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Diabetic Foot Ulcer: Causes, Symptoms & Treatment

Diabetic Foot Ulcer: Causes, Symptoms & Treatment

Apria Editorial |

About 15% of people with diabetes develop foot ulcers, which are open sores or wounds, most often on the soles of their feet. Foot ulcers are the leading cause of hospital admissions in diabetic patients, and this is why we at ApriaHome believe in creating awareness surrounding this preventable complication.

Find everything you need to know, from prevention to treatment, and tips in this handy guide.

Diabetes causes impaired healing due to complicated bodily processes involving vascular, neuropathic, immunological, and metabolic components. Hyperglycemia is associated with rigid blood arteries and microvascular dysfunction, causing decreased tissue oxygenation, which aids healing. Diabetes can cause impaired circulation, which often occurs in the lower limbs and feet. Because of this, it may be hard to detect injuries such as blisters, wounds, or cuts.

Infected wounds that go undetected and untreated may rapidly worsen, requiring drastic measures like amputation. Diabetes is the leading cause of nontraumatic lower limb amputations in the United States. However, there are various ways to prevent ulcers from reaching this level.

Treatment of a diabetic foot ulcer should begin immediately to prevent further infection, as recommended by the Centers for Disease Control and Prevention (CDC). People with diabetes need to examine their lower limbs and feet every day for signs of redness, cracks, and puncture wounds. If a diabetic sore or ulcer is discovered, immediate medical attention is required. They may advise you on how best to treat the wound and demonstrate how to do it at home.

About 15% of people with diabetes develop foot ulcers, which are open sores or wounds, most often on the soles of their feet. Foot ulcers are the leading cause of hospital admissions in diabetic patients, and this is why we at ApriaHome believe in creating awareness surrounding this preventable complication. Find everything you need to know, from prevention to treatment, and tips in this handy guide.

What Is A Diabetic Ulcer?

Diabetic ulcers are a potentially severe diabetic complication caused by inadequate blood flow, vulnerability to infection, and nerve damage due to high blood sugar. In addition, poor circulation makes it difficult for the body to heal skin wounds, causing the formation of a diabetic ulcer.

Many people with diabetes develop ulcers, and some estimates put the percentage at 15%. Unfortunately, infections and other problems often necessitate hospitalization, and amputations may be necessary if the infections are severe enough. Foot ulcers may take many weeks or even months to heal. Diabetes ulcers are often painless due to a lack of sensation in the feet, so knowing what to look for is an important step to getting the correct treatment.

What Do Diabetic Ulcers Look Like?

Long-term diabetic foot ulcers increase the risk of infection, which may migrate from the wound to the bone. While antibiotics can be used to treat these infections, the foot may still need to be amputated if the bone has been severely damaged.

Both patients and caregivers need to recognize these wounds so they may be treated early and effectively. It should be easy to see whether the ulcer has progressed to an advanced stage. But for ulcers at the beginning stages, one of the telltale signs of a foot ulcer is a red, crater-like opening surrounded by calloused skin. Ulcers can be so severe that they spread all the way to the bone or tendons.

The following signs are the most obvious physical signs of a diabetic foot ulcer:

  • Unusual swelling and redness
  • Puss drainage on the socks or shoes
  • Blisters, corns, and calluses
  • Athlete's foot or other fungal infections
  • Noticeable lump
  • Discoloration, characterized by a black or brown tissue called eschar, appears around the wound due to a lack of blood flow
  • Partial or complete gangrene, characterized by swelling, blisters, extreme pain & discomfort, thin, glossy skin, and discoloration (purple, green, grey, black)

Diabetic foot ulcer symptoms should never be ignored. See a medical professional immediately if you experience any of the above symptoms or suspect you have a foot sore or ulcer.

What Are The Diabetic Foot Ulcer Stages?

Ulcers range in size from very small to very large. Untreated, they can spread to cover the entire foot. An ulcer's depth is also varying. Therefore, foot ulcer classification is divided into different grading scales to quantify the severity of an ulcer. For example, there are six stages in the Wagner Diabetic Foot Ulcer Grade Classification System:

  • Grade 0: No damage; skin still intact
  • Grade 1: Superficial ulcer - skin is broken, but the wound is shallow
  • Grade 2: Deep wound with visible tendon, joint, or muscle tissue
  • Grade 3: Deep wound with abscess or osteomyelitis - infection or inflammation in the bone
  • Grade 4: Gangrene affecting the forefoot closest to your toes
  • Grade 5: Gangrene affecting the entire foot

    This encompasses the whole range of ulcer development but highlights stage 3 as the pivotal stage that requires quick and aggressive treatment. Diabetic wound care is multidisciplinary, involving hygiene, metabolic, microbiological, vascular, and educational aspects.

    What Are Diabetic Foot Ulcer Symptoms?

    Drainage from the foot, which may discolor socks or leak through the sole of the shoe, is a common symptom of a foot ulcer. Other early signs often include one or both feet swelling, itching, reddening, or an unusual odor from the area.

    The presence of black tissue (called eschar) around an ulcer is the most noticeable indicator of a serious foot ulcer. This develops when the tissue around an ulcer does not get enough oxygen-rich blood. As the infection spreads, gangrene, the death of surrounding tissue, may set in, either partially or entirely. Symptoms of this condition may include a foul odor, discomfort, and numbness.

    Diabetic foot ulcer symptoms are not always easy to see. It is not uncommon for an ulcer to get infected before any symptoms appear. Diabetes patients experiencing any of the following symptoms should make contact with their medical team as soon as possible to facilitate foot ulcer healing.

    • Variations in skin color
    • Skin temperature fluctuations
    • Foot or ankle swelling
    • Discomfort and pain in the legs
    • Itch, irritation, or inflammation in the foot
    • Ingrown toenails or fungal infections
    • Infected or slow-healing open sores on the feet
    • Painful, infected, or ingrown toenails
    • Calloused feet
    • Skin dryness and cracking, most noticeably at the heel
    • Persistent and unusual odor emanating from the foot.
    • Temperature, fever, or chills
    • Persistent pain when walking

      What Causes Foot Ulcers?

      Infections from ulcers are particularly difficult for people with type 2 diabetes and other chronic conditions. People with diabetes are more likely to develop ulcers due to the following:

      • Inadequate blood flow
      • Blood sugar levels that are too high (hyperglycemia)
      • Nerve damage
      • Injury to the foot that goes unnoticed because of nerve damage (diabetic neuropathy)

        Vascular disease causes poor blood circulation, which leads to insufficient blood supply to the limbs, which contributes to the slow healing of diabetic ulcers. Healing is further impaired by extreme fluctuations in glucose levels when diabetes is not adequately managed.

        Permanent nerve injury may cause a lack of sensation in the feet, reducing the patient's ability to feel pain and leading to ulcers caused by lesions that the patient is unaware of.

        Other risk factors include:

        • Problems with blood flow
        • Heart disease
        • Obesity
        • An issue with the feet, such as a bunion or hammertoe
        • Kidney disease
        • Tobacco and alcohol use
        • Ill-fitting footwear, poor hygiene
        • Poorly trimmed toenails

          How To Treat Diabetic Foot Ulcers?

          Diabetes care and treating foot ulcers mostly focus on promoting rapid healing. The reduced risk of infection depends on the rate at which a wound heals. Several factors must be considered while treating a diabetic foot ulcer properly.

          Preventing infection:

          • Offloading: Relieving the area of pressure which can cause an ulcer to spread
          • Debridement: Removing dead skin and other tissue
          • Wound dressing and antibiotic treatment
          • Monitoring and managing blood sugar levels

            To safeguard your foot, your physician may suggest that you use the following:

            • Compression wraps
            • Casts or foot braces
            • Specialized shoe inserts or insoles

              If an ulcer progresses to an advanced stage and hospitalization is required, infection is a significant risk factor for foot ulcers and must be treated right away. Infections need varying degrees of care.

              It may be necessary to send some of the ulcer's surrounding tissue to a lab to determine the most effective antibiotic treatment. In addition, your doctor might perform an x-ray to screen for bone infection in the case of a very advanced infection.

              Not all ulcers are infected, but if your medical team determines that yours is, you'll need to undergo a treatment plan that includes antibiotics, wound care, and in some cases, hospitalization.

              Infection is managed with the following:

              • Foot baths
              • Cleansing the skin surrounding an ulcer
              • Enzyme treatments
              • Keeping the ulcer dry with regular dressing changes
              • Dressings containing calcium alginates to limit bacterial growth

                How To Prevent Diabetic Foot Ulcers?

                Preventing a diabetic foot ulcer from forming in the first place is the most effective treatment for this condition. Therefore, regular visits to a podiatrist or doctor are recommended as best practice. This helps you assess your risk of developing a foot ulcer, where preventative measures will be prescribed if necessary.

                High-risk factors include:

                • Poor circulation
                • Foot abnormalities
                • Unmanaged sugar levels
                • Diabetic neuropathy

                  The risk of developing a chronic diabetic foot ulcer can be managed by lifestyle modifications such as reducing alcohol and tobacco consumption and maintaining a healthy and balanced diabetic diet. For more guidance on meal plans, consult our diabetic meal guide.

                  Other prevention methods include:

                  • Wearing the appropriate footwear and socks
                  • Being able to recognize the early signs of an ulcer
                  • Daily skin examination, look for cuts, bruises, scrapes, burns, or any skin abnormalities
                  • Maintaining hygiene and foot care, e.g., Washing feet with warm, fragrance-free soaps, keeping toenails trimmed, and managing calloused feet and cracked heels
                  • Drying feet and lower limbs thoroughly after cleaning to avoid moisture build-up

                  Diabetic Wound Treatment: The ApriaHome Diabetic Wound Care & Ulcer Management Kit

                  Seeking diabetic wound care and wound healing assistance? ApriaHome sources and supplies only the highest quality treatment solutions and durable and home medical equipment (DME and HME) from across the globe.

                  We understand new diabetes diagnoses can feel overwhelming, so we have compiled a range or list of products and resources to help manage diabetes. Our online medical equipment platform is a one-stop solution for diabetes management. We supply a range of premium glucose monitoring solutions, lancing devices, equipment, and skincare and diabetic wound care solutions.

                  Learn more about diabetic wounds and ulcers with our diabetic wound care guide.

                  Manage diabetic ulcers with our diabetic wound care kit:

                  To maintain skin integrity:

                  Fragrance-free wipes, topical creams, barrier creams, and mild moisturizers.

                  For wound dressing:

                  3M™ Kerramax Care™ Super-Absorbent Non-Woven Dressing

                  Or browse our range of Non-Adhesive, skin-friendly, moisture-retention & dressings for burns and surface wounds.

                  For compression treatment: 3M™ Coban™ Lite 2 Layer Compression Bandage System Box of 1 System

                  For ulcer management:

                  Water-resistant dressings, absorbent plasters, and compression bandages

                  For nutritional wound care support:

                  ProHeal® Liquid Protein & Critical Care supplements.

                  Restoring Quality Of Life For Diabetic Patients And Loved Ones With ApriaHome

                  Diabetic ulcers are a major threat to the well-being of diabetic patients; this is why ApriaHome believes that education and awareness are important for both patients and loved ones. Diabetic ulcers are preventable. Learn to manage diabetes effectively and recognize the early warning signs.

                  If you suspect an ulcer has developed, do not panic! Contact a medical professional and remember that a wide range of treatment solutions and medical assistance is available to restore and enhance your quality of life.

                  Browse our range of hospital-grade diabetic treatment solutions and diabetic wound management solutions, all available from the convenience of our online medical equipment supply portal.

                  Looking for advice? Our helpful agents are on call at (800) 780-1508 between 8:00 am - 10:00 pm EST daily. Get in touch today.


                  LEGAL DISCLAIMER: Material in this newsletter is only: (1) provided for general health education and informational purposes, and to provide references to other resources; it may not apply to you as an individual. While Apria believes that the information provided through this communication is accurate and reliable, Apria cannot and does not make any such guarantee. It is not intended to be a replacement for professional medical advice, evaluation, diagnosis, services or treatment (collectively, "medical treatment"). Please see your healthcare provider for medical treatment related to you and your specific health condition(s). Never disregard medical advice or delay seeking medical care because of something you have read on or accessed through this website. Reading this newsletter should not be construed to mean that you have a healthcare provider/patient relationship with Apria.