Diabetic Foot Ulcer

By: Bunmi Akindipe

A diabetic foot ulcer is an open wound that occurs in approximately 15% of patients with diabetes mellitus and is commonly located on the bottom of the feet or toes. The ulcer may be round or oval in shape and maybe surrounded by red or discolored skin. The sore may be shallow or deep, and it may be painful to touch. It can occur when the blood glucose level remains too high. Over time, this can damage the blood vessels and nerves in the feet, making foot ulcer more likely.

  • Swelling.
  • A change in color and temperature of the feet thickened, yellow toe nails, drainage or blood on the socks or in the shoes.
  • Fungus infections such as athletes’ foot between toes
  • Slow to heal sore, foul smelling odor from the foot.
  • Infection corn or ingrowing toe nails
  • Cracks between toes.

    Grade 1 – superficial diabetic ulcer
    Grade 2 – ulcer extension to ligament, tendon, joint caps or deep fascia without abscess or bone infection.
    Grade 3 – deep ulcer with abscess, bone infection or joint sepsis.
    Grade 4 – gangrene localized to portion of forefoot or heel.


This can be done in 2 ways:

Lifestyle modification
Self-foot care modification

This involves altering long term habits typically of eating, physical activity, and maintaining a new behaviour for months or years such as;
Healthy diet – make every meal well balanced as much as possible, plan for every meal to have a good mix of carbohydrates, fruits, vegetables, food high in lean proteins, fiber and legumes and low in saturated fats food should contain minerals such as iron, copper, zinc, necessary for the body tissue to grow.
Regular exercise: taking two and a half hours each week of moderate intensity physical activity or one hour 15 minutes of high intensity exercise helps the insulin work more effectively, lower blood pressure and reduces the risk of heart disease.
Examples of such are: Moderate intensity which include brisk walking cycling on relatively flat terrain

Vigorous physical activity includes jogging, football and skipping.

Self-foot care practices
Making right choices of shoes
Getting shoes that fit well is very important because shoes that are too tight or too big can cause problem to the feet.
Shoes must be of right length, width and depth. The length should be a thumb width longer than the longest to.
When you want to get your shoe, it is better to go to the market in the late afternoon because most people’s feet are a bit bigger in the afternoon and evening. Avoid shoes with a narrow toe-box, too tight or high heeled.
Avoid thong sandals and slippers as they may cause injury if not well fitted.
Shoes should be adjustable, choose leather, canvas or suede styles to allow adequate circulation of air.
Ensure the inside of the shoe has a foot bed that is wide and made with shock absorbing materials.
When buying shoes, ensure your toes can move inside them. This prevents toes rubbing against each other, and developing foot problems.
Do not wear socks that are too tight because they will cut into the leg or ankle.
Avoid oversized socks that fall down the ankle the ankle area bunch up in the shoes.
Avoid socks that have seams as they can cause rubbing or irritation that can lead to a blister or callus.
Always inspect your feet daily.
Bathe feet in lukewarm water daily using a soft wash clothe or sponge and keep in-between toes dry.
Moisturize your feet but not in-between toes
Cut nails carefully using nail clippers or nail files. Never use a razor blade. Never walk barefoot, even at home. Shake your shoes and feel the inside before wearing. You must also ensure you protect your feet from hot and cold temperatures. last but not the least, make sure you do not put your feet into hot water.


Foot ulcers can be serious complications of diabetes without immediate care, diabetes foot ulcers can put you at risk of losing your foot, they’re treatable, especially when caught early. When you notice any changes in your feet, contact your care provider.
Foot ulcer is best managed by keeping blood sugar as close to normal as possible and inspect your feet every day. This helps to prevent the ulcer from getting worse.

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