Diabetic Foot Wounds

Diabetic Foot Pain and Ulcers

Diabetic foot is a serious complication of diabetes which aggravates the patient’s condition whilst also having significant socioeconomic impact. Foot ulcers are a common complication of poorly controlled diabetes, forming as a result of skin tissue breaking down and exposing the layers underneath. They’re most common under your big toes and the balls of your feet, and they can affect your feet down to the bones.

All people with diabetes can develop foot ulcers and foot pain, but good foot care can help prevent them. Treatment for diabetic foot ulcers and foot pain varies depending on their causes. Discuss any foot pain or discomfort with your doctor to ensure it’s not a serious problem, as infected ulcers can result in amputation if neglected.

Identifying Symptoms and Diagnosis

One of the first signs of a foot ulcer is drainage from your foot that might stain your socks or leak out in your shoe. Unusual swelling, irritation, redness, and odors from one or both feet are also common early symptoms of a foot ulcer.

The most visible sign of a serious foot ulcer is black tissue (called eschar) surrounding the ulcer. This forms because of an absence of healthy blood flow to the area around the ulcer. Partial or complete gangrene, which refers to tissue death due to infections, can appear around the ulcer. In this case, odorous discharge, pain, and numbness can occur.

Signs of foot ulcers are not always obvious. Sometimes, you won’t even show symptoms of ulcers until the ulcer has become infected. Talk to your doctor if you begin to see any skin discoloration, especially tissue that has turned black, or feel any pain around an area that appears callused or irritated.

Your doctor will likely identify the seriousness of your ulcer on a scale of 0 to 3 using the following criteria:

0: no ulcer but foot at risk
1: ulcer present but no infection
2: ulcer deep, exposing joints and tendons
3: extensive ulcers or abscesses from infection

Causes of Diabetic Foot Pain and Ulcers

Diabetic ulcers are most commonly caused by:

poor circulation
high blood sugar (hyperglycemia)
nerve damage
irritated or wounded feet

Poor blood circulation is a form of vascular disease in which blood doesn’t flow to your feet efficiently. Poor circulation can also make it more difficult for ulcers to heal.

High glucose levels can slow down the healing process of an infected foot ulcer, so blood sugar management is critical. People with type 2 diabetes often have a harder time fighting off infections from ulcers.

Nerve damage is a long-term effect and can even lead to a loss of feeling in your feet. Damaged nerves can feel tingly and painful at first. Nerve damage reduces your sensitivity to foot pain and results in painless wounds that can cause ulcers.

Ulcers can be identified by drainage from the affected area and sometimes a noticeable lump that isn’t always painful.

Dry skin is common in diabetes. Your feet may be more prone to cracking. Calluses, corns, and bleeding wounds may occur.

Risk Factors for Diabetic Foot Ulcers

All people with diabetes are at risk for foot ulcers, which can have multiple causes. Some factors can increase the risk of foot ulcers, including:

poorly fitted or poor quality shoes
poor hygiene (not washing regularly or thoroughly)
improper trimming of toenails
alcohol consumption
eye disease from diabetes
heart disease
kidney disease
obesity

Diabetic foot ulcers are also most common in older men.

Treating Diabetic Foot Ulcers

Stay off your feet to prevent pain and ulcers. This is called off-loading, and it’s helpful for all forms of diabetic foot ulcers. Pressure from walking can make an infection worse and an ulcer expand. For people who are overweight, extra pressure may be the cause of ongoing foot pain.

Your doctor may recommend wearing certain items to protect your feet:

diabetic shoes
casts
food braces
compression wraps

Doctors can remove diabetic foot ulcers with a debridement, the removal of dead skin, foreign objects, or infections that may have caused the ulcer.

An infection is a serious complication of a foot ulcer and requires immediate treatment. Not all infections are treated the same way. Tissue surrounding the ulcer may be sent to a lab to determine which antibiotic will help. If your doctor suspects a serious infection, he or she may order an X-ray to look for signs of bone infection.

Infection of a foot ulcer can be prevented with: