What Are Diabetic Foot Ulcers ? -Understanding The Disease Process

Foot ulcers are a very common complication of diabetes. Approximately 10% of people with diabetes will develop a foot ulcer at some point in time. Even more : foot ulcers are the leading cause of non-traumatic lower limb amputations in the USA and UK !. In this post I will teach you how to identify the various diabetic foot ulcer stages, how to detect early signs of disease and seek early treatment before the late complications occur.


What Is A Foot Ulcer?

An ulcer is an open sore. It is caused by a break in the skin which gradually becomes deeper to expose the tissue layers beneath the skin. They commonly occur at the pressure points of the feet – under the big toe and the soles of your feet. They can also occur on the sides of the feet or on top of the toes due to friction from poor footwear. Ulcers can become very deep and expose the skin right down to the tendons and bones.

These ulcers can take a very long time to heal because people with Diabetes have poor wound healing. This significantly increases the risk of infection. If infection is not identified and treated early, it can lead to

  • cellulitis – an infection of the skin
  • abscess – a pus filled cavity
  • Osteomyelitis- an infection of the bone
  • Gangrene – tissues become starved of oxygen and die leading to amputation of one or many digits.


Why Do Foot Ulcers Develop ?

Foot ulcers are very common in diabetes because the nerves in the feet become damaged (peripheral neuropathy). The sensation in the foot is significantly reduced and abnormal pressure from ill-fitting shoes, cuts and injuries may be completely unnoticed. The wounds become progressively deeper increasing the risk of infection.

Diabetes also affects the small blood vessels to the feet (peripheral vascular disease) leading to reduced circulation to the legs and feet. The lack of blood flow can cause ulcers to develop and impaired wound healing.


How Do I Identify a Foot Ulcer ?

A foot ulcer look like an open red sore or crater often surrounded by callus ( a callus is an accumulation of excess skin due to repeated pressure on the feet) . They are typically found on the side, bottom of the foot or on top of the toes. They can be painful or painless.                     

-If the skin surrounding the ulcer is red and swollen – these are signs of a skin infection called cellulitis.

-If the ulcer is infected you may notice a foul smelling yellow or green discharge.

– If the skin appears black- this implies the soft tissues are starved of oxygen and are no longer viable.

Depending on the severity of foot ulcers, a staging system can used to assess the need for treatment.


Foot ulcers in Diabetes can have very serious consequences. But if you can identify the disease in its early stages, they can be readily treated and reversed. I hope I have been able to guide you through a better understanding of the disease process and how to identify the early features of an ulcer.



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