A diabetic foot ulcer is not a small problem. It’s one of the most serious foot complications a person with diabetes can face, and it is also one of the most preventable when the right care is in place. Left untreated, a foot ulcer can lead to infection, hospitalization, and in severe cases, amputation. Caught early and managed by the right care team, it can heal and be prevented from coming back.
This guide walks through what diabetic foot ulcers are, why they form, what the earliest warning signs look like, and how routine foot care protects you from ever developing one. At Hillside Medical Group, diabetic foot care is a coordinated effort across our network, connecting the diabetes management your primary care physician provides with the specialized foot care available at our podiatry practice.
What Is a Diabetic Foot Ulcer?
A diabetic foot ulcer is an open sore or wound, most commonly found on the bottom of the foot, that develops in a person with diabetes. It can start from something as small as a blister, a callus that broke down, or a scrape you did not feel at the time.
The numbers on how common this is are sobering. About 12% of people with diabetes will develop a foot ulcer during their lifetime, according to the CDC (Centers for Disease Control and Prevention). And when foot ulcers become infected and do not heal, the consequences are serious. The CDC also reports that 80% of lower-limb amputations in the United States are related to diabetes.
Here is what makes these wounds unique to diabetes: they combine three things at once. Reduced sensation in the foot, which means an injury may go unnoticed. Reduced circulation, which means the wound heals slowly. And high blood sugar, which makes the body less able to fight off infection. When all three are present, a small problem becomes a big one quickly.
Why Diabetic Foot Ulcers Develop
Understanding how ulcers develop is the first step in preventing them. The main risk factors, as identified by the CDC, work together in a cascade.
Nerve damage in the feet
Long-term high blood sugar can damage the nerves in the feet, a condition known as diabetic peripheral neuropathy. The National Institute of Diabetes and Digestive and Kidney Diseases reports that about one-third to one-half of people with diabetes have peripheral neuropathy. When your feet lose sensation, you may not feel a pebble in your shoe, a hot floor, or a small cut. That is often where an ulcer begins.
Poor circulation
Diabetes also increases the risk of peripheral artery disease, which reduces blood flow to the legs and feet. When less oxygen rich blood reaches an injured area, healing may be delayed and the risk of complications may increase.
Your healthcare provider may check the pulses, temperature, color, and skin condition of your feet. If poor circulation is suspected, additional testing such as an ankle-brachial index or Doppler ultrasound may be recommended
Uncontrolled blood sugar
Consistently elevated blood glucose can interfere with immune function and slow the body’s ability to repair damaged tissue. Managing diabetes effectively is therefore an important part of protecting the feet and helping wounds heal
Pressure points and foot deformities
Areas of the foot that carry repeated pressure, such as under a callus or over a bunion, are common ulcer sites. When neuropathy prevents you from feeling that pressure, the skin can break down before you realize anything is happening.
Early Warning Signs You Should Never Ignore
Many people search for pictures of what diabetic feet look like in the beginning stages, hoping to compare what they see. The truth is that the earliest signs are often felt more than seen, and some show up before there is ever a visible wound.
Changes in how your feet feel
- Tingling or a “pins and needles” sensation in the toes or soles
- Numbness, or a feeling that your feet are wrapped in a thin sock
- Burning pain, especially at night
- Loss of the ability to sense hot or cold accurately
Changes in how your feet look
- Dry, cracked skin, particularly on the heels
- A change in the color of one or both feet
- A change in skin temperature, feeling unusually warm or unusually cool
- Calluses that keep forming in the same spot
- Toenails that thicken or change color
- The shape of your foot slowly shifting over time
Signs that something has already started
- A blister, sore, or crack in the skin that will not close
- Redness, warmth, or swelling around a small wound
- Drainage or a bad smell
- Dark patches on the skin
If you notice any of the signs on the last list, do not wait. Contact your primary care provider or a podiatrist the same day. The CDC’s guidance on diabetic foot problems is clear: catching these early is what changes outcomes.
Diabetic Foot Care: What Routine Prevention Looks Like
Prevention is not complicated, but it is a daily commitment. A short routine at home, combined with regular professional care, is what stops most ulcers before they start.
Your daily home routine
- Look at your feet every day. Check the tops, bottoms, and between the toes. Use a mirror if you cannot reach.
- Wash daily in lukewarm water, never hot. Dry thoroughly, especially between the toes.
- Moisturize the tops and bottoms of your feet, but not between the toes, where moisture invites infection.
- Trim toenails straight across. If you cannot see or safely reach your feet, ask for help.
- Never go barefoot, even at home. A splinter, a dropped object, or a hot floor can cause an injury you may not feel.
- Check your shoes for pebbles, tears, or rough seams before putting them on.
- Wear diabetic-appropriate socks and shoes that reduce pressure and friction.
- Do not treat corn, calluses, or ingrown toenails at home. These belong in a podiatrist’s office.
Your professional care schedule
Professionals recommend that a basic foot check happen at every primary care visit. Beyond that, a comprehensive foot exam should happen at least once a year through specialized diabetic foot care. If your blood sugar has been difficult to control, or if you have existing foot problems, that comprehensive exam should happen every three to six months instead.
What Happens When You Do Develop an Ulcer
a foot ulcer has already formed, it should be evaluated promptly by a healthcare professional. Diabetic foot ulcers should not be treated like ordinary cuts with over the counter creams or bandages alone. Until you are evaluated, keep the area clean and protected and avoid putting unnecessary pressure on it. Do not apply harsh antiseptics or attempt to cut away calluses or damaged tissue yourself.
Treatment depends on the ulcer’s depth, location, circulation, pressure exposure, and whether infection is present. Care may include cleaning the wound, removing dead or unhealthy tissue, a procedure called debridement and applying an appropriate wound dressing. Special footwear, an orthotic device, a cast, or a walking boot may be used to reduce pressure on the wound. This is known as offloading and is one of the most important parts of healing many diabetic foot ulcers.
Antibiotics are prescribed only when there are clinical signs of infection; they do not help an uninfected ulcer heal. If infection is suspected, the provider may obtain imaging, laboratory testing, or a tissue specimen and prescribe antibiotics based on the severity and likely organism. Circulation testing may also be needed when reduced blood flow is suspected. Surgery is sometimes necessary to drain an infection, remove infected or nonviable tissue or bone, restore circulation, or correct a structural problem contributing to repeated pressure.
Pain management may also be included in the care plan. However, neuropathy can reduce sensation, so a serious ulcer may cause little or no pain.
Even after an ulcer heals, recurrence remains common. The pressure points, neuropathy, footwear problems, or circulation issues that contributed to the first ulcer may still be present. Continued foot surveillance, appropriate footwear, and follow-up with the care team are therefore important.
When to See a Doctor: Do Not Wait on These Signs
Some signs need attention today. Others can wait until the next available appointment. Knowing the difference protects your feet.
Get same-day medical attention if you have:
- Any open sore, cut, or blister on your foot
- Redness, warmth, or swelling that is spreading
- Pus, drainage, or a foul odor
- A change in the color of your foot, especially dark, blue, or bright red patches
- Sudden numbness or loss of sensation
- A wound that has not started healing after a few days
- Foot pain that came on quickly and will not settle
Schedule an appointment soon if you have:
- New tingling, burning, or shooting sensations
- A slow change in the shape of your foot
- Persistent dry, cracked skin
- A callus that keeps coming back in the same place
- Difficulty feeling temperature
If anything on the first list applies, call your primary care provider or book a podiatrist appointment at Podiatry of SA the same day. If you are unsure whether what you are seeing is urgent, err on the side of calling. It is always easier to hear that something is fine than to catch it too late.
How Hillside’s Coordinated Network Handles Diabetic Foot Care
Diabetic foot care often requires collaboration among primary care, podiatry, wound care, vascular specialists, and in more complicated cases infectious disease or surgical specialists.
Your primary care team at Hillside Primary Care manages your diabetes and related health conditions, performs routine foot screening, and helps identify risk factors such as neuropathy, poor circulation, and difficulty controlling blood glucose.
A podiatrist at Podiatry of SA can provide comprehensive foot examinations, evaluate calluses and nail problems, identify pressure points or deformities, recommend appropriate footwear, and manage foot wounds when needed.
When circulation problems are suspected, further evaluation may include an ankle-brachial index, Doppler testing, or referral for vascular assessment. Advanced imaging or surgery may also be recommended when necessary.
Because Hillside Primary Care and Podiatry of SA are part of the same medical group, their teams can coordinate referrals and treatment planning, helping patients move more smoothly between primary and specialty care.
FAQs:
Q1. What is the first sign of a diabetic foot ulcer?
Ans: An ulcer may begin as a blister, crack, red area, blood stained callus, or small wound that does not heal normally. Because neuropathy can reduce pain sensation, visible changes may be more important than how the foot feels. A person with diabetes who develops an open foot wound should contact a healthcare professional promptly.
Q2. Can diabetic foot ulcers heal on their own?
Ans: A diabetic foot ulcer should not be left untreated in the hope that it will heal on its own. Neuropathy, repeated pressure, infection, and in some patients poor circulation can interfere with healing. Professional evaluation is needed to determine the appropriate wound care, pressure relief, infection treatment, and circulation assessment.
Q3. How often should a person with diabetes see a podiatrist?
Ans: People with diabetes should generally receive a comprehensive foot examination at least once a year. A basic foot check should also be performed during routine healthcare visits. People with neuropathy, peripheral artery disease, foot deformities, calluses, or a history of ulceration or amputation need more frequent examinations. The appropriate schedule should be determined by the person’s individual risk level. CDC guidance
Q4. Can diabetic foot ulcers be prevented?
Ans: The risk of diabetic foot ulcers can often be reduced through daily foot inspection, properly fitted footwear, regular professional foot examinations, management of blood glucose and cardiovascular risk factors, and early treatment of calluses, blisters, or other skin problems. However, no prevention strategy can guarantee that an ulcer will never develop.
Q5. Do diabetic foot ulcers come back after they heal?
Ans: Yes. Recurrence is common because neuropathy, pressure points, deformities, or circulation problems may remain after the skin closes. Continued monitoring, protective footwear, pressure reduction, and podiatry follow-up can help lower the risk.
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