What Are Diabetic Ulcers?
Diabetes makes you more likely to have sores and ulcers. Diabetes causes poor circulation and an increased risk of nerve damage and infection, which makes diabetic ulcers a serious complication. Ulcers are open sores (also referred to as wounds) on your skin that don’t heal the way they should. You’re most likely to get ulcers in your feet and legs, but they can also form in other areas, such as your hands or the folds of skin on your stomach.
What Causes Diabetic Ulcers?
There are several reasons why diabetes raises your odds of getting ulcers. One of the main symptoms of diabetes is high blood sugar (also called blood glucose). Over time, high blood sugar levels can damage your nerves and blood vessels. That lessens blood flow (especially to your hands, feet, and limbs), which makes it harder for sores and cuts to heal. It makes you more likely to get an infection, too. What’s more, diabetes is linked to a condition called peripheral arterial disease (PAD), which lessens blood flow to your legs and feet.
Nerve damage also makes it harder for you to feel pain or other symptoms of ulcers or infections. That can keep you from treating smaller wounds before they become ulcers.
Ulcers are dangerous because they can lead to serious infections or even gangrene, which is when your tissue dies. In some cases, the only way doctors can treat the infection or gangrene is to amputate (surgically remove) the affected area.
Stages of Diabetic Ulcers
Doctors type foot and toe ulcers by their size and how much they penetrate your skin. There are several grading systems for diabetic ulcers, including the Wagner Diabetic Foot Ulcer Grade Classification System detailed below:
- Grade 0: Your skin has no damage.
- Grade 1: The wound is shallow and only in the upper layers of the skin.
- Grade 2: The ulcer reaches deeper into the skin.
- Grade 3: The ulcer is so deep that a bone, joint, or tendon is visible.
- Grade 4: Your foot has partial necrosis, commonly known as gangrene (a condition where your skin tissue dies).
- Grade 5: Gangrene has infected your entire foot.
Diabetic Ulcer Symptoms
If a diabetic ulcer is beginning to develop on your skin, you may notice the following symptoms:
- Cracks
- Dryness
- Redness
- Scaliness
- Rashes
As your ulcer worsens, it can expand or deepen, sometimes with your bone being visible. An advanced ulcer may:
- Be calloused
- Have drainage (a sign of infection)
- Appear discolored
- Have a hard area at the center of the wound
- Have a foul smell
Common Locations for Diabetic Ulcers
If you have diabetes, you have a 25% greater likelihood of developing a skin ulcer due to poor circulation, trauma to the affected area, poor foot care, neuropathy, or common conditions such as callouses and cuts.
Diabetic foot ulcers
Foot issues are some of the most common and severe complications of diabetes, raising the risk of amputation by as much as 46%. Early detection of diabetic foot ulcers greatly reduces the risk of having your foot amputated. Sometimes, foot problems are caused by other diabetes-related conditions, such as peripheral neuropathy, but other times, even the shape of your foot may put you at risk.
Diabetic leg ulcers
Venous ulcers make up the majority of leg ulcers and are caused by poor circulation, typically the result of continuous high blood pressure. Your legs may feel tired, ache, or appear swollen with a venous ulcer, and the skin around your wound may appear darker. Diabetic leg ulcers usually form near your ankle bone and have irregular edges around them.
How to Treat Diabetic Ulcers
Diabetic foot ulcers treatment
If you do get an ulcer or notice a change in your skin that you’re not sure about, tell your doctor right away. It's important to heal your wound as soon as possible. The quicker your wound heals, the lower the risk of infection. Your doctor will also work with you to help keep your sore or ulcer from getting infected and becoming bigger.
The following steps can help you treat foot ulcers and avoid complications.
Keep your blood sugar in control. In addition to reducing your risk for ulcers, keeping your blood sugar in check helps your body heal existing ulcers.
Clean and dress your wound. Clean your ulcer daily with soap and water, unless your doctor recommends another cleanser. Don’t use hydrogen peroxide or soak your wound in a bath or whirlpool, as this could reduce healing and may boost your odds of infection. Keep your ulcer bandaged or covered with a wound dressing. (Your doctor may recommend specific bandaging steps, depending on the location of your ulcer.) While you may have heard that it’s important to “air out” wounds, experts now know that not covering a wound actually increases the odds of infection and slows healing.
Offloading. Keep pressure off your ulcer, especially if it’s on your foot. This “offloading” may mean you need to use crutches, special footwear, a brace, or other devices. Reducing pressure and irritation helps ulcers heal faster.
Topical medications. Use the topical medications your doctor recommends. (“Topical” means the medication goes on your skin.) These treatments may include saline, growth factors, and/or skin substitutes.
Antibiotic treatment. If your diabetic foot ulcer is uninfected, you usually don't need antibiotic treatment. However, if infection is present, your doctor will most likely put you on antibiotic therapy. For milder, non-life-threatening infections, an outpatient course of targeted oral antibiotics is recommended. Broad-spectrum antibiotics such as cilastatin, levofloxacin, ciprofloxacin, cefuroxime, and ampicillin have been shown to be effective against severe diabetic foot infections.
Debridement. It is a procedure that removes dead or infected tissue from your wound to expose healthy tissue and aid in healing. You may need to undergo this procedure more than once for diabetic foot ulcer management. There is also a daily ointment your doctor may prescribe for at-home debridement of tissue damaged by diabetic necrosis.
Treating Severe Diabetic Ulcers
If your wound doesn’t heal in about a month or becomes an infection that spreads to the bone, you may need other treatments.
Surgery
Surgery is most often performed to remove, correct, or shave bony protrusions such as bunions or hammertoes and to realign the bones in your foot to ease pressure there. If reduced blood flow to your lower limbs is complicating your diabetes, a vascular surgeon may perform a procedure to improve your circulation. If your diabetic ulcer forms gangrene and your tissue dies, your doctor may have to surgically remove (amputate) your foot or another area of your body.
Hyperbolic oxygen therapy
Hyperbolic oxygen therapy involves breathing pure oxygen in a chamber or a special room to help your body heal. The oxygen is delivered under a pressure that equals a force on the body equivalent to about 33 to 42 feet of water for 60-90 minutes. You may receive these treatments daily for a month or more.
Human skin equivalent (HSE) treatment
With this treatment, doctors use a substance that mimics skin that's placed around the edges of a diabetic ulcer to promote healing.
Tips to Prevent Diabetic Ulcers
There’s a lot you can do to lower your chance of having ulcers in the first place:
Keep your blood sugar in check. Good blood sugar control is the single best way to prevent small cuts and sores from becoming ulcers. If you have trouble managing your blood sugar, tell your doctor. They can work with you to make changes to your medication and lifestyle that will keep your blood sugar from getting too high. Even if your blood sugar level is fairly steady, it’s still important to see your doctor regularly. That’s especially key if you have neuropathy because you may not feel damage to your skin and tissue.
Check your skin every day, and pay special attention to your feet. Look for blisters, cuts, cracks, sores, redness, white spots or areas, thick calluses, discoloration, or other skin changes. Don’t rely on pain; even feeling more warmth or cold than usual can be a sign that you have an open wound on your skin. It’s also possible that you may feel nothing at all.
Ulcers are most likely to form on the ball of your foot or the bottom of your big toe, so be sure to check your feet every night. (Ask a family member to help you if you can’t check on your own.) If you notice a problem, or you aren’t sure if something’s normal, call your doctor.
Try to quit smoking. Smoking damages your blood vessels, decreases blood flow, and slows healing. All raise your risk of ulcers and amputation.
Wear sturdy and protective shoes. Injuring your toes or feet can raise your chances of serious problems. Wearing shoes that cover your whole foot can help prevent injury. Medicare and health insurance may cover prescription shoes that lessen your risk of foot sores.
Takeaways
People with diabetes have an increased risk of sores and infections, especially of the feet. It's important to check your feet daily to observe any changes, keep your toenails trimmed, and wear well-fitting socks and shoes to avoid rubbing. Wash your feet and dry them thoroughly each day and have your doctor check your feet at every visit. Untreated or severe ulcers on feet can cause serious complications, such as gangrene, which may lead to amputation or even death.
Diabetic Ulcers FAQs
What causes diabetic ulcer?
Uncontrolled blood sugar levels can lead to poor circulation or nerve damage in the foot — diabetes-related neuropathy. Neuropathy makes it hard to feel a wound or sore on your feet. Wounds may become infected, and poor blood flow can slow healing.
Why do people with diabetes get sores on their feet?
Diabetes-related neuropathy can make feet numb, tingling, or painful and make it hard to notice small wounds. People with diabetes have a higher risk of infection because of the inflammation and weakened immunity that come from the disease. These types of complications of diabetes can slow wound healing.
How can you tell if you have a diabetic ulcer?
Check your feet for any changes to your skin or toenails such as blisters, calluses, or cuts. Symptoms vary, but other conditions to watch for in your feet include:
- Bleeding
- Pus
- Pain
- Change in color
- Swelling
- Odor
What is the best practice for diabetic foot ulcers?
The best practice is to prevent them:
- Keep your blood sugar levels in check.
- See your diabetes doctor regularly and ask them to check your feet when you do.
- Check your feet and between your toes daily for any changes.
- Protect your feet from extreme temperatures inside and outside.
- Keep your feet elevated and move them often when sitting to increase blood flow.
- Wash your feet daily and dry them thoroughly, putting moisturizer on their tops and bottoms (but not between your toes).
What medication is used for diabetic ulcers?
Your doctor may give you topical ointments or special coverings to apply to your wound. If you have an infection, you may be prescribed oral or intravenous antibiotics.
Are there lifestyle changes that can prevent diabetic ulcers?
Avoid smoking, as it can damage your blood vessels and impact circulation in your feet. Keep shoes on (or slippers indoors) to prevent any injury to your feet. Losing excess weight can help lessen pressure on your feet and help manage your diabetes.
