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Diabetic Foot Ulcer: How to Protect the Limb from an Infection

People with a diabetic foot ulcer are vulnerable to infection. Not treating the condition promptly can result in amputation.

Elderly woman massaging her heel while sitting on a sofa

Did you know that a diabetic foot ulcer is a common cause of foot pain? Yes, that’s right! Malaysia’s National Health and Morbidity Survey show a worrying increase in the diagnosis of this disorder from 2006 to 2015. The total number of people with diabetes with a foot ulcer was 11.6% in 2006, 15.2% in 2011, and 17.5% in 2015.

Hence, taking swift actions to prevent or manage this foot disorder is necessary to prevent an infection or amputation and improve a person’s quality of life. Here are the risk factors of a diabetic foot ulcer, and ways to treat it before it’s too late. 

Man holding his right ankle while planting his feet on the grass
Muscle weakness is a sign of motor neuropathy.

The Risk Factors of a Diabetic Foot Ulcer 

Notable reasons behind a foot ulcer in people with diabetes are peripheral neuropathy, peripheral arterial disease, or various foot traumas. It’s worth noting that foot ulcers can also stem from a combination of these factors. 

Peripheral neuropathy 

Neuropathy is a well-known factor in most diabetic foot ulcer cases. The disease damages nerves, thus impairing the motor, sensory and autonomic fibres.

Motor neuropathy involves muscle paresis, weakness, and atrophy. Sensory neuropathy can degenerate dorsal root ganglia and lead to sensory deficits involving pain, pressure, and heat. Autonomic neuropathy can bring about vasodilation and decrease sweating. Subsequently, a person will lose skin integrity, making an affected area vulnerable to infection. 

A loss of sensation in the feet can increase a person’s risk of sustaining injuries. It can come from internal or external causes. These include: 

  • Burns 
  • Inappropriate shoe use 
  • Foot calluses 
  • Foreign bodies 
  • Foot and nail deformities 

Injuries may appear undetected during the initial stages, and consequently trigger foot ulceration. 

Peripheral arterial disease 

This disease impacts the segments between the ankle and knee. It can be up to eight times more prevalent in people with diabetes. In addition, it’s a predictor of foot ulceration, especially in people who suffer minor injuries with infection complications.

Feet trauma 

Structural foot deformities and abnormalities – flatfoot, claw toes, hammer foot, hallux valgus, and Charcot neuropathy – play a central role in the formation of ulcers. It can be attributed to abnormal plantar pressure, which predisposes the feet to ulceration. 

Deficiency and Excess syndromes 

In Traditional Chinese Medicine (TCM), a diabetes-related foot ulcer is also known as diabetic gangrene. It’s also an advanced stage of the disease, and can be broken down into multiple Deficiency and Excess syndromes.

“The primary pathogenic factors of all chronic diseases during the latter stages possess a Deficiency syndrome, while the secondary factors of a chronic disease are considered Excess syndromes,” explains Real Health Medical Chief TCM Physician Chu I Ta. 

Deficiency syndromes which are linked to a diabetic foot ulcer are blood and qi (vital life force) Deficiency, qi and yin Deficiency, and yin and yang (active energy) Deficiency. Meanwhile, Excess Syndromes can be classified as Damp-Cold Obstructing the Collaterals, Blood Vessel Stasis and Obstruction and Excessive Damp-Heat Toxin. 

How to Prevent the Occurrence of a Foot Ulcer 

Proper foot care and the management of minor injuries can help prevent ulcer formation. A daily inspection of the feet is mandatory. Gently cleanse and dry them at least once a day.

People with diabetes should also use shoes with socks indoors and outdoors, and stay away from heating pads. 

Elderly man pushing an elderly woman sitting on a wheelchair as they laugh together outdoors
Wheelchair use can ease the pressure on the ulcer area.

How to Treat a Foot Ulcer and Avoid Infection 

If a person does develop a foot ulcer, the main objective of clinical treatment will be to heal the wounds as soon as possible. Separately, a TCM physician will propose the use of herbal formulas and ingredients that address the distinct syndromes of a foot ulcer.

Ease the pressure off the injured area 

Also known as ‘offloading’, this treatment step promotes the use of a brace, wheelchair, crutches, or specialised footgear or castings. In doing so, a person can reduce the pressure and irritation on the foot ulcer area.

Remove dead skin and tissue from the ulcer 

Debridement may help with the removal of surface debris and necrotic tissues. Necrotic tissues are characterised by the death of a localised area of living tissue. This process will improve the healing of chronic wounds by encouraging the production of granulation tissue.

Surgical debridement uses scalpels to rapidly remove hyperkeratosis and dead tissue. The tip of a scalpel has to be pointed at a 45˚ angle to remove non-viable tissues and achieve a healthy, bleeding ulcer bed. Enzymatic debridement uses agents like papain – a proteolytic enzyme from raw papaya crab-derived collagenase and krill collagen to remove necrotic tissue without damaging healthy tissue.

Biological debridement uses sterile maggots to digest bacteria, necrotic tissue and surface debris. Autolytic debridement, on the other hand, uses dressings to create a moist wound environment. Consequently, it enables host defence mechanisms to rid the ulcer bed off devitalised tissue.

Herbal formulas or ingredients 

Correct a qi and yin Deficiency with a formula called qi wei bai zhu san (七味白术散) while ba zhen tang (八珍汤) can remedy a blood and qi Deficiency and jin kui shen qi wan (金匮肾气丸) can help a yin and yang Deficiency. 

Likewise, consuming herbal formulas treats excess syndromes. Yang he tang (阳和汤) can alleviate Damp-Cold Obstructing the Collaterals, thereby relieving symptoms like cold intolerance, sore and numb limbs, and pain that transpires from too much walking. Yang he tang (阳和汤) can alleviate Damp-Cold Obstructing the Collaterals, thereby relieving symptoms like cold intolerance, sore and numb limbs, and pain that transpires from too much walking.

Tao hong si wu tang (桃红四物汤) can medicate Blood Vessel Stasis and Obstruction. Clear Excessive Damp-Heat Toxin with the use of a formula called si miao yong an tang (四妙勇安汤). 

Early intervention is the best way to lower the risk of a person’s diabetic foot ulcer exacerbating and becoming infected. If you wish to consider using herbal formulas to regulate imbalances, speak to a TCM practitioner beforehand.


  1. US National Library of Medicine. 2021. Malaysian clinical practice guidelines for management of diabetic foot: A synopsis for the primary care physician. [online] [Accessed 22 March 2022] 
  2. US National Library of Medicine. 2012. Management of Diabetic Foot Ulcers. [online] [Accessed 22 March 2022] 
  3. National Library of Medicine. 2013. Prevention of Diabetic Foot Ulcer. [online] [Accessed 22 March 2022] 
  4. University of Michigan Health. Frequently Asked Questions: Diabetic Foot Ulcers. [online] [Accessed 22 March 2022] 

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