Diabetic Foot Ulcer: Understanding, Prevention, and Treatment

Diabetic foot ulcers are a serious complication of diabetes that can lead to infections, hospitalisation, and even amputation if not treated in time. These open sores or wounds usually develop on the feet due to a combination of poor circulation, nerve damage, and prolonged high blood sugar levels. With early detection, proper foot care, and specialist management, most diabetic foot ulcers can be treated effectively and serious complications can be prevented.

What Is a Diabetic Foot Ulcer?

A diabetic foot ulcer is a deep sore or open wound that typically forms on the bottom or sides of the foot, or around pressure areas like the toes and heel. It often develops due to a combination of:

• Nerve damage (neuropathy): High blood sugar levels can damage nerves, reducing sensation in the feet. As a result, small cuts, blisters, or injuries may go unnoticed and progress into ulcers.
• Poor circulation: Diabetes can narrow and harden blood vessels, reducing blood flow to the legs and feet. This slows healing and increases the risk of infection.
• Pressure and repeated trauma: Ill-fitting footwear, abnormal foot shape, or areas of high pressure can break the skin and lead to ulcer formation.

Risk Factors

Certain factors increase the likelihood of developing a diabetic foot ulcer:

• Long-standing or poorly controlled blood sugar levels.
• Previous foot ulcers or a history of amputation.
• Smoking, which further reduces blood circulation.
• Poor foot care habits or walking barefoot regularly.
• High blood pressure and high cholesterol.
• Foot deformities, calluses, or thickened nails.

Symptoms to Watch For

Early recognition of foot problems is key to preventing serious complications:

• Redness, swelling, or warmth around a sore or callus.
• Unexplained pain or discomfort in the foot (though pain may be absent in neuropathy).
• An open sore or wound that is slow to heal.
• Drainage, discharge, or pus from the wound.
• Foul odour from the affected area.
• Darkening or blackening of the skin in severe cases (possible gangrene).

Preventing Diabetic Foot Ulcers

Prevention is the most effective way to reduce the risk of diabetic foot complications:

• Control blood sugar: Maintaining good glycaemic control helps reduce nerve damage and improves circulation.
• Inspect your feet daily: Check for cuts, blisters, cracks, colour changes, or swelling—especially if you have reduced sensation.
• Wear proper footwear: Use well-fitting shoes with soft insoles and avoid tight footwear or walking barefoot.
• Maintain foot hygiene: Wash your feet daily, dry them gently (especially between the toes), and keep nails trimmed.
• Moisturise dry skin: Use a gentle moisturiser to prevent cracks, but avoid applying cream between the toes.
• Regular check-ups: Routine visits with your doctor or foot specialist help identify problems early.

Treatment Options

Prompt and comprehensive treatment is essential to promote healing and prevent infection:

• Wound care: Cleaning the ulcer, removing dead tissue if needed, and applying suitable dressings that maintain moisture balance and support healing.
• Antibiotics: Prescribed if there is evidence of infection in the wound or surrounding tissues.
• Debridement: Careful removal of dead or infected tissue to encourage healthy new tissue growth.
• Offloading: Reducing pressure on the ulcer using special footwear, insoles, casts, or walking aids to prevent further damage.
• Improving circulation: In patients with poor blood flow, vascular evaluation and procedures (such as angioplasty or bypass) may be needed to improve healing.
• Surgical interventions: In advanced cases, surgery may be required to remove infected tissue, drain abscesses, or, in extreme situations, consider partial or major amputation to control life-threatening infection.

When to Seek Medical Help

You should seek immediate medical attention if you notice:

• Any open wound on your foot that does not improve within a few days.
• Increasing redness, warmth, swelling, or pain around a sore.
• Discharge, bad odour, or blackened areas of skin.
• Fever, chills, or feeling unwell along with a foot wound.

Diabetic foot ulcers are preventable and treatable when managed early and correctly. Regular monitoring, strict blood sugar control, and proper foot care play a vital role in keeping your feet healthy. If you have diabetes and notice any changes in your feet, do not ignore them—early evaluation by a specialist can save your limb and greatly improve your quality of life.