria in it.

How are foot ulcers treated? — Treatment depends on how severe the ulcer is, whether it is infected, and your other symptoms. Some ulcers just involve the surface of the skin and can be treated at the doctor's office and at home. If the ulcer is deep, or if there are signs of infection, you might stay in the hospital while your ulcer is treated.

Your treatment might include:

●Cleaning and bandaging the ulcer

●Removing a small amount of the affected skin on your foot – This is called "debridement." It might be done at the doctor's office or in the operating room.

●Taking medicines called "antibiotics" – These are used to treat infected ulcers.

●"Mechanical offloading" – This means using a device to help you move around without putting pressure on your ulcer. The device might be a special cast, "cast walker" (figure 1), "knee walker" (figure 2), or modified shoes.

●Surgery called "revascularization" – This tries to improve circulation to your foot.

If the ulcer doesn't heal with treatment, or you have a severe infection that is putting your health at risk, part or all of your foot might need to be amputated. This means that it is removed with surgery.

How do I care for myself at home? — Ask the doctor or nurse what you should do when you go home. Make sure that you understand exactly what you need to do to care for yourself. Ask questions if there is anything you do not understand.

While recovering at home, you should:

●Take all of your medicines as instructed.

●Change your bandage as instructed by your doctor or nurse.

●Use any devices the doctor gave you to help you move around. This might be a special cast, walker, or modified shoes.

●Follow your doctor or nurse's instructions about showering or bathing.

Call your doctor for advice if:

●You have signs of infection, such as:

•Fever of 100.4°F (38°C) or higher, or chills

•Signs of problems with the ulcer – These include swelling, redness, warmth around the ulcer, a lot of pain when touched, discharge or pus coming from the ulcer, a bad smell, the ulcer opening up, or the ulcer not seeming to heal.

●You have new blisters, cuts, or sores on your foot.

●Your feet or legs are numb.

●You have black or dead tissue in or around your ulcer.

What follow-up care do I need? — The doctor will want to see you again after your ulcer is treated to check on your progress. Go to these appointments.

If you get a foot ulcer, you are more likely to have another one in the future. Talk to your doctor about what to look for and what you can do to prevent this from happening again.

Can foot ulcers be prevented? — Yes. One of the most important things you can do to lower your risk of a foot ulcer is to keep your blood sugar under control. See your doctor regularly, and have them check your feet.

You should also:

●Take care of your feet – Check your feet every day for any problems like cuts, blisters, or swelling. Keep your feet clean, but do not soak them. Trim your toenails straight across (figure 3).

●Protect your feet – Wear shoes and socks all of the time, even at home. Make sure that your shoes fit well and are not too tight or too loose (figure 4). Do not let your feet get very hot or cold.

●Avoid smoking – If you smoke, try to quit. Your doctor or nurse can help. Smoking causes poor blood flow to your feet and can damage your nerves.

More on this topic

Patient education: Type 1 diabetes (The Basics)
Patient education: Type 2 diabetes (The Basics)
Patient education: Foot care for people with diabetes (The Basics)
Patient education: Nerve damage caused by diabetes (The Basics)
Patient education: Peripheral artery disease and claudication (The Basics)
Patient education: Diabetes and infections (The Basics)
Patient education: Gangrene (The Basics)

Patient education: Type 1 diabetes: Overview (Beyond the Basics)
Patient education: Type 2 diabetes: Overview (Beyond the Basics)
Patient education: Foot care for people with diabetes (Beyond the Basics)
Patient education: Diabetic neuropathy (Beyond the Basics)
Patient education: Peripheral artery disease and claudication (Beyond the Basics)