What exactly is a diabetic foot ulcer and why is it concerning?

Diabetic foot ulcers are a serious complication of diabetes mellitus that can lead to lower extremity amputations. In the provided context, a 65-year-old female with type 2 diabetes developed a diabetic foot ulcer. This patient also had co-existing conditions, including Peripheral Arterial Disease (PAD), Chronic Kidney Disease (CKD), and Coronary Artery Disease (CAD), which further complicated her treatment and recovery. The ulcer developed after using a hot water bottle, highlighting the importance of patient education regarding foot care and avoiding thermal injuries.

How does Peripheral Arterial Disease (PAD) relate to diabetic foot ulcers?

Peripheral Arterial Disease (PAD) is a condition characterized by the narrowing of the arteries in the legs and feet, reducing blood flow. PAD is significant in the context of diabetic foot ulcers because reduced blood flow impairs the body's ability to heal wounds, including diabetic foot ulcers. The patient in this case study was diagnosed with PAD, which, along with other comorbidities such as Chronic Kidney Disease (CKD) and Coronary Artery Disease (CAD), complicated her treatment and recovery. The arterial Doppler indicated diffuse atherosclerotic narrowing in lower limb arteries.

What causes diabetic foot ulcers?

The primary cause of diabetic foot ulcers is often a combination of factors, including diabetic peripheral neuropathy (nerve damage), reduced blood flow (often due to Peripheral Arterial Disease (PAD)), and poor wound healing. Neuropathy can lead to a loss of sensation, making patients unaware of injuries. In this scenario, the patient's ulcer developed after she used a hot water bottle, which resulted in a thermal injury. In this specific case, the patient's history of diabetes, PAD, Chronic Kidney Disease (CKD), and Coronary Artery Disease (CAD) compounded the issue, delaying healing and increasing the risk of complications.

What treatments are typically used for diabetic foot ulcers?

Effective treatment of a diabetic foot ulcer requires a multidisciplinary approach, as demonstrated in the case study. This includes aggressive treatment of any infection with antibiotics, regular debridement to remove necrotic tissue, daily dressing with recombinant human Platelet Derived Growth Factor (rhPDGF), and complete off-loading of the foot. Moreover, the patient should receive medical management, including diabetes control, foot care, and consultations with cardiology and nephrology to address co-existing conditions like Peripheral Arterial Disease (PAD), Chronic Kidney Disease (CKD), and Coronary Artery Disease (CAD).

How can I prevent getting a diabetic foot ulcer?

Preventing diabetic foot ulcers involves several key strategies. Patient education is crucial, emphasizing proper foot hygiene, nail care, and the use of appropriate footwear. Patients should avoid extreme temperatures, such as those from hot water bottles, to prevent thermal injuries. Regular foot examinations are also essential for early detection of any issues. Good blood sugar control is another key element. The patient in the case study had a history of inconsistent diabetes management, highlighting the importance of consistent treatment. Moreover, managing co-existing conditions such as Peripheral Arterial Disease (PAD), Chronic Kidney Disease (CKD), and Coronary Artery Disease (CAD) is vital in preventing and treating diabetic foot ulcers.

Healing diabetic foot ulcer with symbols of comprehensive care.

Diabetic Foot Ulcers: A Comprehensive Guide to Healing and Prevention

Theo Raines in Health & Wellness December 2025 • 4 min read.

"Understanding the complexities, treatments, and preventative measures for diabetic foot ulcers in patients with multiple health conditions."

Diabetic foot ulcers are a frequent and severe complication of diabetes mellitus, often leading to lower extremity amputations. Effective management requires a multidisciplinary approach, especially when patients have co-existing conditions such as Peripheral Arterial Disease (PAD), Chronic Kidney Disease (CKD), and Coronary Artery Disease (CAD). These conditions can complicate treatment and increase the risk of adverse outcomes.

Patient education is crucial in preventing diabetic foot ulcers. Primary care physicians play a vital role in educating patients about proper foot hygiene, nail care, appropriate footwear, and the importance of avoiding extreme temperatures. Simple measures can significantly reduce the risk of thermal injuries and subsequent ulcer development.

This article delves into a case study illustrating the challenges of treating a diabetic foot ulcer in a patient with multiple comorbidities. It highlights the importance of comprehensive care and patient education in achieving successful outcomes.

Understanding the Case: A Patient with Multiple Complications

Healing diabetic foot ulcer with symbols of comprehensive care.

A 65-year-old female with a 15-year history of type 2 diabetes was admitted to the hospital with complaints of breathing difficulty, fever, body swelling, and a non-healing ulcer on her left foot. She had a history of diabetic peripheral neuropathy, CAD with cardiomyopathy, and CKD. The foot ulcer developed after using a hot water bottle on her feet.

Her past treatment history revealed inconsistent management of her diabetes, with periods of stopping treatment. Although she had been on oral hypoglycemic agents and later insulin, her blood sugar control remained poor. Additionally, she had been receiving medical treatment for her cardiac issues without any interventions.

General Examination: The patient presented with poor general condition, obesity, fever, paleness, shortness of breath, facial puffiness, and foot edema. Peripheral pulses were weak in both feet.
Foot Examination: The left foot had an ulcer with cellulitis extending up the leg. The ulcer had purulent discharge and necrotic tissue at the mid-foot and base of the fifth toe.
Investigations: Lab results showed anemia, elevated white blood cell count, high blood sugar, and impaired kidney function. Pus culture grew Staphylococcus aureus and E. coli. Arterial Doppler indicated diffuse atherosclerotic narrowing in lower limb arteries.

Based on these findings, the patient was diagnosed with type 2 diabetes with neuropathy, PAD, CKD, CAD with cardiomyopathy, a left diabetic foot ulcer, severe anemia, and septicemia. Treatment included medical management, diabetic foot care, and consultations with cardiology and nephrology.

Treatment and Recovery: A Road to Healing

The patient received aggressive treatment for the infection with a combination of antibiotics and underwent blood transfusions. Regular debridement and daily dressing with recombinant human Platelet Derived Growth Factor (rhPDGF) were performed. Complete off-loading of the foot was ensured for several weeks.

After three weeks of hospital treatment, the patient's general condition improved, with better blood sugar control and improved kidney function. She was discharged with advice for regular follow-up appointments with a diabetologist, cardiologist, and nephrologist, as well as daily dressing of the ulcer.

Continuous and diligent wound care led to complete wound closure within 10 weeks. This case highlights the importance of early detection, aggressive treatment, and continuous care in managing diabetic foot ulcers, especially in patients with multiple comorbidities. It also reinforces the critical role of patient education in preventing and managing this challenging condition.