What it is
A diabetic foot ulcer is an open sore or break in the skin of the foot, often on the bottom or over a pressure point. Diabetes can affect nerve function, circulation and the body's ability to heal. Together, these changes can let a small blister, callus or scrape become a wound that is slow to close.
Many people with diabetes have reduced feeling in their feet, so an injury may go unnoticed. Pressure, friction, poorly fitting shoes and dry, cracked skin can all play a part. Reduced blood flow can also make healing harder.
Charcot foot is a related condition, and people often search for it alongside ulcers. It involves weakening and changes in the bones and joints of the foot, usually linked to nerve damage. Over time the foot's shape can change, which may create new pressure points where ulcers form. Only a licensed clinician can evaluate and diagnose it.
How it’s traditionally been approached
Diabetic foot ulcers have traditionally been managed by a team rather than one person. That team may include a primary care clinician, an endocrinologist, a wound care physician or nurse, a podiatrist, a vascular specialist and others. Each looks at a different part of the picture.
Common elements of care include a careful evaluation of the wound and its cause, and checking blood flow and nerve sensation. Clinicians often remove non-healthy tissue through debridement. They also use dressings chosen for the wound and look for signs of infection. Offloading, which means taking pressure off the area, is widely recognized as a central part of care. It can be done with specialized shoes, casts, boots or other devices.
Other approaches vary by situation. They may include negative pressure wound therapy, a well-established option for some wounds. Skin substitutes or amniotic and placental grafts are also used in some cases. Their FDA status varies, and most are regulated as minimally manipulated tissue rather than FDA-approved drugs. Hyperbaric oxygen therapy is FDA-cleared for certain diabetic foot ulcers that meet specific criteria. Whether any of these is appropriate is a decision for a licensed clinician after an evaluation.
How the right wound care specialist may help
The right wound care specialist may help by looking at the whole picture, not only the wound's surface. A first visit often includes a review of your health history and blood sugar management. It may also include a foot exam, a look at your footwear, and an assessment of sensation and circulation. The specialist may measure and document the wound so changes can be tracked over time.
Depending on what they find, a specialist may discuss options such as debridement, offloading, dressings and infection management. They may also discuss imaging or lab work, and referrals to other providers. This can include referrals for custom footwear or orthotics, which are often used to reduce pressure on vulnerable areas. What is appropriate varies from person to person and is always decided by a licensed provider.
It can help to bring your questions and a list of your medications and shoes. You might ask your provider: • What is causing my wound, and how is it staged or classified? • What treatment options are available, and what are the pros and cons of each? • How long might healing take? • What does my insurance cover, including any advanced products or therapies? • What warning signs should prompt me to call right away?
The whole-person view
Living with diabetes and a slow-healing wound can be stressful. Stress, poor sleep, pain and worry can affect daily routines, energy and how a person experiences their body. Physical health and emotional wellbeing influence each other, and caring for one can support the other.
Some people find body-based support helpful for stress and for reconnecting with their body, such as the practitioners listed with Somatic Experiences. Others prefer talking with a licensed therapist, such as those found through Therapists.plus. These are optional parts of a whole-person approach and work alongside, not instead of, the care your medical team provides.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Seek medical care promptly for any sign of infection: spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills. Also seek care promptly if a wound is rapidly getting worse.
- Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, signs of sepsis such as confusion, rapid heartbeat or a high fever with feeling very ill, or a deep or severely contaminated wound.
- Foot ulcers can change quickly, so many clinicians encourage regular foot checks and prompt professional attention to new sores. A licensed professional should guide all decisions about your care.
- If emotional distress ever feels overwhelming, call or text the 988 Lifeline.
Diabetic foot ulcers can progress quickly; daily foot checks and prompt care reduce amputation risk.
Wound care specialists
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Frequently asked questions
What is a diabetic foot ulcer?
A diabetic foot ulcer is an open sore on the foot that can develop in people with diabetes. Nerve changes, reduced circulation and repeated pressure can all contribute to one forming and being slow to heal. A licensed provider can evaluate the cause of a specific wound.
What is diabetic wound care?
Diabetic wound care is the professional evaluation and management of wounds in people with diabetes, most often on the feet. It commonly involves assessing the wound, removing non-healthy tissue, choosing dressings, relieving pressure and watching for infection. The specific approach is decided by a licensed clinician.
What is Charcot foot?
Charcot foot is a condition in which the bones and joints of the foot weaken and may change shape, usually in connection with nerve damage. These changes can create new pressure points where ulcers may form. Anyone with a swollen, warm or changing foot should have it evaluated by a licensed provider.
What is offloading for a diabetic foot ulcer?
Offloading means reducing pressure on the ulcer so the area is not repeatedly stressed while walking or standing. Clinicians may use specialized shoes, boots, casts or other devices for this. Your provider can explain which option, if any, fits your situation.
What are signs a diabetic foot ulcer is infected?
Warning signs include spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills. If you notice any of these, seek medical care promptly. For heavy bleeding, exposed bone or tendon, or signs of sepsis, call 911 or go to the ER.
What should I ask a wound care specialist about a diabetic foot ulcer?
Ask about the cause of your wound, how it is staged, your treatment options and the expected healing time. Also ask about insurance coverage, warning signs to watch for, and whether a referral for custom footwear makes sense. Coverage and appropriateness can differ by treatment, product and payer.
Educational resource. WoundKare shares general information and connects people with independent wound care specialists. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health.