Diabetic Foot Ulcers

Diabetic foot ulcers are open sores that typically develop on the bottom of the foot in people with diabetes. They are a serious complication caused by nerve damage (neuropathy) and poor circulation (peripheral vascular disease), which means even a small cut can become a non-healing wound.

According to the CDC, diabetes is the leading cause of non-traumatic lower limb amputations in the United States, but most amputations are preventable with proper diabetic foot care. At Mountain Spine & Orthopedics, our multidisciplinary wound care team combines advanced diagnostics with evidence-based therapies to heal ulcers quickly and protect limb health.

Early recognition of diabetic foot ulcers is critical because they may be painless due to neuropathy.

• Open sore or wound on the foot (often on the bottom)
• Drainage from the wound (clear, bloody, or pus)
• Swelling, redness, or warmth around the wound
• Foul odor indicating infection
• Black tissue (eschar) around the edges
• Discolored skin
• Pain (when present) may indicate deep infection
• Fever or chills with infection

Important: Due to nerve damage, these ulcers are often painless—daily foot inspection is essential.

• Poor blood sugar control: High glucose impairs healing
• Previous foot ulcers: History increases recurrence risk
• Peripheral neuropathy: Loss of protective sensation
• Peripheral artery disease: Poor circulation
• Duration of diabetes: Longer duration increases risk
• Foot deformities: Bunions, hammertoes, Charcot foot
• Improper footwear: Shoes that cause pressure points
• Smoking: Impairs circulation and healing

Diagnosis involves thorough examination of the foot to assess the ulcer's size, depth, and location, and check for signs of infection. We classify ulcers using the Wagner or University of Texas grading systems.

• Neurological exam: Monofilament testing for sensation
• Vascular assessment: Pulses, ankle-brachial index (ABI)
• X-ray: Check for bone infection (osteomyelitis)
• MRI: Detailed soft tissue and bone evaluation
• Wound culture: Identify infecting organisms

Treatment is multifaceted, aiming to promote healing, prevent infection, and save the limb.

Wound Care

• Off-loading: Total contact casts, removable boots, or custom orthotics to reduce pressure
• Debridement: Removal of dead tissue to promote healing
• Advanced dressings: Moisture-retentive, antimicrobial, or growth factor dressings
• Negative pressure therapy: VAC devices for complex wounds

Infection Management

• Antibiotics: Targeted based on culture results
• Surgical debridement: For deep infection or osteomyelitis

Vascular Intervention

For poor circulation, procedures to restore blood flow may be necessary.

Our comprehensive diabetic foot care program addresses all aspects of wound healing.

A significant concern with diabetic foot ulcers is that they are often painless due to diabetic neuropathy. This lack of pain signals means an ulcer can develop and worsen without the individual being aware. Any new pain in the foot of a person with diabetes should be evaluated promptly as it could indicate deep infection or osteomyelitis.

Most diabetic foot ulcers and amputations are preventable—consistent daily care makes all the difference.

• Inspect feet daily: Check for cuts, blisters, redness, or swelling
• Never go barefoot: Even at home
• Wear proper footwear: Diabetic shoes with custom insoles
• Keep feet clean and dry: Wash daily, dry thoroughly between toes
• Moisturize: But not between the toes
• Trim nails carefully: Or have a professional do it
• Control blood sugar: Tight glycemic control is essential
• Don't smoke: Smoking impairs circulation
• Regular foot exams: At least annually by a specialist

For individuals with diabetes, any foot wound or unusual change requires immediate professional attention. Contact Mountain Spine & Orthopedics without delay to arrange an evaluation and receive timely, comprehensive wound care.