Table of ContentsView All
View All
Table of Contents
Causes
Stages
Importance of Treatment
Signs of Healing
Foot Care and Walking Assistance
A diabetic ulcer is a type of skin sore that often occurs on the feet, toes, or legs. It can occur in people who have type 1 diabetes but is more common withtype 2 diabetes.
Diabetes can cause nerve and blood vessel damage in the feet, which can reduce sensation and make injury less noticeable. Diabetes can also cause wounds not to heal well. These factors can lead to the development of foot ulcers in people with diabetes.
The lifetime risk of developing a foot ulcer for a person with diabetes is estimated to be 19–34%, with a recurrence rate of 40% within one year and 65% within five years.
Verywell / Dennis Madamba
Why Do Diabetic Ulcers Form?
Diabetes can cause damage to blood vessels, including the tiny blood vessels that supply the leg nerves. This can result inperipheral neuropathy(burning, pain, or numbness in the feet) and/or reduced pain sensation.
Nerve damage occurs in about half of people with diabetes and commonly affects the nerves in the feet and legs. Some people experience tingling, pain, or numbness, while others have no symptoms. Nerve damage can cause a loss of pain, heat, or cold sensation.
Loss of sensation can lead injuries such as blisters, cuts, calluses, burns, or ingrown toenails to go unnoticed, allowing them to get worse before they can fully heal.
The combination of reduced sensation and poor wound healing increases the risk of infection and can lead to the development of ulcers in the feet,legs, or toes.
The ulcers tend to form in areas where there is increased pressure on the skin, such as the heel, ball of the foot, and bottom of the big toe. Ill-fitting shoes can also cause ulcers on the side of the foot.
This photo contains content that some people may find graphic or disturbing.See PhotoA diabetic ulcer on a foot at a pressure site.Reproduced with permission from ©DermNetwww.dermnetnz.org2023.
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Reproduced with permission from ©DermNetwww.dermnetnz.org2023.
Nerve damagecan occur in anyone with diabetes, but some factors can increase the risk, including:
Stages of Ulcer Formation in Diabetes
Assessment of an ulcer should include the site, size, and depth of the wound as well as any discharge. The neuropathic and vascular status of the foot should also be assessed.
Foot ulcers due to diabetes can be classified in a number of ways, including the perfusion, extent, depth, infection, and sensation (PEDIS) classification system and the University of Texas (UT) classification system.
PEDIS
PEDIS Grade 1:
This photo contains content that some people may find graphic or disturbing.See PhotoA foot with a grade 1 diabetic ulcer.Reproduced with permission from ©DermNetwww.dermnetnz.org2023.
PEDIS Grade 2:
This photo contains content that some people may find graphic or disturbing.See PhotoA foot with a grade 2 diabetic ulcer.Reproduced with permission from ©DermNet and ©Dr. Richard Ashtonwww.dermnetnz.org2023.
Reproduced with permission from ©DermNet and ©Dr. Richard Ashtonwww.dermnetnz.org2023.
PEDIS Grade 3:
This photo contains content that some people may find graphic or disturbing.See PhotoA foot with a diabetic ulcer grade 3.Reproduced with permission from ©DermNetwww.dermnetnz.org2023.
PEDIS Grade 4:
UT Grade
UT Stage
Symptoms to Identify
It is important to inspect the tops, sides, soles, and heels of your feet, and in between your toes daily to check for problems such as:
If you notice any of these problems, see your healthcare provider; don’t try to treat them yourself.
Call your healthcare provider right away and don’t wait for your next appointment if you notice any symptoms like:
Importance of Ulcer Treatment in Diabetes
Foot ulcers related to diabetes can significantly affect quality of life, including physical, financial, and psychological impacts.
Checking feet your every day increases the likelihood you will catch problems early. Early treatment decreases the chances of serious complications.
A multidisciplinary approach to preventing and treating foot ulcers in people who have diabetes may involve multiple healthcare providers, including:
What Are the Risks of Untreated Diabetic Ulcers?Left untreated, foot ulcers related to diabetes could result in complications such as:Wound infectionCellulitis(potentially serious skin infection)Osteomyelitis(bone infection)Wound/ulcer that won’t healAmputation of the toe, foot, or part of the leg (to prevent life-threatening infection from spreading)
What Are the Risks of Untreated Diabetic Ulcers?
Left untreated, foot ulcers related to diabetes could result in complications such as:Wound infectionCellulitis(potentially serious skin infection)Osteomyelitis(bone infection)Wound/ulcer that won’t healAmputation of the toe, foot, or part of the leg (to prevent life-threatening infection from spreading)
Left untreated, foot ulcers related to diabetes could result in complications such as:
Treatment of a foot ulcer depends on the severity of the wound and the extent of the damage. A healthcare provider should perform treatment for foot ulcers.
Superficial Ulcers
If the ulcer only involves the top layers of the skin, treatment typically includes:
More Extensive Ulcers
If the ulcer extends into the deeper layers of the foot and reaches muscle and bone, you will probably require hospital treatment. This treatment may involve:
Severe Damage
Ifgangrene(dead tissue that may be infected) is present or the ulcer will not heal despite aggressive treatment,amputationof part or all of the foot or leg may be necessary. Gangrene can be life-threatening if untreated.
If there is a severe foot ulcer and poor circulation, a procedure to restore blood flow to the foot may prove necessary.
Regardless of the severity of the ulcer, managing blood sugar is important to help promote healing.Quitting smokingand controlling blood pressure and cholesterol levels are also important.
Signs a Diabetic Ulcer Is Healing
A healing ulcer closes back over. Even if you think your ulcer is healing, it’s important to keep following your treatment plan and checking in with your healthcare provider for monitoring.
Signs of Worsening Ulcer
Call your healthcare provider if you havesigns of an infectionor worsening ulcer, such as:
It’s very important to keep pressure off your ulcer. Walking on it can enlarge it and force your infection deeper into the foot.
You may need to rely on certain devices to protect your foot as the ulcer heals and/or after healing to prevent scar tissue from breaking down and the ulcer from recurring. These may include:
To help prevent foot ulcers:
Footwear is very important for people who have diabetes:
Summary
Diabetes can cause nerve and blood vesseldamage in the feet, which can lead to ulcers. Foot ulcers from diabetes can start mildly, affecting just the top layers of skin, but without treatment, they can become infected and lead to complications, including amputation.
Foot ulcers from diabetes are treated with debridement, wound dressing, andantibiotics. More extensive damage may require surgery to remove dead tissue and/or procedures to promote healing.
Protecting the feet and reducing pressure on the feet through measures such as consistently wearing well-fitting shoes are important for treating and preventing foot ulcers. Managing blood sugar and checking your feet daily are other important ways to prevent the kind of foot ulcers that are associated with diabetes.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DermNet.Diabetic foot ulcer.MedlinePlus.Diabetes — foot ulcers.Reardon R, Simring D, Kim B, et al.The diabetic foot ulcer.Aust J Gen Pract. 2020;49(5):250-255. doi:10.31128/ajgp-11-19-5161Grennan D.Diabetic foot ulcers.JAMA. 2019;321(1):114-114. doi:10.1001/jama.2018.18323Centers for Disease Control and Prevention.Diabetes and your feet.MedlinePlus.Diabetes — taking care of your feet.Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A.Health economics of diabetic foot ulcer and recent trends to accelerate treatment.The Foot. 2022;52:101909. doi:10.1016/j.foot.2022.101909UpToDate.Patient education: foot care for people with diabetes (beyond the basics).American Diabetes Association.Foot complications.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DermNet.Diabetic foot ulcer.MedlinePlus.Diabetes — foot ulcers.Reardon R, Simring D, Kim B, et al.The diabetic foot ulcer.Aust J Gen Pract. 2020;49(5):250-255. doi:10.31128/ajgp-11-19-5161Grennan D.Diabetic foot ulcers.JAMA. 2019;321(1):114-114. doi:10.1001/jama.2018.18323Centers for Disease Control and Prevention.Diabetes and your feet.MedlinePlus.Diabetes — taking care of your feet.Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A.Health economics of diabetic foot ulcer and recent trends to accelerate treatment.The Foot. 2022;52:101909. doi:10.1016/j.foot.2022.101909UpToDate.Patient education: foot care for people with diabetes (beyond the basics).American Diabetes Association.Foot complications.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
DermNet.Diabetic foot ulcer.MedlinePlus.Diabetes — foot ulcers.Reardon R, Simring D, Kim B, et al.The diabetic foot ulcer.Aust J Gen Pract. 2020;49(5):250-255. doi:10.31128/ajgp-11-19-5161Grennan D.Diabetic foot ulcers.JAMA. 2019;321(1):114-114. doi:10.1001/jama.2018.18323Centers for Disease Control and Prevention.Diabetes and your feet.MedlinePlus.Diabetes — taking care of your feet.Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A.Health economics of diabetic foot ulcer and recent trends to accelerate treatment.The Foot. 2022;52:101909. doi:10.1016/j.foot.2022.101909UpToDate.Patient education: foot care for people with diabetes (beyond the basics).American Diabetes Association.Foot complications.
DermNet.Diabetic foot ulcer.
MedlinePlus.Diabetes — foot ulcers.
Reardon R, Simring D, Kim B, et al.The diabetic foot ulcer.Aust J Gen Pract. 2020;49(5):250-255. doi:10.31128/ajgp-11-19-5161
Grennan D.Diabetic foot ulcers.JAMA. 2019;321(1):114-114. doi:10.1001/jama.2018.18323
Centers for Disease Control and Prevention.Diabetes and your feet.
MedlinePlus.Diabetes — taking care of your feet.
Jodheea-Jutton A, Hindocha S, Bhaw-Luximon A.Health economics of diabetic foot ulcer and recent trends to accelerate treatment.The Foot. 2022;52:101909. doi:10.1016/j.foot.2022.101909
UpToDate.Patient education: foot care for people with diabetes (beyond the basics).
American Diabetes Association.Foot complications.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
