Dr. Hemanth Kumar Pandharpurkar

Consultant – Vascular and Endovascular Surgery

Book Appointment

Subscribe to our blogs

Reviewed by

Dr. Hemanth Kumar Pandharpurkar

Consultant – Vascular and Endovascular Surgery

Manipal Hospitals, Old Airport Road

Book Appointment

Diabetic Foot Problems Explained: Early Signs, Ulcers, and Limb-Saving Care

Reviewed by:

Dr. Hemanth Kumar Pandharpurkar

Posted On: Jan 07, 2026

7 Min Read

Diabetic Foot Problems Explained: Early Signs, Ulcers, and Limb-Saving Care

What looks like a small sore on the foot can quietly become the most severe problem a person with diabetes faces. A seemingly minor injury can evolve into a serious infection or even lead to amputation when diabetes affects the feet. That progression is not inevitable, but understanding why wounds get stuck, how to spot danger early, and which treatments actually work can change outcomes. This blog explains the biology behind diabetic foot problems, the signs families should never ignore, and the practical steps clinicians take to reduce amputation risk and preserve mobility.

Synopsis

Diabetes and Foot Ulcers
Are You at Risk of Diabetic Foot Ulcers?
Early Warning Signs Families Should Never Ignore
How Doctors Assess a Diabetic Foot?
Why Some Ulcers Become Non-Healing
Principles of Effective Diabetic Foot Treatment
Common Treatments and When They Matter
Prevention: Daily Practices That Save Feet
When Amputation Becomes Necessary?
Conclusion

Diabetes and Foot Ulcers

The foot is a common site of chronic wounds and infection in diabetes patients. They are mainly vulnerable to foot problems for 3 major reasons. These are:

Loss of protective feeling from peripheral neuropathy: Small cuts or pressure points go unnoticed and continue to stress the feet
Poor blood flow from peripheral arterial disease: Tissues lack the oxygen and nutrients needed to repair themselves
Impaired immune and healing responses related to prolonged high blood sugar: The body struggles to fight infection and mount normal healing

Over time, these problems create a cycle: an unnoticed blister breaks down into a diabetic foot ulcer, bacteria colonise the wound and form a stubborn biofilm, the wound fails to progress through normal healing stages, and infection may spread into deeper tissues, including bone. That sequence is why clinicians treat foot sores in diabetes far more aggressively than similar minor wounds in people without diabetes.

Are You at Risk of Diabetic Foot Ulcers?

A substantial share of people with diabetes will develop a foot complication during their lifetime, and prior ulceration or amputation is the strongest predictor of recurrence. Additional risk factors include long-standing diabetes, poor blood sugar control, smoking, peripheral neuropathy, visible foot deformity, and reduced pedal pulses. Regular foot checks help clinicians stratify risk and schedule preventive care.

Early Warning Signs Families Should Never Ignore

A timely clinical review can stop progression. Families and carers should pay attention to the following early signals:

Warning Sign	What It May Mean
Redness, swelling, increasing pain	Local infection or spreading cellulitis
Drainage, foul smell, or pus	Bacterial colonisation or deep infection
New or enlarging sore, especially on the sole	Pressure point breakdown (risk for diabetic foot ulcer)
Numbness or tingling	Peripheral neuropathy and loss of protective sensation
Cool, pale foot or weak pulses	Peripheral arterial disease and poor perfusion

If any of these are present, an urgent clinical review is the safest step; early intervention prevents many admissions and reduces amputation risk.

How Doctors Assess a Diabetic Foot?

A structured clinical assessment is the foundation of good diabetic foot care. Typical elements include:

A detailed wound inspection (depth, presence of slough, exposed tendon or bone).
Neurological testing for protective sensation (monofilament or vibration).
Vascular assessment, including palpation of pulses and bedside measures such as the ankle-brachial index or toe pressures.
Microbiological sampling when infection is suspected (tissue sampling preferred over superficial swabs).
Imaging a deeper infection (osteomyelitis) or bone involvement is suspected (X-ray, MRI).
Systemic evaluation of glucose control, nutrition, and other comorbidities that hinder healing.

This broad approach avoids treating only the surface problem and instead aims to correct the factors that keep a wound from healing.

Why Some Ulcers Become Non-Healing

A non-healing foot ulcer results when the balance between tissue damage and repair favours damage. Important drivers include:

Repeated pressure and shear at the same spot (particularly the plantar surface)
Ongoing infection or bacterial biofilm that resists routine treatment
Critical limb ischemia from peripheral arterial disease that prevents tissue oxygenation
Poor glycaemic control and malnutrition impair cellular repair
Structural deformity (Charcot foot) that alters pressure distribution

Addressing each of these domains is essential to convert a stagnant ulcer into a healing wound.

Principles of Effective Diabetic Foot Treatment

Treating foot complications in diabetes follows a logical sequence: rapid infection control, rigorous wound bed preparation, relieving pressure, restoring blood flow when needed, and optimising systemic health. These steps are standard in international guidance and form the backbone of modern wound care for diabetic feet.

Infection Control: Treat the Wound, Not Just the Swab

Not every colonised ulcer needs systemic antibiotics; only signs of infection or spreading cellulitis do. Tissue cultures guide targeted therapy in deep or persistent infections. When infection reaches bone (osteomyelitis), combined medical and surgical management is frequently required. Delaying treatment increases the chance of limb-threatening spread and, therefore, higher amputation risk.

Wound Debridement: Achieve Healthier Feet

Removing necrotic tissue and biofilm is fundamental. Wound debridement, sharp surgical or regular clinical debridement, is considered a cornerstone to create a healthy wound bed and is recommended repeatedly in guidance documents. Debridement also reduces bioburden and improves the effect of dressings and topical agents.

Offloading: The Most Underused Yet Powerful Tool

Offloading (taking pressure off the ulcer) is frequently the single most effective intervention for plantar ulcers. A properly fitted total contact cast or a pressure-reducing walker removes the repetitive trauma that prevents healing. When offloading is not feasible, therapeutic footwear and custom insoles reduce recurrence risk once the ulcer has healed. Here, patient adherence is the key: the most effective device is the one the person will wear consistently.

Revascularisation: When Circulation Is the Limiting Factor

If vascular studies show severe ischemia, restoring blood flow through angioplasty, stenting, or bypass surgery is often essential to prevent amputation and save the limb. Revascularisation converts a hostile, hypoxic wound bed into one capable of healing, and multidisciplinary vascular input should be early when ischaemia is suspected. Revascularisation enables subsequent wound healing by restoring oxygen and nutrient delivery. Multidisciplinary vascular assessment is essential in ischaemic ulcers.

Each element supports the others: for example, debridement without offloading often fails because the pressure continues to injure the wound.

Optimise Systemic Health

Good glycaemic control, nutrition, smoking cessation, and management of comorbidities are non-negotiable. Coordinate with your primary care team to create a holistic plan; wound care alone is rarely enough.

Common Treatments and When They Matter

Treatment	Indication	What It Does
Debridement (sharp/mechanical)	Necrotic tissue or slough	Removes devitalised tissue and reduces biofilm
Systemic antibiotics	Clinical infection, spreading cellulitis, osteomyelitis	Treats bacterial infection that can otherwise progress
Offloading (total contact cast, removable walker)	Plantar pressure ulcers	Redistributes pressure to allow granulation and closure
Revascularisation (endovascular/surgical)	Critical limb ischemia, poor perfusion	Restores blood flow so tissue can heal
Advanced dressings / NPWT	Large exuding wounds after debridement	Manages exudate and promotes granulation
Glycaemic optimisation & nutrition	Poor metabolic control or malnutrition	Improves cellular repair and infection resistance

Prevention: Daily Practices That Save Feet

Most serious outcomes are preventable when people with diabetes and their carers adopt consistent foot care habits. Daily inspection, basic foot hygiene, protective footwear, prompt treatment of minor injuries, and regular professional foot checks are the pillars of prevention. Education must be practical: advise checking between toes, avoiding barefoot walking, cutting nails straight across, and reporting any change immediately.

Inspect feet daily for cuts, blisters, redness, or swelling.
Keep skin moisturised, but avoid cream between toes.
Wear well-fitting shoes and avoid walking barefoot.
Have a professional foot exam at least annually, more often if high risk.
Keep blood glucose and other chronic conditions well controlled.

These measures lower the chance that a minor injury will become a life-changing problem.

When Amputation Becomes Necessary?

Despite best efforts, some limbs cannot be salvaged. Amputation decisions consider the extent of infection, the chance of functional recovery, comorbidity burden, and patient preferences. The primary aim is to remove infected, nonviable tissue while preserving as much function as possible. Early, limb-sparing interventions combined with rehabilitation often result in better quality of life than delayed major amputation following prolonged sepsis. Multidisciplinary discussion and shared decision-making are essential in these difficult scenarios.

Conclusion

Diabetes affects the feet through a combination of nerve damage, poor circulation, and impaired healing. Early detection, simple daily foot hygiene, pressure relief with offloading, targeted infection control, and timely revascularisation when needed dramatically reduce amputation risk. Most importantly, coordinated care from a multidisciplinary team and clear patient education at Manipal Hospitals convert threats into manageable risks. With attention and the right interventions, most people with diabetes can keep their feet healthy and mobile.