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Diabetic Foot Ulcers-Understanding the cause and how to prevent them…by Cari Normand, PT, CWS

Diabetic foot ulcers (also known as neuropathic wounds) are becoming increasingly common as the rates of diabetes continue to rise, especially in the United States. You may wonder–why does being diabetic make it more likely to get a wound on your foot? Glad that you asked because that is what we are going to discuss in this post.

Most people understand that having diabetes causes a problem with the body’s ability to absorb the energy from the food you eat. With diabetes, the body does not make enough insulin to help the cells absorb this energy and this leads to an excess of glucose (sugar) in the bloodstream. If blood sugar is not well-regulated with external insulin and a healthy lifestyle,  over time this may cause many additional serious health problems, including a condition called peripheral neuropathy.

It is important to explore what peripheral neuropathy is because this ultimately leads to the development of diabetic foot ulcers. Neuropathy simply means “disease or dysfunction of the nerves.”  There are different causes of neuropathy, but with diabetic neuropathy the nerve damage occurs when blood sugar is not well controlled (remains too high), especially over an extended period of time.  The risk increases the longer someone has diabetes. There are several types of nerves in the body that perform different tasks, so damage to each different kind of nerves leads to an increased risk of developing a diabetic foot ulcer.  Not surprisingly, diabetes is also the primary underlying cause of amputations in America today.

The types of neuropathy that most commonly lead to diabetic foot ulcers are:

  • Sensory neuropathy: sensory nerve damage that decreases the body’s ability to feel pain or sense a problem. For example, someone with sensory neuropathy may step on a rock or a nail and not feel pain, or NOT sense that it is there and continue to walk around while the object may fester in the sole of the foot and become infected.
  • Motor neuropathy: motor nerve damage in the foot that may result in weakness in the small muscles of the foot that results in deformities such as claw toes or hammer toes. When the toes become deformed, it causes increased and abnormal pressure on certain areas of the foot during walking. This can result in callouses and eventually ulcers.
  • Autonomic neuropathy: results in decreased sweat and oil production in the feet, leading to dry/cracked skin. This makes the skin more susceptible to injury.

Neuropathy is what sets a person up to get wounds on their feet. However, there are external causes in combination with this predisposition that ultimately led to diabetic wound formation:

  • Ill-fitting shoes, especially those that are too tight around deformed toes. The person may not have discomfort or realize the shoes are too tight because of sensory neuropathy.
  • Walking barefoot or in shoes that do not support the bottom of the foot properly, causing blisters or calluses that can develop into wounds.
  • Stepping on objects (penetrating injuries)

So now we know what causes diabetic foot ulcers. Now let us focus on what can be done to prevent them. Here are a few tips:

  • Blood sugar management
  • Healthy eating and lifestyle habits
  • Check your feet every day, using a mirror to see all areas or ask a loved one to help inspect what you cannot see
  • Wear light colored cotton socks (or other breathable material). Check socks after removing them to make sure there is no blood, etc.
  • Get a thorough foot exam, at least yearly
  • Wear shoes that fit well, consulting a foot specialist as needed
  • Keep feet moisturized (avoid putting moisturizer between the toes)

Managing a diagnosis of diabetes is challenging enough without adding the complication of a diabetic foot ulcer. By prioritizing self-care with these tips and understanding the internal and external contributing factors for the development of diabetic foot ulcers, you empower yourself to manage your disease successfully and achieve an optimal healthy outcome.

For more information on diabetes management and diabetic foot ulcers visit


Cari Normand is the Corporate Wound Care Specialist for Nexion Health Managment, Inc.

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