Diabetes-related foot ulcer

A foot ulcer is an open sore or wound on your foot that is slow to heal because of your diabetes, and sometimes there are circulation problems too.

If it gets infected it can be very serious.

If you have diabetes you have a greater chance of developing foot ulcers because you’re more likely than other people to not notice if you damage the skin on your feet. This is because diabetes can cause nerve damage, so you don't notice if your foot is injured or sore. Diabetes also causes sores to heal slowly and causes blood vessel damage so your skin can't heal easily.

• About 1 in 4 people with diabetes (25%) will develop a foot ulcer sometime during their life, and about 50% of those ulcers will become infected. 
• 1 in 5 (20%) people with a severe foot infection may end up with an amputation. In fact amputations are 15 times more common in people with diabetes than in those without.

You are at low risk for diabetes-related foot problems if:

• you have feeling in your feet
• your feet have a good blood supply.

You are at moderate risk for developing diabetes-related foot problems if you have 1 of these risk factors:

• you have lost some feeling in your feet (loss of protective sensation)
• you have reduced circulation in your feet (peripheral arterial disease)
• you have corns or calluses (hard skin) on your feet
• you have foot deformities (eg, bunions, claw toes, hammer toes)
• you have end stage kidney disease.

You are at high risk for diabetes-related foot problems if:

• you have more than 1 of the foot problems in the moderate risk category
• you have had ulcers before
• you have had an amputation
• You have a foot deformity called a Charcot Foot.

Foot ulcers are open sores or wounds that occur most often on the ball of your foot or on the bottom of your big toe. They may also develop on the side of your foot, usually because of poorly fitting shoes. The ulcers are usually painless. Not all diabetes-related foot ulcers become infected but if you have diabetes you are at high risk of developing infection of the ulcer and the surrounding skin (cellulitis). Infected diabetes-related ulcers are a serious problem and need urgent attention.

Depending on the severity of the wound and the presence of infection, diabetes-related foot ulcers can be classified in 4 ways:

• Uninfected – the wound doesn't have signs of infection. 
• Mild infection – the area around the wound may be warm to the touch, red, slightly swollen, painful or tender, and the wound/ulcer may ooze pus.  
• Moderate infection – foot infection that involves the deeper layers of your skin, into the muscle, tendons, bone or joints.
• Severe infection – foot infection that causes sepsis (which is a life-threatening complication of infection). The symptoms of sepsis are high body temperature (fever), fast heartbeat, and heavy or quick breathing.  

If you have diabetes and notice a sore or blister on your foot, contact your healthcare provider immediately. If ulcers aren't treated it can result in infection, which can cause loss of a limb. This can be avoided if you take care of your feet and act quickly if you have a problem.

Treatment of the foot ulcer depends on the severity of the wound. 

Lifestyle factors that improve wound healing

In addition to managing the wound, attention to other lifestyle factors can also contribute to improved wound healing.

• Maintain good blood glucose management.
• Treat high blood pressure and high cholesterol.
• Stop smoking.
• Eat a healthy diet.
• Keep active – if you have a foot ulcer, your podiatrist will advise when this is appropriate.
• Manage your weight (if needed).

Apps reviewed by Healthify

You may find it useful to look at some diabetes apps.

You can lower your risk of developing diabetes-related foot problems by:

• keeping your blood glucose in your target range
• managing your blood pressure and cholesterol levels
• looking after your feet and checking them daily (ask someone to help if you can’t reach them or see well enough to check them)
• eating a healthy diet
• staying active and exercising
• not smoking.

Learn more about diabetes and foot care.

Video: Preventing diabetic complications with foot and skin care

When you have diabetes, it's important to take extra care of your feet to prevent ulcers and other complications.

If the foot ulcer doesn't heal, becomes worse or badly infected, or if the infection spreads to nearby bones or joints, this can lead to gangrene. The only solution then may be to surgically remove (amputate) the affected part.

There are many groups and people keen to share their knowledge and tips for living well with diabetes. Diabetes New Zealand(external link) has branches around the country with a wide range of services, resources, groups and shops.  

Regional diabetes support 

• Diabetes New Zealand Auckland branch and website(external link)
• Diabetes Help Tauranga(external link) Phone 07 571 3422 for their diabetes helpline. Also offers network groups, drop-in services, counselling services, diabetes courses, registered diabetes nurse specialist. 
• Diabetes Trust (Palmerston North)(external link) Phone 06 357 5992. Offers education courses, youth and family support, personal stories and more.
• Diabetes Wellington(external link)
• Diabetes Christchurch (external link)
• Diabetes New Zealand – all regions(external link)