People with diabetic foot problems may develop chronic wounds (foot ulcers). But these wounds can heal again if treated in time. Amputation can often be avoided in this way.
Treating a chronic wound on the foot takes patience, but it often pays off: The right measures can be very effective. But doctors might still suggest amputation if the wound is large. It is then a good idea to seek further advice and get a second medical opinion.
The most important things you can do are:
Other options include:
How quickly a wound heals due to treatment mainly depends on how big and deep the wound is, where it is, and how consistently pressure is relieved. If there's a blood flow problem, it should be fixed with surgery. Small wounds can heal within a few weeks. Bigger wounds may take months to heal.
There is a rare kind of diabetic foot known as Charcot foot (neuroarthropathy), which leads to broken bones and deformations. The treatment here involves completely immobilizing the foot (keeping it still) to stabilize it and prevent further bone damage. A plaster cast or a knee-high brace is worn for several months. Special custom orthopedic shoes are worn afterwards to prevent any further damage.
A wound can only heal properly if it's completely relieved of pressure. Depending on the type of wound, the following options are available:
Wound treatment involves:
The most suitable wound dressing will depend on things like how deep the wound is, whether it’s infected, and what stage of healing it’s at. The dressings have to be changed regularly.
An infected wound can't heal. Severe infections may also spread through the body and become life-threatening. For this reason, it’s very important to regularly clean an infected wound thoroughly and take antibiotics for long enough (often for several weeks). Infected pieces of bone and other tissue can be surgically removed.
A skin graft or tissue graft may speed up the healing process. Skin grafts involve covering the wound with skin taken from another part of your body. A thin layer of skin from the thigh is normally used. It grows onto the wound and can help to close it up. In tissue grafts (flap surgery), the wound is covered with a piece of tissue from your own body – taken from the thigh, for example.
A lot of people with diabetes have narrow blood vessels. Typical symptoms of blood circulation problems (like pain in the lower legs) easily go unnoticed if people can no longer feel them because of nerve damage. Poor blood flow in the legs prevents the wound from healing properly. Blood flow can be improved again with surgery. This can be done in two ways:
These procedures are particularly suitable for people with blood flow problems where wound care and pressure relief isn’t helping enough.
An amputation is only considered if no other treatment options are left. It can often be avoided with good preventive measures and treatment – even if the wound has been there for a long time.
There are different kinds of amputations:
Amputations may be necessary if
When doing an amputation, doctors only remove as much of the foot as absolutely necessary. A minor amputation (for instance, removing individual toes) is usually enough. An amputation above the ankle joint is rarely needed.
Ideally, you should go to a diabetes practice that specializes in treating diabetic foot problems as soon as possible. It is also a good idea to have treatment in a specialist foot care center. People living in Germany can find specialized diabetes practices and certified foot care centers on the German Diabetes Association's (DDG) website.
The treatment will be most successful if the various specialists work closely together. These usually include family doctors, diabetologists, podiatrists, vascular medicine (blood vessel) specialists, surgeons, orthopedic technicians, and nursing staff. It is important that the diabetic foot treatment is coordinated by one doctor’s office. That is usually done by a diabetes center or a diabetic foot outpatient department in a hospital.
It is important to have regular foot check-ups. How often you have a check-up depends on how severe the diabetic foot problems are. If you don't have any nerve damage (neuropathy), an annual check-up is enough. If nerves are already damaged, a check-up every six months is recommended. If you’ve already had a wound, a check-up every one to three months is recommended.
You should also check your feet yourself for sore areas, injuries, redness, fungal infections and any other abnormalities – ideally every day. It can be helpful to use a hand mirror so you can see your whole foot, including the sole and between your toes.
It is sometimes a good idea to get a second medical opinion. If a doctor recommends a foot amputation, they are even legally obliged to inform you that you have a right to get a second opinion.
The most important question is why the amputation was recommended: Is there really no other way to save the foot? What are the possible pros and cons of the operation?
Getting a second medical opinion means going to another doctor’s office or hospital for advice from specialists. Our decision aid may help too. It briefly summarizes the main pros and cons of the different treatment options.
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The International Working Group on the Diabetic Foot. IWGDF Guidelines on the prevention and management of diabetic foot disease. 2019.
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.
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