As a Indianapolis podiatrist that specializes in diabetic foot care and wound care, I often get asked by patients as well as by family & friends, what does a foot ulcer look like? And why do people with diabetes develop foot ulcers?
A foot ulcer is an open sore. These can be superficial such as a blister that has opened with underlying pink raw tissue exposed or an ulcer can be deep and extend down to the bone. Some ulcers are infected and drain heavily while some have very little or no drainage. An ulcer may or may not be painful. People develop foot ulcers for many different reasons and you don’t need to have diabetes to develop a foot ulcer. Pressure, trauma, and poor circulation can all lead to foot ulcers.
A diabetic with a red open sore on the bottom of their foot generally surrounded by a callus has a diabetic foot ulcer. A diabetic foot ulcer, also called a neuropathic ulcer, occur most often on the bottom of the foot over a bony prominence. Ulcers can also develop on the sides of the foot or tops of the toes from friction and pressure of shoes or from poor circulation. For example, a person with diabetes develops a callus on the bottom of their foot. A callus is a build-up of skin due to increased pressure on the foot. Left untreated or, often when self-treated, the callus becomes infected or breaks down into an ulcer. The callus and the eventual ulcer many times go left untreated because a diabetic patient lacks feeling called neuropathy and is unaware that the ulcer is present. This is why you often hear that diabetics should check their feet daily and see a foot doctor routinely. Or the person may be aware of the ulcer but because it is not painful they do not seek immediate treatment.
Once an ulcer is discovered it is imperative that professional treatment is received quickly. Postponing treatment or trying to treat the ulcer on your own can lead to worsening of the wound, infection and even amputation.
Treatment of diabetic ulcers will vary. Treatment often consists of debridement of the wound – removing any nonviable tissue and callus from the wound so that healthy tissue is exposed and can start to heal. Often an ulcer will bleed when debrided. This is generally done purposefully because blood is what brings the oxygen and nutrients to the tissues to help them heal. Another important aspect in the treatment of ulcers is to eliminate pressure. Often times for diabetic ulcers, a patient will need to wear a special boot or cast to offload pressure on the bottom of the foot to allow the ulcer to heal. There are also many different wound care products that can be applied to the wound and therapies that can be implemented to help with wound healing. Treatment will differ from patient to patient due to the many variables that come in to play such as severity of the ulcer, presence of infection, health of the patient, etc.
Those with diabetes should check their feet daily using a mirror if they are unable to bend to see the bottom of their feet. Any discolored area or open area should be brought to the attention of your doctor or wound care specialist immediately.