Diabetic Foot Ulcer
by Diane Voyatzis Norwood, MS, RD, CDE
Ulcers are slow-healing wounds on the skin. Diabetic foot ulcers occur on the feet of people with type 1 and type 2 diabetes. Diabetic foot ulcers usually occur on the bottom of the foot.
Diabetes can cause problems with blood flow in feet and nerve damage. Poor blood flow will make it harder for damaged skin to heal. Damage to the nerves can make it hard to feel pressure, blisters, or other injury to the feet. This makes it hard to prevent sores and can lead to larger sores.
The ulcer itself is usually caused by:
The risk of diabetic foot ulcers is higher in those with:
Symptoms may include:
You will be asked about your symptoms and past health. A physical exam will be done. A foot specialist may be needed. Fluid from the wound and blood tests may be done to look for signs of infection. Other tests may include:
Early treatment can prevent more problems. Treatment options include the following:
Good wound care is important to help the ulcer heal and prevent infection. It will include keeping area clean and bandaged. Special bandages can help the wound heal faster. Other steps that can help during recovery include:
Some large skin ulcers may have a hard time fully healing with basic care. A skin graft can use a section of skin from somewhere else to help the wound heal. The patch of skin may be taken from other area of the body, come from donors, or be a synthetic skin.
Dead tissue can build up inside and around the wound. This tissue will slow or prevent healing and increase risk of infection. Surgery may be needed to remove the dead tissue and clean the wound. This surgery is called debridement. Surgery may also be needed to improve blood flow to the legs.
Sometimes an infection is too severe or does not respond to treatment. Amputation may be needed if the area cannot heal and tissue continues to die. Part of the foot is removed to stop infections from spreading to the rest of the body.
Hyperbaric oxygen therapy may help with healing. Pure oxygen is pumped into a chamber to increase the amount of oxygen in the blood. The extra oxygen can improve the ability to heal.
Negative pressure wound therapy may also be used. A vacuum device and dressing help to draw fluid and infected tissue away from the wound. This can help the wound heal faster for some.
Steps that can help keep feet healthy:
American Diabetes Association
American Podiatric Medical Association
Canadian Diabetes Association
Canadian Podiatric Medical Association
Bakker K, Apelqvist J, et al; International Working Group on Diabetic Foot Editorial Board. Practical guidelines on the management and prevention of the diabetic foot 2015. Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:2-6. doi: 10.1002/dmrr.2694.
Diabetic foot ulcer. EBSCO DynaMed website. Available at:
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Accessed January 29, 2021.
Markakis K, Bowling FL, Boulton AJ. The diabetic foot in 2015: an overview. Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:169-78.
Ndip A, Bowling F, et al. The diabetic foot in 2013: an update from the 14th Malvern Diabetic Foot Meeting. Int J Low Extrem Wounds. 2013 Mar;12(1):71-5.
Nelson EA, O’Meara S, et al. Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med. 2006;23(4):348-359.
Last reviewed September 2020 by EBSCO Medical Review Board Shawna Grubb, RN
Last Updated: 1/29/2021