Diabetic Foot Ulcers

People with poorly controlled diabetes usually experience decreased foot sensation and impaired wound healing. As a result, they may develop foot ulcerations that are painless and heal poorly. The lifetime incidence of diabetic foot ulcers in people with diabetes is 19%–34%.^[1]

Ulcerations typically develop on the weight-bearing areas of the foot, such as the heel or metatarsal head (also known as the ball of the foot).^[2] These ulcerations look round and crater-like. In severe cases, they may ooze and bleed.

A clinician will assess the ulcer by looking at its length, width, depth, and accompanying drainage as well as looking for signs of infection or ischemia (i.e., cell death due to decreased blood supply).

There are several classification systems for diabetic foot ulcers. Some commonly used ones are the University of Texas (San Antonio), Wagner-Meggitt, PEDIS, and SAD classifications.^[3]

The main treatments include wound debridement (removing dead skin and tissue), moist wound dressings, reducing weight on the ulcer (via orthotics or shoe changes), antibiotics to combat infections, and controlling blood sugar levels (poorly controlled blood sugar can impair wound healing).^[4]

Magnesium, Vitamin E, Zinc, Arginine, omega-3 fatty acids, Vitamin D, protein, and probiotics have been studied for diabetic foot ulcers, but there is no strong evidence that any of these supplements are beneficial.^[5]

Because there is limited evidence on diet and diabetic foot ulcers, the American Limb Preservation Society (ALPS) recommends a diet with adequate fluids, energy, protein, carbohydrates, fat, and micronutrients (i.e., Zinc, Vitamin C, Vitamin D, and Vitamin E) to facilitate proper wound healing. People with diabetic foot ulcers, like other wound patients, have higher energy and macronutrient needs. The ALPS guidelines therefore recommend foods rich in the aforementioned micronutrients with an intake of 30–35 kcal per kilogram of body weight, 1.25–1.5 grams of protein per kilogram of body weight, and 25-35 mL of fluid per kilogram of body weight daily. Carbohydrate and fat intake should be individualized to the person’s current level of diabetes control while supporting their overall energy needs.

The development of diabetic foot ulcers is multifactorial. Since poorly controlled diabetes can cause nerve damage, the resulting neuropathy (dysfunction of peripheral nerves) causes foot deformities, dry skin, and decreased sensation. Moreover, diabetes can impair the body’s ability to heal. As a result, a callus (thickened skin) develops. Over time, constant pressure on that callus damages the skin, producing an ulcer.^[1]