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Heather Hanks
Written by Heather Hanks

Reviewed by Veena Angle, MBBS, MD and Physician Chu I Ta on July 5, 2022

How To Heal A Diabetic Foot Ulcer

A diabetic foot ulcer isn't just painful. It can also lead to infection and even amputation if it's not properly cared for. Learn more here.

Doctor treating a foot ulcer min scaled

A diabetic foot ulcer is a wound or an open sore commonly found on the bottom of the foot. It affects approximately 15% of people with diabetes.

Among these people, about 6% will become hospitalized due to an infection related to the ulcer. While this number isn’t high, it can be extremely painful if you’re one of the sufferers.

In this guide, our experts explain what a diabetic ulcer is. They will also provide tips on how to care for your feet if you have diabetes.

What Causes A Diabetic Foot Ulcer?

A diabetic foot ulcer is caused by damaged nerves. It may lead to muscle weakness and atrophy.

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 fibers.

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 play a central role in the formation of ulcers. These include flatfoot, claw toes, hammer foot, hallux valgus, and Charcot neuropathy. 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 that 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. 

Tips For Preventing A Diabetic 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. 

Diabetic Foot Ulcer Treatment Options

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.

Take the pressure off the injured area 

Offloading refers to the use of a walker or crutches to take the pressure off the ulcer.

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

Remove dead skin from the ulcer 

Debridement may help with the removal of surface debris and necrotic tissues. Necrotic tissues are characterized by the death of a localized 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 defense mechanisms to rid the ulcer bed of devitalized tissue.

Herbal formulas or ingredients 

Correct a Qi and Yin Deficiency with a formula called Qi Wei Bai Zhu SanBa Zhen Tang can remedy a Blood and Qi Deficiency and Jin Kui Shen Qi Wan can help a Yin and Yang Deficiency. 

Likewise, consuming herbal formulas treats excess syndromes. Yang He Tang can alleviate Damp-Cold obstructing the collaterals. This relieves symptoms like Cold intolerance, sore and numb limbs, and pain that transpires from too much walking. 

Tao Hong Si Wu Tang can medicate Blood Vessel Stasis and Obstruction. Clear Excessive Damp-Heat Toxin with the use of a formula called Si Miao Yong An Tang.

Many studies have shown to aged black garlic may help control blood sugar levels to help manage diabetes. It has also been shown to help reduce the risk of infections from a diabetic foot ulcer.

Early Detection Is Best For Diabetic Foot Ulcer Treatment

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.

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