Healing diabetic foot ulcers: how to speed recovery and prevent complications

Foot ulcers are a common complication of diabetes. In the U.S., the risk of getting a foot ulcer ranges between 19% and 34% for people living with diabetes.¹

If you get a diabetic foot ulcer, there are steps you can take to speed your recovery and ensure it heals properly. Here’s what you need to know about healing diabetic foot ulcers and the signs it’s time to see a doctor.

What is a diabetic foot ulcer?

A diabetic foot ulcer is an ulcer that forms on the foot in people with diabetes who have some degree of nerve damage. Nerve damage in diabetes is also known as diabetic neuropathy.²

Become a patient

Our primary care team is here to give you the focused support you need.

Find a clinic

Diabetes is characterized by high blood sugar levels, which can damage your nerves and reduce blood flow.² This can sometimes make it difficult to feel wounds when they occur, particularly those on your feet.

Nerve damage and reduced blood flow can interfere with the body’s natural healing process. Reduced blood flow to the feet can prevent wounds from getting the oxygen and nutrients they need to heal properly within a normal time frame. Eventually, wounds that never heal or heal too slowly can become infected.²

Leg or foot amputation is one of the most serious complications that can result from diabetic foot ulcers. In fact, diabetic foot ulcers are the leading cause of non-traumatic lower-limb amputations in the world.³

By addressing foot wounds the moment you notice them, you can significantly reduce your risk for ulcers and amputation.

How long do diabetic foot ulcers take to heal?

Diabetic foot ulcers typically take several weeks or months to fully heal.⁴ Sometimes, they don’t heal at all.

According to a study in Diabetes Therapy, 60% to 80% of diabetic foot ulcers heal successfully, while 10% to 15% remain active.⁵ An estimated 5% to 24% of diabetic foot ulcers eventually result in amputation within six to 18 months after the first evaluation.⁵

The healing process for diabetic foot ulcers

The faster a diabetic foot ulcer heals, the lower the risk of infection.

Preventing an infection is usually the topmost priority when treating a diabetic foot ulcer.⁶ This process usually involves:

• Keeping blood sugar levels tightly controlled.
• Keeping the ulcer clean and bandaged at all times.
• Cleaning the ulcer daily.
• Not walking around barefoot.

After focusing on prevention, the next step is to reduce pressure on the area—a process known as offloading.⁶

Offloading requires you to avoid applying pressure to the wound so it can begin healing. This may involve using devices such as:

• Foot braces
• Wheelchair
• Crutches
• Cast
• Specialized footwear

These devices help reduce pressure and irritation on the wound, which may speed up the overall healing process.

In some instances, the wound may be treated using a process called debridement.^{4, 6} Debridement is the removal of dead skin and tissue, which can be done by your doctor or podiatrist. During this procedure, your provider removes dead tissue and cleans the ulcer to prevent infection.

The healing process for diabetic foot ulcers varies for everyone, depending on factors such as age, weight and wound size. Your doctor may give you a more accurate healing timeline based on your medical history.

How to heal diabetic foot ulcers faster

Multiple factors often affect how quickly your diabetic foot ulcer heals. These tips may help speed up the healing process^{4, 6}:

• Keep your blood sugar levels within a normal, healthy range at all times.
• Use off-loading devices as recommended by your doctor.
• Wear shoes made with breathable materials, such as canvas, leather or suede.
• Wear shoes that can be adjusted easily with laces, buckles or velcro.
• Wear properly fitting shoes that aren’t too tight. You may want to ask your doctor about custom orthotics for people with diabetes.
• Keep the wound clean and bandaged at all times.
• Replace the bandage or wound dressing daily.
• Avoid walking barefoot, including in your home or backyard.
• Don’t smoke.
• Control high blood pressure and high cholesterol, if applicable.
• Avoid using hydrogen peroxide, whirlpools or soaking to treat the ulcer. These methods may lead to further complications.

Is it possible to heal diabetic foot ulcers at home?

The short answer is yes. Healing diabetic foot ulcers at home is possible, but only after you have seen a doctor who has agreed to oversee your treatment.

Diabetic foot ulcers are often highly complex and have the potential to become more serious without the proper care. A doctor or podiatrist can first evaluate the wound and recommend how it can be safely treated at home.⁴

After you have seen a doctor, follow their instructions closely to ensure the ulcer heals. This often involves managing your blood sugar level, taking diabetes medications as directed and caring for the wound around the clock. Reach out to your doctor right away if you notice new signs of infection or if the wound isn’t healing as expected.

Signs your diabetic ulcer isn’t healing

With professional treatment, diabetic ulcers usually start to look and feel better within a few weeks. Your ulcer should become gradually smaller and appear shallower as new, healthy tissues grow and form inside the wound. You may also experience less pain and swelling.

If these signs are not apparent within a few weeks of treatment, it’s possible the ulcer isn’t healing as it should.

Signs your diabetic ulcer isn’t healing^{6, 7}:

• The appearance of the wound hasn’t changed.
• Redness and swelling (signs of inflammation) are still present.
• Redness and swelling come back after initially going away.
• An unpleasant odor is coming from the wound.
• Pus or liquid is oozing from the wound.
• The wound feels tender, hot or painful to the touch.

When to see a doctor

See your doctor right away the moment you suspect you have a diabetic foot ulcer. Your doctor can take a look at the wound and advise on the next best steps.

Signs it’s time to see your provider^{2, 4, 6}:

• Numbness, tingling or burning sensation in the foot.
• Warmth, heat or any noticeable temperature changes in the foot.
• The color of the wound is white, blue or black.
• Dry, cracked skin on the foot.
• Loss of feeling in the foot, including the ability to feel heat or cold.
• Thick, yellow toenails.
• Loss of hair on the toes, foot or leg.
• Fungal infection on the feet, such as athlete’s foot.
• Ingrown toenails.
• Blisters or corns.
• Extra pus and drainage coming from the wound.
• Fever or chills.
• Increased pain or firmness around the wound.
• Pain or cramping in the legs, thighs, buttocks or calves when being active.
• Changes in the shape of your foot over time.

How to prevent future foot ulcers

Managing your diabetes is often the most effective way to prevent diabetic foot ulcers.⁶

In diabetes, foot ulcers are typically driven by nerve damage and reduced blood flow to the feet due to high blood sugar levels. Therefore, controlling your blood sugar levels is often the best prevention method.

Steps you can take to prevent diabetic foot ulcers^{2, 6}:

• See a podiatrist regularly. A podiatrist can examine your feet, trim your toenails and look for signs of ulcers at every visit.
• Wash your feet every day. Avoid soaking your feet, as this can break down skin tissues and increase the risk for infection.
• Avoid walking barefoot. Going barefoot can put you at risk for cuts, scrapes and other foot injuries.
• Manage your cholesterol and high blood pressure. Your doctor can help with lowering your readings if they are higher than normal.
• Wear comfortable, properly fitting shoes and socks. Choose shoes and socks made with breathable or moisture-wicking materials to keep your feet dry.
• Keep your toenails trimmed. Toenails that are long, thick or jagged may lead to open sores. Many podiatrists offer toenail-trimming services for people with diabetes.
• Examine your feet every day. Look for signs of cuts, cracks, blisters, redness and sores on the soles of your feet and between the toes.
• Don’t smoke. Smoking promotes nerve damage and reduces blood flow to the feet.
• Reduce your alcohol intake. Alcohol worsens nerve damage, reduces blood flow and interferes with blood sugar management.
• Take your diabetes medications as prescribed. This reduces your risk for complications and supports good blood sugar control.
• Get your blood flowing. Elevate your feet, wiggle your toes or exercise regularly to promote good blood flow and reduce the risk of slow-healing ulcers.

Special considerations for older adults

Older adults with diabetes are often subject to factors that make detecting and caring for foot wounds more complicated. Lower immunity, comorbid conditions and the use of multiple medications are examples of factors that may affect diabetes wound care in this population.

Here are special considerations for older adults with diabetes:

• Use a mirror or ask a caregiver for help when inspecting feet. Vision problems and limited mobility can sometimes make foot inspections more difficult without help.
• Use a continuous glucose monitor (CGM) to manage diabetes. A CGM can help you manage your blood sugar and can even alert your doctor when readings are too high or low.
• Consider wearing custom orthotics. Custom orthotics can provide extra support for people with diabetes and offer extra protection against falls and foot wounds.
• Visit the doctor frequently. Older adults with reduced immunity can benefit from seeing their doctors more frequently so that infections can be caught early.
• Provide your doctor with a list of all your medications. Older adults tend to take multiple medications, which may delay the healing process.

Conclusion

Healing diabetic foot ulcers before they become serious is entirely possible, especially if you seek help the moment you notice signs of infection.

See your doctor if you notice any abnormalities in your feet or if you need help managing diabetes. Your doctor can examine and treat your feet or refer you to a podiatrist or diabetes foot specialist who can discuss your treatment options.

Contact WellMed today at (888) 781-WELL or visit our website to find a doctor near you.

Resources

• 1. McDermott, K., Fang, M., Boulton, A. J. M., et al. (2022, December 22). Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care, 46(1), 209–221. https://doi.org/10.2337/dci22-0043
• 2. Centers for Disease Control and Prevention. (2024, May 15). Your Feet and Diabetes. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-your-feet.html.
• 3. Packer, C. F., & Manna, B. (2023, July 17). Diabetic foot ulcer. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499887/
• 4. MedlinePlus. (2024, May 20). Diabetes – foot ulcers. https://medlineplus.gov/ency/patientinstructions/000077.htm.
• 5. Alexiadou, K., & Doupis, J. (2012). Management of Diabetic Foot Ulcers. Diabetes Ther., 3(1), 1–15. https://doi.org/10.1007/s13300-012-0004-9
• 6. American Podiatric Medical Association. (n.d.) Diabetic Wound Care. https://www.apma.org/patients-and-the-public/conditions-affecting-the-foot-and-ankle/diabetic-wound-care/.
• 7. University of Kentucky. (n.d.) Slow-healing or Nonhealing Wounds. https://ukhealthcare.uky.edu/barnstable-brown-diabetes-center/diabetes-complications/slow-healing-nonhealing-wounds.