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Diabetic Foot Ulcers

Foot ulcers are common complications of diabetes.
Why Are People With Diabetes at Risk of Ulcers?
Inspection for Diabetic Foot Ulcers
Foot and lower leg ulcers are one of the many problems caused by
Patients with diabetes should inspect
poorly controlled diabetes. Ulcers that do not heal can lead to their feet daily for calluses, blisters, Blister
amputations of toes, parts of the foot, or the lower leg. Diabetes cuts, burns, and ingrown toenails.
damages blood vessels throughout the body. Tiny blood vessels These minor injuries can develop
into diabetic foot ulcers
that supply the nerves in the legs may be affected, resulting in or may become infected.
burning pain or numbness in the feet (peripheral neuropathy) and
reduced pain sensation. Calluses, blisters, cuts, burns, and ingrown
Callus
toenails can all lead to diabetic foot ulcers. A patient may not be
aware of these minor injuries due to peripheral neuropathy, so Ulcer

ulcers may develop and enlarge before they are noticed. Larger
Cellulitis
blood vessels in the legs may also be affected by diabetes, resulting
in poor circulation (peripheral artery disease). Ulcers may heal
slowly due to peripheral artery disease. High blood glucose levels
also delay healing. Daily foot inspection is an important part of dia-
Foot ulcers that are infected appear warm and red and may drain pus.
betes management and can help prevent foot ulcers. Infected ulcers should be treated by a clinician. Treatment usually
includes oral antibiotics for 1 to 2 weeks.
Infection and Diabetic Foot Ulcers
If underlying bone is infected, long-term intravenous antibiotics may
Diabetic foot ulcers may become infected. If there is pus draining ! be prescribed, and in severe cases amputation may be necessary.
from the ulcer and the surrounding skin is warm and red, the ulcer
is probably infected. A clinician will often need to cut away callus
and dead tissue from an ulcer; if the ulcer appears infected, tissue • Good nutrition
sample testing in a microbiology laboratory may be helpful in iden- • Evaluating the circulation in the legs
tifying the type(s) of bacteria causing the infection and choosing an • Antibiotics if the ulcer is infected
appropriate antibiotic. An infected ulcer is usually treated with
an oral antibiotic for 1 to 2 weeks. Prevention
The bone underlying an ulcer may become infected if the ulcer
• Keep feet clean, dry, and well moisturized.
is deep. Bone infection is called osteomyelitis and can cause bone
• Wear shoes that fit well.
to die. Antibiotics have no effect on dead bone. Once bone is dead,
• Inspect feet daily.
it should be removed, usually by amputation of the affected part of
• Never walk barefoot.
the foot or leg. Many amputations in patients with diabetes are due
• See a podiatrist for calluses, minor injuries, or ingrown toenails.
to osteomyelitis. If the bone has been infected only for a short time
• Schedule clinical foot examinations at least once a year.
or if removing the dead bone is not possible, a patient may be pre-
• Maintain good blood glucose control.
scribed a long course of antibiotics. If a patient needs 4 to 6 weeks
• Do not smoke.
of intravenous antibiotics, a long-term intravenous line called
a PICC line is placed. The patient will also need blood tests once a
week to monitor for signs of infection and antibiotic side effects.
FOR MORE INFORMATION

Treatment • American Diabetes Association

www.diabetes.org/living-with-diabetes/complications/foot-
• Removal of callus and dead tissue by a podiatrist complications/?loc=lwd-slabnav
• Good wound care • American Podiatric Medical Association
• Reducing pressure on the ulcer (“off-loading”) www.apma.org/Patients/FootHealth.cfm?ItemNumber=981
• Good blood glucose control

Author: Dara Grennan, MD
Source: Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of
America clinical practice guideline for the diagnosis and treatment of diabetic foot
infections. Clin Infect Dis. 2012:54(12):e132-e173.
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