What it is
A diabetic foot ulcer is an open sore, usually on the bottom or side of the foot, that can develop in people with diabetes. Nerve changes may reduce feeling in the feet, and circulation changes may slow healing, so a small wound can go unnoticed for some time.
An ulcer is considered infected when bacteria enter the wound and begin to multiply in the tissue. Commonly described diabetic foot ulcer infection signs include spreading redness around the wound, red streaking, increasing warmth, swelling, new or increasing pain, pus or cloudy drainage, and a foul odor. Fever or chills can also signal that an infection is affecting the whole body.
Infection signs can be subtle in people with diabetes. Reduced sensation may mean little pain, and the body's response may be muted. Changes in the wound's color, size, depth or drainage, or a wound that stops improving, are also worth bringing to a clinician's attention.
How it’s traditionally been approached
Traditionally, a suspected foot wound infection is evaluated in person by a licensed clinician. This often includes looking closely at the wound, checking the surrounding skin, and asking about symptoms, blood sugar management and how long the wound has been present.
Clinicians may use additional tools to understand what is going on, such as wound cultures, blood tests or imaging to look at deeper tissue and bone. Which tools are appropriate is a decision for the treating clinician after an evaluation.
Care of diabetic foot ulcers has long involved a team approach. Depending on the situation, that may include a primary care provider, an endocrinologist, a podiatrist, a vascular specialist, an infectious disease physician and a wound care specialist. Wound cleaning, removal of non-healthy tissue, dressings and relieving pressure on the foot are among the approaches commonly discussed.
How the right wound care specialist may help
The right wound care specialist may help by examining the ulcer, looking for infection signs, and working to understand the underlying contributors, such as pressure, circulation, nerve changes and overall health. They may also coordinate with other providers involved in your care.
A visit generally includes a history, a look at the wound and the whole foot, and possibly measuring or photographing the wound to track changes over time. The specialist may discuss what they find and what options may be appropriate for you. Nothing is guaranteed, and recommendations depend on your individual evaluation.
Questions you might ask a licensed provider include: What is causing my wound? How is it staged or classified? Are there signs of infection? What are my treatment options? How long might healing take? What will my insurance cover? What warning signs should prompt me to call you or seek urgent care?
The whole-person view
Body, mind and stress affect each other. Living with diabetes and a slow-healing wound can bring worry, fatigue and frustration, and stress may in turn affect sleep, daily habits and how supported a person feels while managing their health.
Some people find it helpful to add whole-person support alongside medical care. Body-based approaches such as those from Somatic Experiences may help some people relate to stress in the body, and talk therapy through Therapists.plus may offer a space to process the emotional side of a chronic health condition. These complement, and never replace, professional wound care.
Somatic Experiences: trauma and emotional healing →Somatic Experiences: embodiment and movement →Therapists.plus: mind body connection →
Keep in mind
- Any sign of infection, such as spreading redness, red streaking, increasing warmth or pain, pus, foul odor, fever or chills, or a wound that is rapidly worsening, means you should seek medical care promptly.
- For emergencies, call 911 or go to the ER. These include heavy bleeding, exposed bone or tendon, signs of sepsis (such as confusion, rapid heartbeat, or feeling severely ill), or a deep or severely contaminated wound.
- Licensed professionals should guide all care for diabetic foot ulcers. This page is educational and cannot diagnose or tell you what to do about your own wound.
- If you are feeling overwhelmed or in crisis, call or text the 988 Lifeline.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Frequently asked questions
What are the signs of an infected diabetic foot ulcer?
Common signs include spreading redness, red streaking, increased warmth, swelling, new or worsening pain, pus or cloudy drainage, and a foul odor. Fever or chills may mean the infection is affecting the whole body. Because nerve changes can mask symptoms, any change in a foot wound is worth showing to a licensed provider.
Can a diabetic foot ulcer be infected without pain?
Yes, it can. Nerve changes from diabetes may reduce pain, so an infected ulcer may feel less painful than it looks. Visual changes like redness, swelling, drainage or odor still matter, so have a clinician evaluate them.
When should I see a doctor about a diabetic foot ulcer?
Seek medical care promptly if you notice any infection signs or if the wound is getting worse. Many clinicians also recommend having any new foot wound evaluated rather than waiting. Call 911 or go to the ER for heavy bleeding, exposed bone or tendon, or signs of sepsis.
What does an infected diabetic foot ulcer look like?
It may have red, swollen or warm skin around it, drainage that is yellow, green or cloudy, and sometimes a bad smell. The wound may look larger or deeper than before. Appearances vary, so only a licensed provider can tell whether a wound is infected.
How do doctors check a diabetic foot ulcer for infection?
Clinicians typically examine the wound and surrounding skin and review your symptoms and health history. They may also use tests such as wound cultures, blood work or imaging. Which tests are used is decided by the clinician after an evaluation.
How can a wound care specialist help with a diabetic foot ulcer infection?
A wound care specialist may evaluate the wound, look for infection, assess factors that affect healing and coordinate with your other providers. What they recommend depends on your evaluation, and results are never guaranteed. Ask about your wound's cause, staging, treatment options, expected healing time and insurance coverage.
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.