January 21, 2026

Diabetic Foot: Symptoms, Risks, Diagnosis, and Modern Treatment Approaches

Diabetic foot is a serious condition that can develop when nerve damage, reduced blood flow, and infection come together. Because early changes may not be painful, problems can go unnoticed and progress over time. In this guide, we explain the key causes, diagnostic steps, and current treatment principles in clear terms.

Op. Dr. Sedat Duman – Orthopedics & Traumatology Op. Dr. Muhammed Duman – Orthopedics & Traumatology

Why does diabetic foot occur?

Diabetic foot ulcers rarely have a single cause. Most often, three problems interact and create a “chain reaction”: nerve damage, reduced circulation, and infection. When these factors overlap, even minor friction or a small skin crack can develop into a deep, slow-healing wound.

Key point: In diabetic foot, a “small” wound can be misleading. When pain sensation is reduced, the issue may be noticed late—making treatment more difficult.

1) Nerve damage (Neuropathy)

Persistently high blood sugar can affect the nerves in the feet. Neuropathy may show up in different ways:

Sensory neuropathy

The foot may lose its protective sensation. Pain, heat, and minor injuries may not be felt properly. As a result, shoe pressure, hard surfaces, or small cuts can go unnoticed and gradually worsen.

Motor neuropathy

When muscle balance is disrupted, toe deformities and changes in foot shape can develop. This shifts pressure to specific points during walking. A callus often forms first; then tissue damage beneath it may lead to an ulcer.

Autonomic neuropathy

Sweat regulation may be impaired, leaving the skin dry and prone to cracking. Cracks can become entry points for microorganisms and increase infection risk.

2) Reduced blood flow (Peripheral arterial disease)

Diabetes can accelerate atherosclerosis and narrow the arteries supplying the legs and feet. When circulation is reduced, tissues receive less oxygen and nutrients—this can delay wound healing and increase infection risk. Poor blood flow is a common reason why some ulcers do not close despite proper care.

How are diabetic foot ulcers classified?

Treatment planning depends on the ulcer’s depth, whether infection is present, and the level of blood supply. Different systems may be used in clinical practice:

Wagner: Focuses mainly on ulcer depth.
University of Texas (UT): Adds infection and ischemia to depth assessment.
WIfI: Combines wound, ischemia, and foot infection to estimate risk and need for vascular intervention.
SINBAD: A practical scoring approach for communication and follow-up.

A special condition: Charcot foot

Charcot foot is a condition where, due to neuropathy, bones and joints weaken and can deform over time. Early on, the foot may look red, warm, and swollen. Pain is not always prominent. Because these signs can resemble infection, careful assessment is essential.

In the acute phase, the cornerstone of treatment is removing weight from the foot (offloading), often using specialized casts or immobilization devices. Early recognition can help prevent permanent deformity and reduce the risk of recurrent ulcers.

How is it diagnosed?

Diagnosis combines clinical examination, circulation assessment, and evaluation for infection. Imaging is used when needed to clarify the depth and extent of involvement.

Clinical exam: Ulcer depth, surrounding tissue, and infection signs are assessed. Contact with bone may raise concern for bone infection.
Imaging: X-rays are often the first step. MRI can provide detailed information when deeper infection or bone involvement is suspected.

Treatment approach

Managing diabetic foot often requires a team approach. The main goals are to control infection, reduce pressure on the ulcer, optimize blood flow, and address underlying structural problems when necessary.

1) Infection control

If infection is suspected, appropriate sampling and targeted antibiotics are planned. When bone infection is possible, treatment may be longer and sometimes surgery is needed.

2) Offloading (pressure relief)

Reducing pressure on the ulcer is essential for healing. This may include specialized boots, casts, or customized devices. In selected cases, procedures aimed at lowering forefoot pressure may be considered.

3) Restoring circulation

If blood supply is insufficient, vascular assessment may lead to endovascular procedures or bypass surgery. When an ulcer does not shrink as expected, circulation should be re-evaluated.

4) Surgical intervention

When needed, surgery may include debridement, abscess drainage, management of bone infection, or correction of deformities that cause repeated pressure and recurrent ulcers.

Conclusion

The most effective strategy in diabetic foot is early recognition and timely, structured care. Good blood sugar control, daily foot checks, and proper footwear are the foundations of prevention. If you notice redness, warmth, swelling, or any wound on the foot, prompt specialist evaluation can significantly reduce the risk of serious complications.

Note: This content is for general information only. Diagnosis and treatment should be individualized after medical evaluation.

Frequently Asked Questions (FAQ)

How do diabetic foot ulcers usually start?

They often start with minor friction, tissue damage under a callus, a crack in dry skin, or an unnoticed pressure point. If sensation is reduced, the problem may be detected late.

Which symptoms require urgent evaluation?

Rapidly increasing redness, warmth, swelling, foul odor, drainage, fever, blackened skin, sudden shape change, or a noticeable decline in walking ability should be assessed without delay.

Why is walking on the ulcer harmful?

Weight-bearing increases tissue stress, slows healing, and raises infection risk. That is why offloading (pressure relief) is a cornerstone of treatment.

Why might an ulcer not heal if circulation is poor?

Reduced blood flow limits oxygen and nutrient delivery to tissues, delaying repair and making infection harder to control. In selected cases, vascular procedures may be needed.

How can Charcot foot be confused with infection?

Charcot foot can present with warmth, redness, and swelling—similar to infection. Clinical evaluation and appropriate imaging help differentiate conditions. Early offloading is critical in the acute stage.

What are the most effective prevention steps?

Consistent blood sugar control, daily foot inspection, regular skin care, proper footwear and socks, cautious nail care, and routine medical follow-up are key measures.