What Causes a Diabetic Foot Ulcer and How to Prevent One

A diabetic foot ulcer is the most common long-term complication of diabetes. It results from nerve damage and poor blood flow caused by high blood sugar levels.  Since peripheral neuropathy can cause numbness, someone with diabetes might not feel a foot injury, cut or even a blister, which can turn into an open wound or ulcer (Ulcers form when skin tissue breaks down exposing the layers underneath.). Once peripheral neuropathy develops, the annual incidence of ulcer formation increases from less than one percent to greater than 7%.[1]

Left untreated due to diminished sensation, a diabetic foot ulcer can get worse over weeks or months without someone knowing because they do not feel the pain. In the initial stages, a diabetic foot ulcer can be treated successfully, increasing the chance of a full recovery.

However, in advanced stages, the risk of complications like a foot or limb amputation are high. 

Diabetic foot ulcers account for more [hospital} admissions than any other complication of diabetes. [2] Statistics indicate that approximately 25% of diabetic individuals will develop an ulcer at some point in their lives, with a concerning 50% of those cases progressing to amputation.[3]

The earliest signs of a diabetic foot ulcer include:[4]

• Swelling
• Warmth or redness of the foot
• Skin discoloration
• Drainable or blood on your socks or in your shoes
• Foul-smelling odor coming from the foot
• A tender spot on your foot

Know the stages of a diabetic foot ulcer

Doctors use classification and scoring system to determine the severity of a diabetic foot ulcer and determine proper diabetic foot ulcer treatment. There are several classification systems, but the Wagner Ulcer Classification System is used most often. It uses six grades (0 to 5) that focus on the depth of the ulcer penetration, the extent of the tissue necrosis, and the presence of infection and inflammation of the bone or osteomyelitis (OM).

The Wagner Scale[5]

• Wagner Grade 0: Although, there is no open wound, there may be potential risk factors, such as calluses, redness or swelling, often accompanied by neuropathy. Prevention involves proper foot care and relieving pressure to prevent an ulcer from developing.
• Wagner Grade 1: A superficial ulcer that has not moved beyond the surface layers of the skin. Diabetic foot ulcer treatment focuses on removing dead tissue (debridement), controlling infection, and relieving pressure to promote healing.
• Wagner Grade 2: Deep ulcer extended to ligament, tendon, or joint capsules. At this stage, foot ulcer treatment is more aggressive. Surgery may be necessary to remove infected or damaged tissue.
• Wagner Grade 3: The wound is critical stage since it penetrates the bone and can be accompanied by signs of infection or bone inflammation. The foot ulcer treatment includes antibiotics, surgical removal of the nonviable tissue, and potential bone reconstruction.
• Wagner Grade 4: Partial-foot gangrene. At this stage, there is tissue death in a specific area of the foot. Intervention is urgent, and usually involves specialized wound care, restoring blood flow in blocked arteries and veins, and potentially amputation to prevent further loss of tissue.
• Wagner Grade 5: Whole-foot gangrene. This stage, damage from infection is severe throughout through the foot, requiring amputation.

Understand the factors that lead to a diabetic foot ulcer:

While having diabetes increases your chance of getting a diabetic foot ulcer, other factors that can increase the risk include:

• Poorly fitted or poor-quality shoes
• Poor hygiene (not washing regularly or thoroughly or not drying feet well)
• Improper toenail trimming
• Alcohol consumption
• Eye disease caused by diabetes
• Heart and kidney disease
• Obesity
• Tobacco use (inhibits blood circulation)

Prevention for foot problems

Considering the high risk of getting a diabetic foot ulcer if you have diabetes, prevention is crucial. Proper foot care includes:

• Check your feet daily.
• Put feet up when sitting.
• Trim nails carefully and treat corns and bunions with special care.
• Avoid extreme hot and cold on your feet.
• Take short lukewarm baths or showers and try not to scrub too hard when bathing or showering. Use a gentle cleanser. Do not rub skin; blot it dry.
• Use mild soaps. Fragrance free soaps to avoid irritations.
• Make sure to dry your skin everywhere after washing. Dry well patting gently.
• Use a humidifier during winter to add moisture back into the air.
• Moisturize your skin. Best to moisturize right after shower or bath to lock water into your skin.

To keep feet from getting dry and cracked, which can lead to infections, consider products such as EASE-Z Diabetics’ Dry Skin Therapy Foot Cream. It is an over-the-counter (OTC) offering that uniquely features active Zinc Acetate to relieve and protect dry, cracked skin associated with diabetes. EASE-Z Diabetics’ Dry Skin Therapy Foot Cream covers feet with a thick protective layer that penetrates to provide real, long lasting-relief.  It is unscented and non-greasy for added comfort. Daily use gives superior recovery and continuous relief, assuring long-lasting comfort.

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#diabeticfoot ulcer #diabetes #diabeticfoot #diabeticfoot care

[1] “Diabetic Food Infections,” STATPearls, Accessed December 25, 2023. https://www.statpearls.com/articlelibrary/viewarticle/20441/

[2] Oliver TI, Mutluoglu M. Diabetic Foot Ulcer (archived) [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537328/

[3] Wagner Scale for Diabetic Foot Ulcers,” Diabetes Management Plus, Accessed August 16, 2024. https://www.diabetesmanagementplus.com/wagner-scale-for-diabetic-foot-ulcers/

[4] Anderson, Bernadette, MD, MPH, The Stages of a Diabetes Foot Ulcer: Why You Shouldn’t Wait to Seek Treatment,” GoodRX Health, April 21, 2023. https://www.goodrx.com/conditions/diabetes/diabetes-foot-ulcer-stages

[5] Wagner Scale for Diabetic Foot Ulcers,” Diabetes Management Plus