Foot Center Clinic

Prevention of foot ulcers and gangrene


Foot ulcer

Over the years, more diabetic patients have become affected by diseases (diabetic foot disease) such as foot ulcers and gangrene. The cause of this is the rising number of patients developing complications of diabetes: nerve damage (neuropathy) and poor circulation by arteriosclerosis (vascular disease).

Foot ulceration is a state of skin damage. When accompanied by infection, the surrounding area will become red with leaking discharge.

Foot gangrene

Foot gangrene is a disease triggered by severe vascular diseases and bacterial infection where the skin and/or subdermal tissue become necrotic and turn into a dark black color. Foot amputation is unavoidable if you have a spreading gangrene or foot ulcer in the presence of severe infection.

Check to see if you are at high risk (in the chart below) and protect your feet from ulcers and gangrene by daily foot care.

Risk factors for the diabetic foot

lf assessment of risk factors leading to foot ulcer and gangrene

□Age 65 ≦
□Duration of diabetes 15 years≦
□HbA1c 8% ≦
□Poor blood flow to the feet
□Weak vision
□Kidney problems

□Swollen feet
□Deformed feet
□Stiff joints
□Calluses and/or corns
□History of amputation
□History of foot ulcers
□Wearing ill-fitting shoes

You are at high risk if you have check marks on more than one factor above, or if the single factor that you have checked is severe.

Clinical pathways leading to the diabetic foot

How diabetic foot ulcers and gangrene are formed

If you have diabetes and have had prolonged elevated blood glucose levels, you may develop complications of diabetes: nerve damage (neuropathy) or poor circulation by arteriosclerosis (vascular disease).

On the other hand, having prolonged elevated blood glucose levels can make you prone to bacterial infection due to weakened resistance in your body. Therefore, you should be cautious for external damages such as trauma, shoe irritation and low temperature burns as they can trigger ulceration or gangrene.


With the progression of neuropathy, you may easily develop shoe irritation or burns as your ability to sense pain and temperature decreases.
Furthermore, it may take time for you to realize that you have developed these problems.

You may have a hard time noticing that you have stepped on a nail or other foreign objects.
Be cautious for trauma -not only outdoors, but also indoors.

You can easily get burns as your feet loses ability to sense temperature.
Before taking a bath, check the temperature of the water (40℃) with a thermometer.

Case of damaged toes by wearing tight shoes.
The patient had not realized sores on the feet. There were blood stains in the patient's shoes. It is important to wear well-fitting shoes as well as checking inside your shoes regularly.

Case of infection by self treating the callus.
The patient had not realized signs of strong inflammation and discharge.

Vascular disease -1

Vascular disease (arteriosclerosis obliterans)

If you have diabetes, your chance of developing a lower extremity vascular disease will be five times higher than people without diabetes. Also, progression of the disease will be faster if you have diabetes. Initially, you would have no symptoms, but soon after, numbness and coldness will appear. The, you will experience a condition called intermittent claudication where the lower extremity will become painful after walking and become better when you take a rest. Eventually, you will have rest pains followed by ulceration and gangrene. Consult your doctor if your are experiencing aforementioned symptoms (arteriosclerosis obliterans).

Vascular disease -2

If you have diabetes, an extended lower limb arteriosclerosis will develop on both of your legs.
Occlusions often develop in areas like the lower limb (calves) where the peripheral arteries flow.<

Diabetic foot gangrene
-Arteriosclerosis obliterans complicated by bacterial infection-

You should be aware that foot amputation may be unavoidable if arteriosclerosis obliterans develops into gangrene, as the foot can easily become infected.

Lowered immunity by high blood glucose levels

Since high blood glucose levels can reduce your ability to fight bacteria, they would grow at the wound and create an infectious environment.

Even if the wound is small and not so deep in the beginning, if you don't treat it properly, it may develop into severe lesions such as deep ulcers or gangrene. Unfortunately, these severe lesions lead to amputation and will also take longer to heal.
In order to prevent your feet from gangrene or ulcers, the most important step is a simple daily foot care.

National Hospital Organization Diabetic Foot Research Group

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