Diabetes-Related Foot Ulcer

Wound and Ulcer Conditions· Also known as: diabetic foot ulcer, DFU, diabetic foot wound, diabetes foot ulcerUpdated Nov 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

A diabetes-related foot ulcer is an open sore on the foot of a person with diabetes that does not heal promptly. About 3.2 per cent of Australians with diabetes have one, and around 6.3 per cent of people with diabetes worldwide. Because diabetes can dull feeling in the feet, a sore may cause little pain, so it can go unnoticed. Taking pressure off the sore, regular wound care and good blood glucose control all help it heal.

What is it?

For someone with diabetes, a diabetes-related foot ulcer is a gap in the skin of the foot that does not close promptly.

The key point is that ulcers are slow to heal. If you have diabetes, any break in the skin of your foot matters.

Who does it affect?

Any person with diabetes can develop a foot ulcer. Around 6.3 per cent of people with diabetes worldwide have one, and about 3.2 per cent of Australians with diabetes. Estimates of the chance of getting one at some point in life range from about 1 in 10 people with diabetes up to 34 per cent.

Some people are at higher risk. The main risk factors are:

nerve damage in the feet (neuropathy) that reduces feeling
poor blood supply to the feet (peripheral arterial disease)
a past foot ulcer or amputation
a change in the shape of the foot, such as bunions or hammertoes
blood glucose that has been high for a long time
kidney disease or eye damage from diabetes
smoking, older age and having had diabetes for many years

In Australia, Aboriginal and Torres Strait Islander people are affected more than other people. Compared with non-Indigenous people, their risk of undergoing a major amputation is as much as 38 times higher.

Signs and symptoms

The most common sign is an open sore on the foot that does not heal. There may be redness, swelling, and pain or tenderness around it. Sometimes the sore is hidden under a thick layer of discoloured, hardened skin (callus).

Because diabetes can reduce feeling in your feet, an ulcer may not hurt at all. You might not know it is there until someone else sees it, or you notice a mark on your sock. Changes such as a new smell, discharge, heat, a change in colour or a change in the shape of your foot are also important.

What causes it?

Over time, high blood glucose can damage the nerves and blood vessels that supply your feet. It also keeps inflammation going in the body. As a result, your feet lose feeling and blood supply, and the skin heals poorly.

Once feeling is reduced, a small injury or rubbing can break the skin without you noticing. Nerve and muscle damage can also change the shape of the foot, and shoes then rub on the bumps. When nerves are damaged, extra pressure under the foot as you walk also helps cause ulcers on the sole.

A reduced blood supply slows healing further. In some people the skin heals so poorly that even a minor injury can lead to an ulcer or an infection. These factors are linked with ulcers, but they don't prove that any one of them caused a particular ulcer.

How is it diagnosed?

Your podiatrist or doctor will look at the sore and at your whole foot. They will check for signs of infection. Infection is recognised by at least two of the usual signs of inflammation (such as redness, warmth, swelling or pain), or by pus. It is then graded as mild, moderate or severe.

They will also check the blood supply to your foot, because this helps decide the treatment you need. They will record where the ulcer is, how big and deep it is, and whether there is infection or poor blood supply. This helps different members of your care team describe your ulcer in the same way.

If the wound looks infected, a sample of tissue is usually taken after the dead tissue is cleaned away, so it can be tested for germs. Imaging may be used to look for infection in the bone, which can be hard to find. An MRI scan is far more sensitive and specific than a plain X-ray.

A foot check for people with diabetes looks for problems with feeling (neuropathy) and circulation (ischaemia) in the feet, even when there is no sore, because diabetes can affect both.

Treatment

Care for a foot ulcer is a package: taking pressure off the sore, cleaning and dressing it, treating infection if there is any, and keeping blood glucose under control. If the foot has a poor blood supply, that needs attention too. Taking pressure off the sore is arguably the most important part.

Looking after it at home

Wear any boot, cast or special shoe your team gives you, exactly as advised. This protects the sore from the pressure of walking. Make sure all your shoes fit well and don't rub, because reduced feeling can hide rubbing. Care often includes regular debridement, dressings and follow-up from the podiatry or foot team, with dressings kept as your team shows you. Keeping your blood glucose well managed is also an essential part of care.

Treatment from your podiatrist

Hard, dead or infected skin that is preventing the ulcer from healing is usually taken away by a podiatrist, practice nurse or another health professional. Removing it in this way is known as debridement. After that, they will put dressings on the wound and, if needed, fit a temporary pad to relieve pressure on it.

Taking pressure off the sore is called offloading. For an ulcer on the ball or middle of the sole, the first choice is a knee-high device that you can't take off. If you can't use one, or can't tolerate it, a knee-high or ankle-high device that you can remove is the next choice. If no devices are available, well-fitting footwear with felted foam is the third choice.

Total-contact casting is a close-fitting cast that spreads pressure across the whole sole. It is the gold standard for long-lasting ulcers on the sole that are not infected and have a good blood supply. In the figures available, 91 per cent of ulcers healed with casting in an average of 42 days, compared with 32 per cent with traditional dressings in an average of 65 days. A removable walking boot that has been made non-removable seems to work just as well and needs less skill to fit. A cast is not used when there is infection in the soft tissue or bone.

Other options

If the ulcer isn't improving, ask for a review by a multidisciplinary foot team (a team of different health professionals who treat feet). These teams improve outcomes. If the blood supply to the foot is poor, it may need to be restored with a procedure called revascularisation. Some people who don't respond to standard care may benefit from extra treatments. It isn't yet clear which of these suits which ulcer.

Surgery

Most serious foot infections need some surgery. This can range from minor work to clean out the wound to major surgery. When an infection is severe, surgery to clear the wound may be required. A very severe infection may need amputation to save the healthy parts of the foot. When circulation to your feet is reduced, a referral for surgery to improve blood flow to the ulcer may follow.

Recovery

Healing takes time, and a poor blood supply to the feet makes it slower. High blood glucose over a long time also gets in the way of healing. Sticking with offloading, wound care and follow-up visits gives your ulcer its best chance.

A foot ulcer is a serious condition. It is linked with a higher chance of heart, kidney and limb problems, and with earlier death. Among people with an ulcer, poor blood supply (peripheral arterial disease) was the strongest sign that a person may need an amputation. In Australia, foot ulcers affect around 50,000 people and lead to about 28,000 hospital admissions and 5000 amputations each year. This is why careful care, and having your blood supply checked, matter so much.

Having had one ulcer raises the chance of getting another, so your foot needs ongoing attention afterwards.

Preventing it

The most important step is a foot check by a trained health professional every year. If you have already had an ulcer, an amputation, loss of feeling, a change in foot shape or poor blood supply, your feet are at higher risk, and your podiatrist can plan checks that suit you.

Wear shoes that fit well and don't rub, because reduced feeling can hide rubbing. Poor blood glucose control and smoking are both recognised risk factors for diabetes-related foot ulcers. A new wound, redness, swelling, discharge or any other change in your foot can be an early warning sign of infection.

What can make it serious?

You have a foot wound, ulcer or infection and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine (possible sepsis).
Your leg or foot suddenly turns cold and pale, with pain or numbness, or you suddenly can't move it.
You have a foot ulcer or wound and also have a fever, flu-like symptoms, a high or low temperature or a fast heartbeat.
You have diabetes or poor circulation and signs of infection in your foot, toe or nail, such as redness, warmth, swelling, pus, a bad smell or more pain.
You have diabetes or poor circulation and a foot infection that is spreading fast, with a fever, and you feel very unwell.
You have diabetes, poor circulation or reduced feeling in your feet and notice a new wound, sore, blister or colour change on your foot, or a sore that isn't healing.
You have diabetes or reduced feeling in your feet and one foot becomes red, hot or swollen, or suddenly changes shape, even if it doesn't hurt (possible Charcot foot).
You have constant pain in your foot or toes that is worse at night or when your legs are raised, and eases when you hang your leg down (this can be a sign of poor circulation).
The skin on your toes or foot turns dark or black, or a wound turns black and smells bad.

Frequently asked questions

Will I need antibiotics for my foot ulcer?

Only if the wound is infected. An ulcer with no sign of infection in the soft tissue or bone does not need antibiotics. If it is infected, your team will usually take a sample of tissue to find the germs, so they can choose the right antibiotic.

Who treats a diabetes-related foot ulcer?

Usually your podiatrist, practice nurse or another trained health professional does the regular wound care. If the ulcer is not improving, ask for a review by a foot team and for your circulation to be checked, because poor blood supply slows healing.

Can a foot ulcer be healed completely?

Ulcers can heal with the right care, especially when pressure is taken off the sore and any infection or poor blood supply is dealt with. Casting healed 91 per cent of suitable ulcers in the figures available. Your foot will still need ongoing attention afterwards, as another ulcer is more likely.