Nearly half of the patients with diabetes experience some form of nerve damage to the feet and legs and around 15% will progress to develop foot ulcers (defined as an open wound or sore on the foot).   Common risk factors for ulcer formation include diabetic peripheral neuropathy, structural foot deformity and peripheral arterial disease.  Foot complications are one of the most frequent reason for hospitalisation in patients with diabetes, accounting for up to 25% of all diabetic admissions.

Texas Classification of Foot Ulcer

Grade	Stage A	Stage B	Stage C	Stage D
0	Pre or post ulcer completely epithelialised	With infection	With Ischemia	With both Infection & Ischemia
1	Superficial wound NOT involving tendon, capsule, bone or joint	With infection	With Ischemia	With both Infection & Ischemia
2	Wound penetrating tendon or capsule	With infection	With Ischemia	With both Infection & Ischemia
3	Wound penetrating joint or bone	With infection	With Ischemia	With both Infection & Ischemia

Treatment

The good news is that most serious complications of diabetic foot ulcers can be prevented or delayed with an appropriate care plan.  The goal in foot ulcer treatment is to get complete healing as fast as possible to prevent secondary infection.  Treatment involves;

• Prevention and control of wound infection.  Antibiotics may be necessary if there is infection at the ulcer site
• Taking the pressure off the ulcer or pressure sore (known as ‘off-loading’)
• A healthy diet can promote wound healing.  Nutrients such as protein, iron, calcium and vitamins A, C, E and K may help with skin and tissue repair
• Regular wound dressings to the ulcer

Click to view Michigan Medicine video on Diabetic Foot Ulcer

Surgery Options

Most foot ulcers can heal with treatment by your doctors and podiatrists.  However, some may require surgery and include;

• Wound debridement and/or removal of granulation or infected tissue
• Treatment of limb ischemia
• Shaving or excision of any bunions or bony protrusions
• Surgical correction of any bony deformities
• Amputation

Prevention

Careful attention to foot care and avoiding unnecessary injuries are key to preventing ulcer formation.  Minor foot injuries (such as cuts, scrapes or blisters) should be washed gently with soap and water.  Patients should avoid soaking in hot water or using strong solutions such as hydrogen peroxide or iodine (Betadine).  All diabetes patients are recommended to keep good control of their diabetes and to see their healthcare professionals regularly to prevent any diabetic related complications.  These include;

• Regular monitoring of their blood glucose
• Eating diabetic friendly diet
• Checking your foot on a regular basis
• Taking good care of your feet

See your Vascular or Orthopaedic Surgeon, Nurse or Podiatrist for treatment advice

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