Understanding Diabetic Foot Ulcers

A foot ulcer is an open sore where the skin has broken down, exposing the underlying tissue. Even a mild injury — stepping on a small object or pressure from tight shoes — can trigger an ulcer in people with diabetes.

Why People With Diabetes Develop Foot Ulcers

Foot ulcers occur mainly due to two common diabetes-related problems:

1. Loss of Sensation (Diabetic Neuropathy)

High blood sugar levels damage nerves over time, especially those carrying sensation from the feet. This leads to:

  • Reduced ability to feel pain, pressure, or injury
  • Increased risk of unnoticed wounds
  • Continuous walking on small injuries, allowing them to worsen and form ulcers

2. Poor Blood Circulation (Peripheral Vascular Disease)

Diabetes increases the likelihood of narrowing of blood vessels, especially in the legs. Reduced blood flow:

  • Slows healing
  • Increases the risk of minor injuries turning into ulcers
  • Becomes especially problematic when combined with neuropathy

Who Is at Higher Risk of Foot Ulcers?

You are more likely to develop ulcers if you have:

  • Loss of feeling in the feet
  • Poor circulation
  • Changes in foot shape due to muscle weakness or deformity
  • A past history of foot ulcers
  • Other diabetic complications (eye or kidney disease)
  • Frequent minor foot injuries, corns, or calluses
  • Poorly controlled blood sugar
  • Smoking habit

Are Diabetic Foot Ulcers Serious?

Yes. Untreated ulcers can lead to:

  • Deep infections
  • Gangrene
  • In rare cases, amputation

Immediate care by a foot specialist and strict blood sugar control are essential to prevent complications.

Why Is There No Pain Even With an Ulcer?

Diabetic neuropathy causes loss of sensation, so many people do not feel pain even when the ulcer is severe. This lack of warning often delays early care and increases the risk of complications.

How Long Does Healing Take?

Healing time varies widely because ulcers may be caused by:

  • Poor circulation → may require peripheral angioplasty plus medications
  • Abnormal pressure or bone deformity → bone correction may be needed

Since each ulcer has different underlying causes, there is no single healing timeline.

Preventing Foot Ulcers

1. Regular Medical Foot Exams

Most people with diabetes should have their feet checked by a healthcare professional at least once a year.

2. Good Diabetes Control

Checking blood sugars and monitoring HbA1c helps reduce the risk of complications, including ulcers.

3. Self-care at Home

Proper foot care significantly reduces ulcer risk:

  • Inspect feet daily
  • Avoid walking barefoot
  • Keep feet clean and moisturized
  • Wear well-fitting shoes

What Should You Do If an Ulcer Appears?

  • Contact your doctor immediately.
  • Avoid self-treatment or home dressings.
  • Most ulcers heal with regular dressings and sometimes a total contact cast to reduce pressure.

If the ulcer is infected, worsening, or not healing:

  • Surgery may be needed to remove infected tissue
  • If a bone prominence is the cause (often under the arch), excision of the bone may be required for healing

Example: Diabetic Heel Ulcer

Images (not shown here) often demonstrate:

  • Severely damaged heel skin
  • Healing progression with proper diabetic control and regular treatment