Living with diabetes means managing more than just blood sugar. One of the most serious complications of this condition is the development of —open sores or wounds that form on the feet and can lead to severe health consequences if not treated promptly. In fact, foot ulcers precede approximately 85% of diabetes-related amputations, making their management and prevention a top priority in diabetic care.
Fortunately, with early intervention, specialized care, and patient diligence, diabetic foot ulcers can be effectively treated and even prevented altogether. In this blog, we’ll break down the causes, symptoms, and most importantly, the proven methods for treating these potentially life-altering wounds.
What Are Diabetic Foot Ulcers?
Diabetic foot ulcers are open sores, typically located on the bottom of the foot, resulting from a combination of neuropathy (nerve damage), poor circulation, and immune system impairment. Because people with diabetes often experience reduced sensation in their feet, minor cuts, blisters, or pressure points can go unnoticed and develop into serious ulcers before any discomfort is felt.
Contributing factors include:
Peripheral neuropathy – Damages the nerves that sense pain, heat, and injury.
Peripheral arterial disease (PAD) – Limits blood flow to the feet, impairing healing.
Hyperglycemia – High blood sugar levels weaken immune response and tissue repair.
Poor foot care or footwear – Increases the likelihood of injuries that can lead to ulcers.
Left untreated, these ulcers can become infected, spread to bone tissue (osteomyelitis), and result in gangrene, sometimes requiring amputation.
Recognizing the Signs Early
One of the most important steps in treatment is early detection. Regular foot inspections should be part of every diabetic patient’s routine. Some key signs to watch for include:
Redness or swelling around a specific spot
Drainage on socks or footwear
Odor coming from the wound
Black tissue (necrosis) indicating severe tissue death
Pain (although many patients may not feel any due to neuropathy)
If any of these signs appear, immediate medical evaluation is critical. The earlier the ulcer is addressed, the better the chances for full recovery.
Step-by-Step Treatment for Diabetic Foot Ulcers
The goal is not only to close the wound but to treat the underlying causes and prevent recurrence.
1. Wound Assessment and Classification
Treatment begins with a clinical evaluation. Doctors assess:
Size, depth, and location of the ulcer
Presence of infection (e.g., cellulitis, osteomyelitis)
Circulation status using tests like Ankle-Brachial Index (ABI) or Doppler ultrasound
Glycemic control to understand how well diabetes is being managed
Wounds are often classified using the Wagner or University of Texas wound grading systems, which help guide treatment based on severity.
2. Blood Sugar Management
No wound can heal properly without stable blood sugar levels. Poor glycemic control slows the immune response, impairs white blood cell function, and prolongs inflammation. Strict glucose monitoring and medication adherence are essential.
Doctors may adjust insulin dosages or oral medications during the healing period and work closely with endocrinologists for optimal diabetes management.
3. Debridement: Cleaning the Wound
Methods of debridement include:
Enzymatic debridement – Applying topical agents to dissolve necrotic tissue.
Mechanical debridement – Using physical force, such as irrigation or wound dressings.
Debridement should be done regularly under the supervision of a wound care specialist.
4. Infection Control
Infected ulcers can spread rapidly, so infection management is a key part of treatment. This may include:
Topical antimicrobials like silver or iodine-based dressings
Systemic antibiotics for more advanced infections
Surgical intervention if an abscess, gangrene, or bone infection is present
Cultures are often taken to determine the exact bacteria involved and guide antibiotic selection.
5. Moisture Balance and Advanced Dressings
Keeping the wound moist—but not too wet—is essential for healing. Common types include:
Hydrocolloid dressings – Promote moist healing and protect the wound.
Foam dressings – Absorb excess drainage and cushion pressure points.
Alginate dressings – Ideal for heavily exuding wounds.
Antimicrobial dressings – Help reduce bioburden in infected or colonized wounds.
Wound dressings are typically changed every 1–3 days under medical supervision.
6. Offloading: Reducing Pressure on the Ulcer
Continued pressure delays healing and increases ulcer size.
Methods of offloading include:
Removable cast walkers – Easier for patients to manage at home.
Therapeutic footwear or orthotic inserts – Customized to minimize friction and shear.
Patients should avoid walking barefoot and follow all offloading recommendations.
7. Vascular Evaluation and Support
Poor circulation is a common issue in diabetic patients. If blood flow is insufficient, even the best treatments will fail. Vascular specialists may perform procedures such as:
Angioplasty or stenting to reopen narrowed arteries
Bypass surgery to restore blood flow
Hyperbaric oxygen therapy (HBOT) to enhance tissue oxygenation
Addressing circulation problems greatly improves the likelihood of ulcer closure and reduces the risk of amputation.
8. Grafting and Advanced Therapies
In some cases, standard treatments aren’t enough. Advanced therapies may be required to promote healing, such as:
Skin grafts or biological dressings (e.g., allografts, xenografts)
Negative pressure wound therapy (wound vacs) to promote granulation tissue
Stem cell therapy or platelet-rich plasma (PRP) to accelerate healing
These treatments are typically used for non-healing or complex ulcers.
Long-Term Prevention: Keeping Ulcers from Returning
Long-term prevention strategies include:
Daily foot inspections – Use a mirror or ask for help checking soles and between toes.
Routine podiatrist visits – For nail trimming, callus removal, and professional evaluations.
Proper footwear – Always wear shoes that fit well and provide protection and support.
Good hygiene – Keep feet clean and dry; moisturize dry skin but avoid excess between toes.
Smoking cessation – Smoking impairs circulation and healing.
Continued blood sugar management – Remain vigilant with diet, exercise, and medication.
Educating patients on foot care and creating a personalized prevention plan can drastically reduce the risk of future ulcers and complications.
Conclusion
Diabetic foot ulcers are serious, but they don’t have to lead to disability or amputation. With early detection, comprehensive care, and a proactive approach, most ulcers can heal completely and leave patients with a better understanding of how to care for their feet long-term.
From debridement and dressings to advanced therapies and offloading techniques, treating diabetic foot ulcers requires commitment from both healthcare providers and patients. It’s not just about healing a wound—it’s about restoring quality of life and preventing future complications.
If you or a loved one is living with diabetes, don’t wait for a small sore to become a big problem. Regular foot care and prompt attention can make all the difference.