At a glance
What it is
A breakdown of skin tissue on the foot that exposes the layers underneath — a common complication of poorly controlled diabetes, most often under the big toe or the ball of the foot.
Why it matters
An untreated infected ulcer can extend to the bone, and in neglected cases can lead to amputation. Any foot pain or discomfort in a person with diabetes should be discussed with a doctor.
How we treat it
A three-part plan — blood sugar control, treating infection, and physiotherapy — combined for the best chance of healing.
Overview
Foot ulcers are a common complication of poorly controlled diabetes. They form as the skin tissue breaks down and exposes the layers underneath. They are most common under the big toe and the ball of the foot, and if left untreated they can extend all the way to the bone.
Any person with diabetes can develop foot ulcers and foot pain, but good foot care can help prevent them. Treatment depends on the cause, so discuss any foot pain or discomfort with your doctor — an infected sore can lead to amputation if it is neglected.
Symptoms and diagnosis
One of the first signs of a foot ulcer is discharge from the foot that may stain the socks or seep into the shoe. Swelling, irritation, redness, and odour on one or both feet are common early signs.
The most obvious sign of a serious ulcer is black tissue around the wound. This forms because healthy blood flow is not reaching the area. Partial or complete gangrene — tissue death from infection — can appear around the ulcer. In this case there may also be foul-smelling discharge, pain, and numbness.
Signs are not always obvious. Sometimes symptoms only appear once the sore has become infected.
Causes
Diabetic foot ulcers are most commonly caused by:
- **High blood sugar (hyperglycaemia)** — sustained high glucose slows wound healing, so managing blood sugar is critical. - **Nerve damage** — a long-term effect of diabetes that can lead to loss of sensation in the feet. Damaged nerves may feel tingling and painful at first; later, reduced sensitivity means small injuries go unnoticed and can turn into painless wounds that develop into ulcers. See also diabetic neuropathy. - **Irritated or broken skin on the foot** — minor trauma that would normally heal quickly instead persists. - **Poor circulation** — a form of vascular disease in which blood does not flow efficiently to the feet, making ulcers slower and harder to heal.
Treatment: the therapeutic triangle
Treatment of diabetic foot ulcers rests on three combined elements:
1. **Regulating cumulative blood sugar** — bringing HbA1c and daily glucose under control. 2. **Treating infection** — antibiotics and local wound cleaning. 3. **Physiotherapy** — an indispensable complement to the medical management, not an optional add-on.
Physiotherapy for the diabetic foot
Physiotherapy plays a central role in supporting circulation, reducing inflammation, and encouraging wound healing. The following modalities are used at the centre — selected and combined according to the patient's condition:
Energy-based modalities
- Electrical stimulation — using specific waveforms at a defined intensity
- Ultrasound therapy — deep heat delivery that supports blood flow and aids wound healing
- Infrared heat
- Magnetic wave therapy
Interventional therapies
- Radiofrequency — reduces nerve inflammation and restores vitality to the foot
- Ozone injection — increases oxygen supply to the tissue, helping to reduce inflammation and nourish the affected area
Need more information?
Reach out to our team for more details about the topics covered in this article.
This article provides general information and is not a substitute for professional medical advice. If you have specific health concerns, please consult with a healthcare provider.