Diabetic Foot Ulcers

Last Updated: September 21, 2022

Diabetic complications commonly include decreased sensation in the feet and impaired wound healing. Damage to the feet often goes unnoticed and can cause ulcerations.

Diabetic Foot Ulcers falls under theDiabetes & Blood Sugarcategory.

What are diabetic foot ulcers?

People with poorly controlled diabetes usually experience decreased foot sensation and impaired wound healing. As a result, they may develop foot ulcerations that are painless and heal poorly. The lifetime incidence of diabetic foot ulcers in people with diabetes is 19%–34%.[1]

What are the main signs and symptoms of diabetic foot ulcers?

Ulcerations typically develop on the weight-bearing areas of the foot, such as the heel or metatarsal head (also known as the ball of the foot).[2] These ulcerations look round and crater-like. In severe cases, they may ooze and bleed.

How are diabetic foot ulcers diagnosed?

A clinician will assess the ulcer by looking at its length, width, depth, and accompanying drainage as well as looking for signs of infection or ischemia (i.e., cell death due to decreased blood supply).

There are several classification systems for diabetic foot ulcers. Some commonly used ones are the University of Texas (San Antonio), Wagner-Meggitt, PEDIS, and SAD classifications.[3]

What are some of the main medical treatments for diabetic foot ulcers?

The main treatments include wound debridement (removing dead skin and tissue), moist wound dressings, reducing weight on the ulcer (via orthotics or shoe changes), antibiotics to combat infections, and controlling blood sugar levels (poorly controlled blood sugar can impair wound healing).[4]

Have any supplements been studied for diabetic foot ulcers?

Magnesium, Vitamin E, Zinc, Arginine, omega-3 fatty acids, Vitamin D, protein, and probiotics have been studied for diabetic foot ulcers, but there is no strong evidence that any of these supplements are beneficial.[5]

How could diet affect diabetic foot ulcers?

Because there is limited evidence on diet and diabetic foot ulcers, the American Limb Preservation Society (ALPS) recommends a diet with adequate fluids, energy, protein, carbohydrates, fat, and micronutrients (i.e., Zinc, Vitamin C, Vitamin D, and Vitamin E) to facilitate proper wound healing. People with diabetic foot ulcers, like other wound patients, have higher energy and macronutrient needs. The ALPS guidelines therefore recommend foods rich in the aforementioned micronutrients with an intake of 30–35 kcal per kilogram of body weight, 1.25–1.5 grams of protein per kilogram of body weight, and 25-35 mL of fluid per kilogram of body weight daily. Carbohydrate and fat intake should be individualized to the person’s current level of diabetes control while supporting their overall energy needs.

What causes diabetic foot ulcers?

The development of diabetic foot ulcers is multifactorial. Since poorly controlled diabetes can cause nerve damage, the resulting neuropathy (dysfunction of peripheral nerves) causes foot deformities, dry skin, and decreased sensation. Moreover, diabetes can impair the body’s ability to heal. As a result, a callus (thickened skin) develops. Over time, constant pressure on that callus damages the skin, producing an ulcer.[1]

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  1. ^Armstrong DG, Boulton AJM, Bus SADiabetic Foot Ulcers and Their Recurrence.N Engl J Med.(2017-06-15)
  2. ^Oliver TI, Mutluoglu MDiabetic Foot UlcerStatPearls.(2022-05)
  3. ^Amin N, Doupis JDiabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities.World J Diabetes.(2016-Apr-10)
  4. ^Everett E, Mathioudakis NUpdate on management of diabetic foot ulcers.Ann N Y Acad Sci.(2018-01)
  5. ^Moore ZE, Corcoran MA, Patton DNutritional interventions for treating foot ulcers in people with diabetes.Cochrane Database Syst Rev.(2020-07-17)
Examine Database References
  1. Diabetic Foot Ulcers Symptoms - Purandare H, Supe AImmunomodulatory role of Tinospora cordifolia as an adjuvant in surgical treatment of diabetic foot ulcers: a prospective randomized controlled studyIndian J Med Sci.(2007 Jun)
  2. Diabetic Foot Ulcers Symptoms - Carvalho AF, Feitosa MC, Coelho NP, Rebêlo VC, Castro JG, Sousa PR, Feitosa VC, Arisawa EALow-level laser therapy and Calendula officinalis in repairing diabetic foot ulcers.Rev Esc Enferm USP.(2016)
  3. Wound Healing - Halschou-Jensen PM, Sauer J, Bouchelouche P, Fabrin J, Brorson S, Ohrt-Nissen SImproved Healing of Diabetic Foot Ulcers After High-dose Vitamin D: A Randomized Double-blinded Clinical Trial.Int J Low Extrem Wounds.(2023-Sep)