# Foot ulcer

> Foot ulcers are open sores that heal slowly and are frequently associated with diabetes, nerve damage, poor blood flow or pressure. Treatment calls for expert management: relieving pressure, caring for the wound and dealing with any infection.

Guide in [Wounds and ulcers](https://footanklelowerlimb.com.au/learn/topics/wounds-and-ulcers), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/foot-ulcer
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 1 November 2026.
Next review by 1 November 2027.

- **It's an open sore on the foot** that is slow to heal.
- **Diabetes and nerve damage raise the risk,** and an ulcer may not hurt.
- **It needs professional care from the start,** not self-treatment.
- **Prevention relies on regular foot checks, daily checks at home to spot problems early, and suitable footwear.**

## What is a foot ulcer, and how common is it?

A foot ulcer is an open sore or break in the skin of the foot that is slow to heal [1][2]. It may be shallow, in the top layer of skin, or reach deep into the tissue [2]. Pressure, diabetes, nerve damage, poor blood supply, injury or rubbing can all cause one [1]. About 6.3% of people with diabetes have a foot ulcer at any one time [3]. Rates of foot ulcers in adults with diabetes vary around the world [3].

## What causes a foot ulcer, and who gets one?

Foot ulcers usually have several causes acting together [4]. Neuropathy (nerve damage) is the most important cause [4]: loss of feeling means minor injuries or infection may go unnoticed [5]. Deformities such as hammer toes create pressure points that lead to calluses and ulcers [5]. Poor circulation (peripheral artery disease) is a contributing cause in about one-third of foot ulcers, and is present in up to about half of diabetic foot ulcers [4][5]. People with diabetes who are older or have had it longer are more often affected, though age and length of time with diabetes may not directly cause the ulcer [3][6].

## What does a foot ulcer look like, and how is it diagnosed?

The most common sign is an open sore that doesn't heal, often with redness, swelling, pain or tenderness [2]. It can also be hidden under thick, discoloured callus [2]. Foot problems may not hurt, so checking your feet every day helps spot problems early [7]. A podiatrist or doctor checks feeling in your foot, your circulation, the wound and how deep it goes [5][8][9]. If you have diabetes or a slow-healing sore, you can ask for sensation and circulation tests.

## What helps a foot ulcer heal?

For people with diabetes who have a plantar forefoot or midfoot ulcer from nerve damage, without poor circulation or infection, taking pressure off the ulcer (offloading) is arguably the most important step in healing, with a non-removable knee-high device as first choice and a removable knee-high or ankle-high device as second choice if a non-removable device is not suitable or not tolerated [10][11]. Regular removal of dead or unhealthy tissue (debridement) and wound care are also very important [5][12]. Offloading devices or footwear are worn as the podiatrist instructs, wound care visits are attended regularly because debridement and dressing changes are part of treatment, and the multidisciplinary team may include podiatry, vascular, orthotics and diabetes care. Ulcers with poor circulation or infection need the team's assessment first [10][11].

## What if standard care isn't enough?

Add-on treatments, such as special dressings or oxygen therapy, are specialist decisions that follow offloading, infection control and a circulation check [12]. Ask whether circulation has been checked.

## What's the outlook, and how can I stop it coming back?

Ulcers often come back in adults with diabetes: about 40% within a year of healing [13]. Some people need an amputation [14]. Your own outlook depends on your health, circulation and care [13][15][16].

Keep going to foot checks at the interval your clinician sets, even after healing [11][17], and ask about suitable footwear.

> [!tip] Try this
> Check the tops, soles and between your toes daily, using a mirror or a helper [7].

## What can make it serious?

- An infection is getting worse, with more pain, redness, swelling or pus, but the redness isn't spreading and you feel well.
- A wound or sore on your foot or leg hasn't started to heal after two weeks, or keeps coming back.
- Your foot ulcer is being treated but isn't getting better (ask about a review by the foot team).
- Redness from a wound, sore or infection is spreading into your foot or leg, or red streaks run up from it.
- You have a foot wound, ulcer or infection, or a red, hot, swollen foot, and also have a fever, chills, a fast heartbeat or feel unwell.
- Your foot, or a patch of skin on your foot or leg, becomes red, hot, swollen and painful.
- 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 and a foot problem, and you also feel unwell, or your foot swells quickly.
- 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.
- You have pain in a bone with a fever.
- 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).

## Common questions

### How do I know if my foot sore is infected?

An infected sore may look, feel or smell different, and you may feel unwell. Check your foot daily, and read that section if anything changes.

### Why don't diabetic foot ulcers hurt?

Diabetes can damage the nerves in your feet (neuropathy), so pain, pressure and temperature are felt less or not at all. A sore can then go unnoticed. That's why looking at your feet each day matters, even when they feel fine.

### Can I walk on a foot ulcer?

Walking presses on the ulcer, and taking pressure off it is a key part of healing. Wear the offloading device or footwear your podiatrist gives you, as instructed. How much activity suits you, and what to do if it rubs, are topics covered in structured education on weight-bearing activity and footwear.

### Should I keep my ulcer dressing dry?

Yes. A wet dressing can stop an ulcer healing or let bacteria in. Please don't try to treat a foot ulcer yourself. Attend your wound care appointments regularly, because dressing changes are part of treatment, and keep the dressing dry.

## Further reading

- [Foot ulcer on Clindice](https://clindice.com/foot-ulcer)
- [Patient Information](https://www.sath.nhs.uk/wp-content/uploads/2025/06/Diabetes-foot-ulcer-information.pdf), NHS
- [Diabetes - foot ulcers: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000077.htm), MedlinePlus
- [Foot Ulcers](https://www.wwl.nhs.uk/media/.leaflets/65785005dc30b4.52022268.pdf), NHS
- [Section 9: Foot Ulcers](https://www.nhstaysideadtc.scot.nhs.uk/wound%20Formulary/Sections/Section%209%20-%20WMF%20-%20Foot%20Ulcers.pdf), NHS
- [NHS HIGHLAND BEST PRACTICE DFU AND FU PATHWAY AND STANDARDS OF CARE: A VIP APPROACH](https://www.nhshighland.scot.nhs.uk/media/de5jy4yl/best-practice-foot-ulcer-pathway-standards-of-care.pdf), NHS

## Sources

1. Foot Ulcer Diagnosis Guidance · dbth.nhs.uk. https://www.dbth.nhs.uk/wp-content/uploads/2024/09/Foot-Ulcer-Diagnosis-Guidance-2024-2027.pdf
2. Foot ulcers · Health New Zealand | Te Whatu Ora. https://www.healthnz.govt.nz/health-topics/conditions-treatments/skin/foot-ulcer
3. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis · Zhang P, Lu J, Jing Y et al. · Annals of Medicine · 2017. https://doi.org/10.1080/07853890.2016.1231932
4. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists · Boulton AJM, Armstrong DG, Albert SF et al. · Diabetes Care · 2008. https://doi.org/10.2337/dc08-9021
5. Current concepts for the evaluation and management of diabetic foot ulcers · Mavrogenis AF, Megaloikonomos PD, Antoniadou T et al. · EFORT Open Reviews · 2018. https://doi.org/10.1302/2058-5241.3.180010
6. Risk factors for diabetic foot ulcers: A systematic review and meta-analysis · Tang WH, Zhao YN, Cheng ZX et al. · Vascular · 2024. https://doi.org/10.1177/17085381231154805
7. Diabetes & Foot Problems - NIDDK · National Institute of Diabetes and Digestive and Kidney Diseases · 2026. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
8. Chronic Wounds: Evaluation and Management · Bowers S, Franco E · American Family Physician · 2020. https://pubmed.ncbi.nlm.nih.gov/32003952/
9. Global vascular guidelines on the management of chronic limb-threatening ischemia · Conte MS, Bradbury AW, Kolh P et al. · Journal of Vascular Surgery · 2019. https://doi.org/10.1016/j.jvs.2019.02.016
10. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update) · Bus SA, Armstrong DG, Crews RT et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3647
11. Foot care for people with diabetes: Western Australia standards · health.wa.gov.au. https://www.health.wa.gov.au/~/media/Corp/Documents/Health-for/Health-Networks/Disability/Foot-care-for-people-with-diabetes-WA-Standards-2024.pdf
12. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update) · Chen P, Campillo Vilorio N, Dhatariya K et al. · Diabetes/metabolism Research and Reviews · 2024. https://doi.org/10.1002/dmrr.3644
13. The current burden of diabetic foot disease · Edmonds M, Manu C, Vas P · Journal of Clinical Orthopaedics and Trauma · 2021. https://doi.org/10.1016/j.jcot.2021.01.017
14. Diabetic Foot Ulcer Classification Models Using Artificial Intelligence and Machine Learning Techniques: Systematic Review · Silva MA, Hamilton EJ, Russell DA et al. · Journal of Medical Internet Research · 2025. https://doi.org/10.2196/69408
15. Diabetic Foot Ulcer Beyond Wound Closure: Clinical Practice Guideline · Wendland DM, Altenburger EA, Swen SB et al. · Physical Therapy · 2025. https://doi.org/10.1093/ptj/pzae171
16. Podcast on the IWGDF 2023 Guidelines on the Prevention of Foot Ulcers in Persons with Diabetes · Bus SA, Van Netten JJ · Diabetes Therapy · 2024. https://doi.org/10.1007/s13300-024-01578-7
17. Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease · Kaminski MR, Golledge J, Lasschuit JWJ et al. · Journal of Foot and Ankle Research · 2022. https://doi.org/10.1186/s13047-022-00534-7

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This is general information, not advice about your own situation. To discuss your issues, book with one of our podiatrists. In an emergency, call 000.