Diabetic Wounds & Foot Ulcers

Foot ulcers are a common and serious diabetes complication. Many people with diabetes will have one at some point in their lives, and ulcers are a leading reason for diabetes-related hospital stays and amputations.

• Neuropathic ulcers: caused mainly by nerve damage and pressure, often under the ball of the foot or big toe.
• Ischemic ulcers: caused mainly by poor blood flow, often on the toes or edges of the foot, and slower to heal.
• Mixed ulcers: from both nerve damage and poor blood flow.
• Infected wounds: an ulcer with infection of the skin, deeper tissue or bone (osteomyelitis).
• Other diabetic wounds: slow-healing cuts, blisters or pressure sores elsewhere on the body.

• Nerve damage (neuropathy) in the feet
• Poor circulation (peripheral artery disease)
• Blood sugar that has been high for a long time
• Calluses, corns, bunions, hammertoes or other foot shape changes
• Shoes that don't fit well, or walking barefoot
• A past foot ulcer or amputation
• Smoking
• Kidney disease, vision problems or trouble reaching your feet

• An open sore, blister or crack in the skin
• Drainage on your socks or a bad smell
• Redness, warmth or swelling around a wound
• A callus with dark color or blood under it
• Pain, or no pain at all if you have nerve damage
• Skin that turns black (a sign of tissue death)
• At your visit, your provider removes your shoes and socks to look at your whole foot, checks feeling with a monofilament, checks the pulses in your feet, and measures any wound's size and depth. They look for signs of infection and check whether a probe reaches bone.

Diagnosis is based on a careful foot exam.

Lab tests your provider may order include: A1C and blood glucose, a complete blood count (CBC), inflammation markers (ESR and CRP), a comprehensive metabolic panel (kidney function), and a wound culture if infection is suspected.

Other tests may include a screening Doppler or ankle-brachial index to check blood flow, done in our office; if more detail is needed, confirmation and mapping are done at a vascular clinic. You may also need an X-ray or MRI to check for bone infection. We don't do X-rays or other imaging at our office; we refer you to a trusted outside center and review the results with you.

Wound care works best when started early:

• Off-loading: taking pressure off the wound with special shoes, a boot, cast or crutches. This is one of the most important steps.
• Wound care: cleaning, removing dead tissue (debridement) and the right dressings, done by a trained team.
• Treating infection with antibiotics when needed; deeper infections may need a hospital stay.
• Improving blood flow, sometimes with a vascular specialist.
• Keeping blood sugar near goal to help healing.
• Quitting smoking.
• Prevention: check your feet every day, wear well-fitting shoes and socks, never walk barefoot, keep skin moisturized (but not between the toes), and get regular foot exams.

Many foot ulcers heal with good wound care and off-loading, but healing can take weeks to months. Ulcers often come back, so prevention stays important.

Serious infections can lead to hospital care or amputation, which is why getting help early matters. Results vary, and no one can promise a specific outcome.

Your primary care team at Moaddel Medical checks your feet at visits, helps manage your blood sugar and orders the tests you need.

Royal Wound Care, part of Moaddel Medical and led by Dr. Moaddel, provides full-scope wound care in house. Our networking partners offer home nursing for dressing changes and medication management. We coordinate with vascular, podiatry and endocrinology partners and imaging centers when needed.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.