Differential Diagnosis of Diabetic Foot Ulcer

Other conditions that may look like Diabetic foot Ulcer

- Venous ulcer: like DFU, this ulcer takes time to heal and it results when the veins in the leg can't move blood towards the heart as it ought to. The resulting pressure that builds up in the leg leads to ulceration

-Sickle cell ulcer:This occurs in sickle cell disease patients. It also tends to take long to heal. The ulcer mostly occurs at the ankle.

- Majorlin's ulcer: This ulcer is cancerous and usually doesn't heal

- Atherosclerosis/Peripheral vascular disease: This may occur in both diabetics and non-diabetics.

There is narrowing of artery delivering blood to the leg. When oxygen and other nutrients necessary for wound healing cannot be delivered to the wound adequately because of this narrowing, wound healing becomes difficult.


"Diabetic Foot Ulcer Treatment"


Management/ Diabetic Foot Ulcer Treatment

Management begins from history. The doctor will ask for questions looking out for ;

-A history of diabetes and how long it has been on

-Other complications(adverse outcomes) of Diabetes. Like eye problems, erection problems, heart problems.

- complications of the Diabetic foot Ulcer. e.g A fever may suggest blood Infection.

-Other problems that may go with diabetes like hypertension, obesity, kidney problems, heart problems

  • He will then examine the patient and examine the foot ulcer
  • Examination of the ulcer will reveal how advanced the ulcer is
  • Examination of the foot and ulcer will also help to know if it is predominantly due to nerve damage or to problem of blockage of the artery delivering blood to the leg

Some of the tests done are

-Fasting blood sugar/ random blood sugar test confirms diabetes and tells how high the blood sugar is

-Full blood count will tell if there is blood Infection

-A sample from the wound can be taken and tested(with culture) to find the specie of bacteria/Infection in the ulcer so that antibiotics treatment can well directed


-X ray of the foot may confirm bone involvement of the ulcer

-An special kind of ultrasound (duplex ultrasonography) can be used to check the artery for blockage of abnormal flow.


"Diabetic Foot Ulcer Treatment"


Diabetic Foot Ulcer Treatment

The treatment of Diabetic foot Ulcer is multi disciplinary meaning it has to involve doctors from different specialties. This may include the plastic surgeon, orthopedic surgeons, foot doctor called podiatrist, diabetologist/endocrinologist - doctor that treats diabetes



The principle involves

  • Control of blood sugar; for the ulcer to heal, the blood sugar level most be controlled to its normal value
  • If the wound is dirty or deep, tetanus injection is given as there may be risk of tetanus
  • Wound care is done; this depends on the grade of the wound and predominant cause whether nerve damage or

It may involve

  1. Debridement: this is surgically cutting off the parts of the flesh of the foot that have become dead from the ulcer. The dead tissue most go away for living tissues to grow and for the wound to heal

Infection in the wound is treated with antibiotics. A sample from the wound may be tested to find the most suitable antibiotics


"Diabetic Foot Ulcer Treatment"


  1. Off-loading of the ulcer: This is more needed when the predominant cause is from nerve damage. Remember that when the nerves are damaged, the muscle cannot function well to keep the foot in the right posture and position. Because of this, the weight of the body is not well distributed on the leg. Some areas suffer much more. These areas are prone to ulceration. The problem is compounded as the person cannot feel pain in these areas because of the nerve damage. And so he continues to injure himself without even knowing.

Now off-loading is simply techniques used to redistribute this weight in the right way.

One of the common ways this is achieved is by use of special footwear/aid like non-removable total contact cast that redistribute the weight on the foot

There is another option of revisional surgeries of the bony prominence of the foot. these bony prominences where pressure can build is surgically removed

Revascularization surgery: this is used in severe cases of Peripheral vascular disease. Remember that one of the mechanisms from which foot ulcer develops is from blockage of artery. This surgery is used to re-establish blood supply to the leg/foot. To improve symptoms it causes and to help wound healing.


"Diabetic Foot Ulcer Treatment"


Wound cleaning and dressing : the ulcer has to be cleaned with fluid or solution and covered with a dressing. An ideal dressing most be free of contaminants, it should be able to absorb excess fluid draining from the wound, there should little moisture, it should allow for gaseous exchange

Frequency of wound dressing depends on the wound. A wound draining excessively may be dressed up to twice a day.

Grafting: This is using part of the body( usually of self but can be from another) to cover the exposed area of the foot.

It is done when the wound is very clean( for instance, after debridement and prolonged cleaning and dressing of wound).

Even though the wound is now clean, healing may be prolonged if the exposed area is extensive. Also the scar that may result from the wound if allowed to heal on its own may be ugly. For this reason grafting may be the best option


"Diabetic Foot Ulcer Treatment"


Amputation is done when there is death of an extensive area of the foot/leg. Dead tissues cannot be brought back to life.

Unlike in debridement, there is no living tissue from which growth and healing can take of.


Leaving such extensive dead tissue in the body may cause Infection to enter the blood and this can be life threatening

Other problems that the patient may have , some of which may be linked to the diabetes, most be treated.

The patient must be taught how to care for the foot and how to prevent further ulcer


Prevention of Diabetic foot Ulcer

Up to 85% of Diabetic foot ulcers is said to be preventable if certain measures are put in place

-Daily foot inspection: this will help to spot some pre-ulcer sign . One most look out for blisters, redness, thickening and other abnormalities.And see the doctor if any of these is noticed.

Mirrors may be used to inspect under the foot

A blind person would need an assistant to help with the daily inspection

-Gentle soap and water cleansing

Never use hot water in Diabetic foot. It could burn the skin without one even knowing due to reduced sensation


"Diabetic Foot Ulcer Treatment"


Application of skin moisturizer:

-The skin of the foot in DFU is prone to dryness(due to nerve damage). dry skin is prone to cracking, thickening, Infection and ulceration hence the need to keep moisturized.

-Exception to this is the space between the toes as it tends to be damp and prone to fungal infection in Diabetics. This one should be kept dry

-Ensure to inspect shoes to ensure good support and fit.

-Also inspect foot wear to ensure there are no foreign bodies inside before wearing

-A person at risk of DFU should not walk bare foot

-Minor wounds require prompt medical evaluation and treatment.

-Preventive foot surgery to correct high-risk foot deformities may be need in some cases.

-Besides these measures, smoking most be avoided entirely and the blood sugar level most be kept in normal level


"Diabetic Foot Ulcer Treatment"


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