Diabetic Toe Ulcers: Causes, Diagnosis, Treatment Options, Prevention

We will discuss how your doctor will diagnose an ulcer and what your various treatment options are as well as…(continue reading)

Diabetes, also called diabetes mellitus, is one of the leading causes of foot and toe ulcers.

These ulcers are caused by elevated blood sugar levels that can damage the nerves and blood vessels in the feet.

Diabetic ulcers can also be difficult to diagnose, as there are many other causes of foot and toe ulcers.

However, there are several treatment options available for diabetic foot and toe ulcers, including surgery and medication.

Below we will discuss how your doctor will diagnose an ulcer and what your various treatment options are as well as several ways to prevent diabetic foot and toe ulcers from developing in the first place.

What is an ulcer?

An ulcer is a chronic wound on your skin that does not heal or continually returns.

A diabetic foot or toe ulcer is a sore on the foot or toe that does not heal due to diabetes.

If these ulcers are left untreated it can lead to infection and even amputation as diabetes is the leading cause of lower limb amputations in the United States.

There are two types of ulcers: neurotrophic ulcers, which are diabetes-related ulcers, and arterial ulcers, which are also called ischemic ulcers and are due to poor circulation.

If you have diabetes you are at a higher risk for both types of ulcers, not just neurotrophic ulcers.

Ulcers can have various shapes and colors but if you are diabetic it is most often found on the bottom of your feet.

Some shapes of an ulcer are more common though, including a wedge shape or crater shape and the color of an ulcer will often be gray, red, pink, yellow, or black.

If the ulcer is black, you likely have necrotic soft tissue, also called gangrene, which is a very serious condition and you need to seek medical care immediately.

Your doctor may use a classification system to also identify how deep the ulcer is such as the Wagner Diabetic Foot Ulcer Grade Classification System which has six grades ranging from grade 0 (undamaged foot) to grade 5 (your entire foot has gangrene).

There are some common symptoms that can occur if you have an ulcer and they include:

  • A callous at the site of the ulcer
  • A ring around the wound that may feel calloused or harder than other skin
  • Drainage of liquid from the wound
  • Foul odor from the wound

These symptoms may be preceded by other skin problems including dry skin or cracked skin, a rash, redness, or scaly skin.

If you have an ulcer on your skin or feet please see your doctor or podiatrist (foot doctor).

How does diabetes cause ulcers?

Diabetes is a chronic condition where you have elevated blood sugar levels, also called blood glucose levels, and there are a few ways that it can cause an ulcer.

First, when you have diabetes your blood vessels narrow which decreases the blood flow to your feet and toes.

The blood circulation issues due to elevated blood sugar levels can then cause damage to the nerves in your feet and toes which is called diabetic neuropathy.

Diabetic neuropathy is the most common reason for diabetic foot or toe ulcers. When you have diabetic neuropathy you can also have a loss of sensation in your feet and toes which means that you may not feel a cut, blister, or other injuries to your foot.

If an injury does occur and you do not know about it, you risk wound infections which can lead to gangrene and amputation.

The second way diabetes can cause an ulcer is through poor circulation due to diabetic microvascular disease.

Diabetic microvascular disease is when the small blood vessels in your body are damaged due to diabetes and this can cause a decrease in blood flow to your feet and toes.


Michigan Medicine
– Diabetic Toe Ulcer

How are ulcers diagnosed?

Your doctor will likely ask about your medical history and symptoms and then do a physical examination of your feet.

They will look for any open wounds, calluses, or other skin problems. Your doctor may also order tests to check your blood sugar levels and for diabetic neuropathy.

After assessing the wound, your doctor may need to follow up with tests such as a magnetic resonance imaging (MRI) test, X-ray, or computer tomography scan (CT scan) to determine the depth of the ulcer. Depending on the severity of the ulcer, you may then be sent to a specialist such as a podiatrist or a wound specialist to discuss treatment options.

What are the treatment options for foot and toe ulcers?

The treatment options for foot and toe ulcers will depend on the severity of the ulcer.

If the ulcer is small and superficial, your doctor may prescribe an oral antibiotic or antibiotic cream to prevent infection and recommend that you clean the wound daily and cover it with a sterile wound dressing on a regular basis.

You may also be advised to wear comfortable shoes that do not rub against the wound and to practice proper foot care such as daily washing of your feet with mild soap and water and moisturizing your feet.

Resting your foot by not using it and having crutches, a cast, or a medical boot is also an option.

Keep your foot elevated as much as possible while also wearing orthotic insoles to help alleviate the impact of walking on a wounded foot. Your doctor may drain the ulcer to help with wound healing.

If the ulcer is larger or deeper, you may need to be hospitalized so that your wound can be cleaned and dressed multiple times a day.

You may also need intravenous (IV) antibiotics to prevent infected wounds. In some cases, surgery may be necessary to remove dead tissue (debridement) or repair damaged blood vessels.

If gangrene has developed, amputation may be necessary to remove infected or necrotic tissue.

Other surgical treatment options include:

  • Hammertoe repair
  • Removal of part of the bottom of your feet (plantar exostectomy)
  • Removal of scar tissue (tenotomy)
  • Realigning your metatarsal bone (metatarsal osteotomies) is often done for bunion surgeries
  • Removal of bone
  • Lengthening your Achilles tendon
  • Skin grafts through reconstructive surgery to place healthy skin where it is needed

After treatment,  the healing process for your ulcer may take anywhere from a couple of weeks to months to fully heal.

Please talk to your doctor or specialist about which treatment option will be best for you.

What are the other causes of foot and toe ulcers besides diabetes?

Diabetes is not the only common risk factor for foot and toe ulcers as it may also be caused by the following medical conditions:

  • An injury such as trauma to your legs, ankles, or feet
  • Bacterial infections such as cellulitis
  • Irritation caused by your feet rubbing against your shoes
  • Foot deformities or toe deformities
  • Any condition that causes poor blood flow also called vascular diseases
  • An uneven gait where you put too much pressure on certain parts of your feet
  • Peripheral artery disease which is the narrowing of your blood vessels or arteries

These medical conditions increase your risk of foot ulcers and toe ulcers and it is important for your doctor to know any underlying conditions you may have besides diabetes when diagnosing an ulcer.

Are there ways to prevent foot and toe ulcers?

Yes, there are preventive measures that you can take to decrease diabetic foot and toe ulcers.

The best way to prevent diabetic ulcers is to monitor your blood sugar levels and practice good blood sugar management by taking prescription medicine as directed by your doctor, eating a healthy diet, regularly exercising, and maintaining a healthy weight.

Besides managing your diabetes, the best ways to prevent diabetic ulcers include:

  • Wearing shoes that fit well and do not rub against your feet; you may also need special shoes for the nerve damage from diabetic neuropathy with special orthotic shoe inserts
  • Not walking barefoot to avoid injury
  • Manage any other underlying conditions such as high cholesterol and high blood pressure levels
  • Check your feet daily for any irritation, cuts, sores, or other skin issues to avoid infection and the risk of amputation
  • Get regular foot exams from your doctor or podiatrist
  • Quitting smoking
  • Wearing clean, dry socks every day
  • Washing your feet with mild soap and using moisturizing cream on your feet daily
  • Cut your toenails in a straight line to avoid ingrown toenails and possible infection

By following these preventative measures, you can help avoid diabetic foot and toe ulcers. Please consult with your doctor if you have any more questions regarding preventative measures you can take to avoid ulcers on your feet and toes.

Summary

Ulcers on your feet and toes can be painful and diabetic ulcers are a common complication of diabetes.

Diabetes can lead to ulcers by damaging the nerves and blood vessels which reduces blood flow to your extremities, mainly your legs and feet.

The reduced blood flow makes it difficult for wounds to heal and increases the risk of infection too.

Treatment for ulcers will depend on the severity, and range from cleaning your wound and caring for it, to several surgical options.

There are preventative measures you can take to help avoid diabetic foot and toe ulcers such as managing your diabetes, wearing proper footwear, and checking your feet regularly for any issues.

If you have any other questions regarding diabetic foot or toe ulcers, please talk to your doctor, podiatrist, or health care provider.

References and sources:

Cleveland Clinic 

University of Michigan Health 

Healthline

NHS

MedlinePlus 

Fact Checked and Editorial Process

Diabetic.org is devoted to producing expert and accurate articles and information for our readers by hiring experts, journalists, medical professionals, and our growing Diabetic.org community. We encourage you to read more about our content, editing, and fact checking methods here. This was fact checked by Jacqueline Hensler and medically reviewed by Dr. Angel Rivera.

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