Diabetic Foot Ulcer

A diabetic foot ulcer is a chronic foot wound that develops in diabetic people. It most often develops on weight-bearing areas such as the heel and the plantar surface of the metatarsal heads.

Its development involves four key mechanisms: neuropathy, hypoperfusion, infection, and impaired healing.

Neuropathy plays a central role. Loss of protective sensation prevents injury awareness.

Motor neuropathy leads to muscle imbalance and structural deformities. Autonomic dysfunction reduces sweating, leaving the skin dry and fissured.

Hypoperfusion, caused by peripheral artery disease and microvascular dysfunction, restricts blood flow.

Combined with impaired oxygen release from glycosylated hemoglobin, this leads to hypoxia, suppressing angiogenesis and cellular repair.

Disrupted skin barrier function, poor perfusion, and impaired immune function allow infection to develop easily and spread rapidly.

Hyperglycemia worsens healing by weakening neutrophils, prolonging macrophage activity, and reducing fibroblast and keratinocyte function.

These disturbances keep the ulcer in a chronic, non-healing state.