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Diabetic Foot Ulcer

​​​​​Open sore or wound that occurs on the bottom of the foot in patients with diabetes.

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About diabetic foot ulcer

For patients with diabetes, they may have impaired blood flow and/or impaired sensation to their feet. This may result in a wound, tear, hole or break in the skin over the foot and ankle. It is estimated that up to 1 in 4 adults with diabetes are at risk of developing a diabetic foot ulcer in their lifetime. ​

Signs and symptoms

Impaired blood flow to the feet: 
  • ​​​​aches in their leg when walking (also known as intermittent claudication) 
  • shiny and hairless skin over their shin
  • a pale foot when elevated and redness when lowered
  • cold feet or leg pain at night when in bed
Impaired sensation to the feet: 
  • ​numbness, prickling or tingling sensations over their feet and occasionally their hands
  • foot callus and deformities
Trauma, poor nail care or blisters of the feet may eventually worsen, leading to poor healing foot wounds or even gangrene (dead tissue). When there is active foot infection, there may be redness, swelling, fluid (pus), pain, toes turning purple/black or fever with chills.

Causes and risk factors

Diabetic foot ulcers are caused by: 
  • ​poorly controlled diabetes, which results in impaired blood flow to the feet, impaired feet sensation and poor wound healing 
  • poor foot care and inappropriate footwear resulting in trauma to the feet, leading to callus formation or foot ulcers 
  • smoking significantly increases risks of leg amputations by 37% in patients with diabetes
​If you have had a previous diabetic foot ulcer or amputation, chronic kidney disease or known peripheral arterial disease (impaired blood flow) and/or neuropathy (impaired foot sensation), you are at high risk of developing a diabetic foot ulcer.
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Treatment and programmes

Diabetes control and cardiovascular risk factor optimisation

Good diabetes control and cardiovascular risk factor optimisation (high blood pressure, high cholesterol) are essential and you may consult your primary care doctor or endocrinologist. If there is evidence of impaired blood flow, you may be started on a blood-thinning medication to improve circulation. ​

Diabetes foot screening and foot care 

Diabetic foot screening is important to ensure regular foot assessment, expedient referral for new diabetic foot ulcers and continual patient / carer education. Frequency of screening is in accordance to your risk profile. Good foot care practices and appropriate footwear will help prevent callus or ulcer formation and you may consult your podiatrist. Please check your feet daily as identifying early warning signs (see signs and symptoms) and highlighting them to your doctor, nurse or podiatrist will give you the best chance of healing.

​Contributed by Endocrinology