Diabetic foot ulcer is a wound in the foot ( area beyond the ankle) of a person living with diabetes.

This wound may be shallow and just involving the skin or it may be deep enough to affect the underlying bone.

Diabetes is a medical condition where there is sustained high blood glucose concentration either due to inability of the body to produce enough insulin or due to ineffectiveness of the insulin produced.

Insulin is a hormone produced by the pancreas in the human body and its function is to lower the level of glucose in the body.


The burden of Diabetic Foot Ulcer;

Diabetes affects about 6% of the adult population in Nigeria(5-7million adults).

There is no National data with regards to Diabetic Foot Ulcer in Nigeria.

In America for instance, Among patients with diabetes, 15% develop a foot ulcer, and 12-24% of individuals with a foot ulcer require amputation. However , based on individual studies in Nigeria.DFU constitutes about a quarter of diabetes related admissions. It is also the second commonest cause of diabetes related deaths after hyperglycemic emergencies

Nationwide, it is the leading cause of non-traumatic (accident/injury related) lower extremity amputation.

Amputations from Diabetes is even higher in our environment where people come to the hospital late. Many of these amputees are working age adults and so this has serious impacts on productivity with its implications on the economy.


"Diabetic Foot Ulcer Symptoms"


Predisposing/Risk factors to Diabetic Foot Ulcer

There are a number of factors which may predispose to this lack or ineffectiveness; Genetic and environmental

When one is Diabetic, his losses ability of the body to control/reduce the sugar he takes in and not : that sugar causes Diabetes.

However sugar in its different forms may be a risk factor for obesity which is a risk factor for Diabetes

Also Diabetics are advised to stay away from sugar as their system has reduced or no capacity to clear the sugar from the blood


Genetics does play a role in Diabetes. If one or both parents have diabetes, the chances of the person having diabetes is higher. The pattern of this inheritance is not usually straight forward so we simply say genetics is risk factor

Taking too much sugar is generally not advisable. Like I said, sugar can indirectly lead to obesity which puts one at risk of diabetes

If one is not Diabetic and has no risk factors, just enough sugar to taste should be enough. Honey is a good alternative:


How Foot Ulcers develop in Diabetics;

Diabetes especially when it has been on for years and not well controlled, can lead to some adverse outcomes (complications) which includes Diabetic foot ulcer by;

1, Affecting the tiny vessels which feed blood to the nerves leading to PERIPHERAL NEUROPATHY.

2, Affecting larger arteries which feed blood to the muscle and other parts of the leg and foot



"Diabetic Foot Ulcer Symptoms"



In peripheral neuropathy where

the nerves stop functioning well due to Diabetes, there is ;

  1. loss of normal sensation.

Pain is a powerful protective mechanism. With diminished ability to feel pain and other sensation, there is increase risk of injury from e.g. unknowingly wearing improper fitting shoes, bruising feet on objects without knowing, repetitive shearing from unnoticed objects inside the shoes worn.

  1. loss of normal muscular function.

The nerves ensure normal muscle tone and coordination. With its integrity affected, the leg may adopt poor posture and anatomy that predispose to foot ulcer

  1. the nerves are also responsible for activities such as sweating. It's poor function leads to drying of the feet and puts the feet at risk of ulcer

2 Diabetes affects the larger vessel delivering blood to the legs and feet. With this the leg and feet is poorly nourished of nutrients and oxygen.


Other factors

3 Trauma; Accidental injuries e.g friction from foot wears, injury to the foot following fall, and fingernails cut errors

4 Diabetes(high blood sugar) causes poor wound healing


"Diabetic Foot Ulcer Symptoms"


Symptoms and Stages

Before diabetic foot ulcer, there are signs that may show that foot is at risk

This may be due to


symptoms from peripheral vascular disease that leads to reduced blood supply causing a symptom called

-intermittent claudication;

It is a cramping pain on the legs, thighs or buttocks

The symptom typically comes when patient walks a distance and it gets relieved when he stops to rest. It results from reduced blood flow to the muscle due to partial artery blockage. The inadequate supply of oxygen and nutrition that results from this causes pain

Other signs due to Peripheral vascular disease include

- loss of skin hair of the affected feet


Symptoms from neuropathy(nerve damage)

Reduced sweating on the feet can contribute to

-Dryness of the feet


-Thickening called callus

Loss normal muscle function may cause

- deformity and loss of the normal architecture of the foot

Other symptoms from nerve dysfunction include

- reduced sensation, abnormal sensation and absent sensation on the feet

There are also symptoms "diabetic foot ulcer symptoms" itself. Depending on the grade, the ulcer may present with

-discolouraton of the skin

-Foul smell from the wound

-Fluid discharge from the wound

-Pain on the foot

There may be symptoms of complications of the ulcer

Ulcers can become infected leading to systemic symptoms like fever


"Diabetic Foot Ulcer Symptoms"


Grades of DFU

According to Wagner classification, there is grades 0 to 5

Grade 0: No obvious ulcer. Their skin is intact, though there may be signs the foot is at risk

Grade 1: Superficial ulcer.its depth just involves the skin and (or and the underlying fat)

Grade 2: deep ulcer involving the tendon,capsule and bone


Grade 3: deep ulcer Infection of the bone(osteomyelitis) or large pus collection(abscess)

Grade 4: Gangrene (extensive tissue death) involving the portion of the foot close to the toes

Grade 5: gangrene of the whole foot


Complications of Diabetic foot

Diabetic foot ulcers may have some adverse outcomes(complications);

- the ulcer may spread, affecting more areas

- healing can be very prolonged

- Infection from the ulcer may enter the blood causing it to be infected. This can be life threatening

- it may set the stage for some other serious conditions in Diabetics, like Diabetic ketoacidosis

- it may lead to amputation

Now in our environment, these adverse outcomes tend to occur more often because of late presentation to the hospital.

It's not uncommon to see a patient with an extensive infected foot ulcer. This patient may have visited a traditional healer who may have told him it is bad blood that's in the foot before sticking needles into the foot to remove the so called "bad blood." Of course, this only helps to spread the Infection. By the time this patient comes to hospital, it might be impossible to save the leg and amputation becomes the only option.

In a particular study by Ejiofor Ugwu, Olufunmilayo Adeleye, [...], and Ignatius Ezeani;

21.1% of patients sought treatment in health facility as first option

42% resorted to self medications

19.6% patronized the traditional healers

While 9.2% chose to go to the prayer house


"Diabetic Foot Ulcer Symptoms"


In Conclusion

Long-standing, poorly controlled diabetes lead to nerve damage - nerve damage lead to diminished ability to feel pain - this increases the chances of injury as one may not feel pain when the danger of injury presents - this injury leads to ulceration - ulcer may become infected and blockage of the leg artery(PAOD) may worsen the problem - the infected ulcer may spread - in severe cases, it may lead to amputation



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