If you’re living with diabetes, one area of the body you need to be especially aware of is your feet. We’ve all likely taken our feet for granted at one time or another, but people living with diabetes are at particular risk from diabetic foot ulcers that won’t heal, a potentially life-threatening complication of diabetes.
But what are diabetic foot ulcers? Not every weird thing going on with your feet is a reason to panic, so let’s be clear before we start. A diabetic foot ulcer is a wound, or sore, on the foot of someone living with diabetes. If left untreated, these ulcers can lead to severe infections that (worst case scenario) can result in amputation. Because the consequences of not treating a diabetic foot ulcer are so potentially dire, it’s important to seek treatment as soon as you realise an ulcer is present.
The short version is: if you have a sore (any sore) on your foot, and you have diabetes, get it checked immediately before it becomes a sore that won’t heal, and a potentially major problem. For more details, keep reading…
Diabetic Foot Ulcers That Won’t Heal: What To Do Now
If you have diabetes and notice a new blister, cut, wound or ulcer on your foot, do not wait to see whether it heals before seeking help. Contact your GP or local foot protection team straight away. Diabetes UK advises urgent assessment within 24 hours for new blisters, cuts or wounds, wounds that smell or leak fluid or pus, new unexplained pain, and significant changes in the colour, shape or temperature of the foot.
While you are waiting for help, take the weight off the affected foot as much as possible. Do not burst blisters, cut away hard skin around the wound or attempt to treat the ulcer yourself.
If you have a diabetic foot ulcer alongside fever or signs of sepsis, a serious problem with the blood supply to the foot, suspected deep or bone infection, or gangrene, this needs immediate acute medical care.
What Are Diabetic Sores And Foot Ulcers?
Diabetic sores and foot ulcers are an issue commonly faced by those living with diabetes. They are wounds on the feet, and NICE estimates that around 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives. They may start as a small injury, like a cut, a blister, or dry and cracked skin.
If you have diabetic peripheral neuropathy (nerve damage caused by your diabetes) you’re at a greater risk of developing a diabetic sore or ulcer. Diabetic peripheral neuropathy can cause pain, tingling, numbness or a loss of feeling in your feet. This means you may not notice an injury when it happens, and a significant ulcer may cause little or no pain. If pain itself is the problem, there are several possible causes of diabetic foot pain.
Peripheral artery disease (PAD) can also increase the risk of foot ulcers because narrowing of the arteries reduces blood flow to the feet. Poor blood supply can make wounds more difficult to heal.
If you do develop diabetic sores or foot ulcers they are best treated by medical professionals. An active diabetic foot ulcer should be assessed through the appropriate diabetic foot pathway rather than treated as a routine foot-care problem. NICE classifies ulceration as an active diabetic foot problem.
What Causes Diabetic Foot Ulcers?
Diabetic foot ulcers are primarily caused by two major complications of diabetes: nerve damage (diabetic neuropathy) and poor circulation (peripheral arterial disease). Neuropathy reduces sensation in the feet, making it hard to feel injuries, while poor circulation impairs wound healing, increasing the risk of infection and ulcers.
- Neuropathy: Over time, elevated blood glucose levels can damage the nerves in the feet, leading to decreased sensation. This means injuries like cuts or blisters may go unnoticed and untreated, eventually leading to ulcers.
- Poor Blood Circulation: Diabetes can lead to atherosclerosis, where the blood vessels narrow and harden, reducing blood flow to the feet. Poor circulation can slow down the healing process of wounds, significantly increasing the risk of developing ulcers.
- Foot Deformities and Pressure Points: Changes in the shape of the feet and toes can create pressure points. If neuropathy has reduced sensation, constant pressure may go unnoticed and can eventually lead to skin breakdown and ulcer formation.
- Injury and Shoe Friction: Footwear that does not fit properly can cause repeated rubbing, leading to blisters and sores that can develop into ulcers.
Small injuries can also happen around the nails. Cuts caused while trimming toenails, damaged skin around an ingrown nail or other nail problems can create a break in the skin. Taking particular care with nail care for diabetics can help reduce the risk of causing an injury without realising it.
Understanding these causes is crucial for prevention, which includes managing blood sugar levels, wearing appropriate footwear, and conducting regular foot inspections.
What Does A Diabetic Foot Ulcer Look Like?
A diabetic foot ulcer may begin as a blister, crack or small break in the skin, or it may already appear as an open sore or deeper wound when you first notice it.
Common signs include swelling, redness, and irritation around a wound on the foot, sometimes accompanied by an unusual odour, pus, or fluid leakage. Many patients do not feel pain due to nerve damage. A change in the temperature or colour of the foot can also be significant.
One of the most important things to remember is that appearance and pain do not reliably tell you how serious a diabetic foot problem is. Neuropathy can reduce sensation, so a wound may not hurt even when it needs urgent assessment. A new blister, cut, sore or wound should therefore be taken seriously even if you cannot feel it.
Non-Healing Diabetic Sores
Failure to effectively treat a diabetic sore can lead to extreme complications, so it’s vital that you get any sores healing as swiftly as possible.
If a diabetic foot wound won’t heal, there may be several reasons. Reduced blood flow can make it harder for oxygen and nutrients to reach damaged tissue. Infection can delay healing, while continued pressure on the same area can repeatedly damage the wound. The size, depth and position of the ulcer also affect how it needs to be managed.
Professional treatment depends on the individual ulcer. It may involve taking pressure off the wound, known as offloading, treating infection, addressing problems with blood supply, removing dead or damaged tissue and using appropriate dressings. These are treatment decisions for the healthcare team managing the ulcer, rather than things to attempt yourself.
Prevention, in this case, is always better than cure. If you have diabetes, check your feet for sores regularly so that you are aware of any issues as quickly as possible. Remember, your diabetes may cause damage to the nerves in your feet, so you may not feel any issues going on down there. Visually inspect your feet daily. Building those checks into how you care for diabetic feet can help you find small problems before they become more serious.
When treatment has started, follow the wound-care advice you have been given and attend all check-up and follow-up appointments. Monitoring is important because the treatment plan may need to change depending on how well the ulcer is healing or whether another problem develops.
A non-healing sore or ulcer can lead to a chronic infection, gangrene, or even – at the most extreme – amputation – so be sure to take them seriously and be vigilant!
Reducing The Risk Of Another Diabetic Foot Ulcer
Once an ulcer has healed, continuing to look after your feet is important. Check them every day, wear well-fitting footwear and deal with small problems before they create another break in the skin. Good diabetic foot care also means paying attention to dry or cracked skin, nail problems and areas of rubbing or pressure.
Routine podiatry can help with preventative foot care, including skin and nail problems, pressure areas and changes in the feet. However, if you currently have an active ulcer, a new wound or another serious diabetic foot problem, contact your GP or local diabetic foot service promptly rather than waiting for a routine private podiatry appointment.
If you do not have an active ulcer but would like help looking after your feet and managing routine foot problems associated with diabetes, you can book an appointment with Northwich Foot Clinic.
