Diabeticfootwounds,treatedurgently.

• A diabetic foot ulcer is an open wound or sore on the foot in a person with diabetes — most commonly under the ball of the foot or on the heel.
• Diabetic ulcers heal slowly because of impaired circulation and nerve damage that prevent the body's normal healing response.
• Treatment includes wound care, offloading, infection control, blood sugar optimization, and addressing the underlying cause.
• Untreated ulcers can lead to deep infection, bone infection, or amputation — early treatment is essential.
• Our diabetic foot program is led by Dr. Cara Beach at our Cedar Mill and Hoyt offices.

What are diabetic foot ulcers?

A diabetic foot ulcer is an open sore or wound on the foot in a person with diabetes. They typically develop in areas of high pressure or repeated friction — under the ball of the foot, at the heel, or over a bunion or hammertoe. Diabetic ulcers are particularly dangerous because two complications of diabetes work against healing: peripheral neuropathy (loss of protective sensation, so patients don't feel injury early) and peripheral arterial disease (reduced blood flow to the feet, which impairs the healing response).

About 15% of people with diabetes will develop a foot ulcer in their lifetime, and ulcers are the leading cause of non-traumatic amputation in the United States. The single most important risk factor is peripheral neuropathy combined with mechanical overload — a callus that becomes a blister that becomes an ulcer because the patient never felt the pain that would have prompted them to stop and look.

At Northwest Extremity Specialists, our diabetic foot program is led by Dr. Cara Beach at our Hoyt office, with same-day urgent evaluation available at our Milwaukie clinic. The treatment approach is aggressive and multi-disciplinary: thorough wound assessment, sharp debridement, advanced dressings, total contact casting or specialized boots for offloading, infection control, and coordination with the patient's primary care or endocrinologist for blood sugar optimization. The vast majority of diabetic ulcers heal completely when treatment is started early.

See it in motion

What it feels like

Diabetic ulcers can be subtle, especially in patients with significant neuropathy who feel no pain. Look for:

• An open sore, blister, or break in the skin — particularly under the ball of the foot or on the heel
• A callus that's become discolored (red, brown, or black) — often the precursor to an ulcer underneath
• Drainage or unusual odor from the foot
• Swelling, redness, or warmth around a wound or callus
• A sock or shoe with unexplained staining
• Fever or chills along with foot drainage (urgent — possible deep infection)
• A wound that's not healing after a few days
• Pain that's changed character (could indicate progression to deep infection or bone involvement)

Why it develops

Diabetic ulcers develop from the interaction of several diabetes complications:

• Peripheral neuropathy — loss of protective sensation in the feet
• Peripheral arterial disease — reduced blood flow that impairs healing
• Foot deformities (bunions, hammertoes, Charcot foot) that create pressure points
• Poorly fitting shoes that cause blisters or pressure sores
• Walking barefoot — particularly dangerous for neuropathic patients
• Poorly controlled blood sugar, which impairs immune response and healing
• Smoking, which dramatically reduces circulation
• Prior amputation, which alters pressure distribution on the remaining foot

How we diagnose diabetic foot ulcers

A diabetic foot ulcer evaluation is comprehensive. Your provider will measure and document the ulcer (size, depth, drainage, surrounding tissue), probe to assess depth and possible bone involvement, check pedal pulses and protective sensation, and look at the contralateral foot for similar risk areas. On-site digital X-ray is taken to evaluate for bone infection (osteomyelitis) and underlying bony abnormalities. Wound cultures may be taken if infection is suspected. Vascular studies are ordered if circulation appears compromised. Most patients begin treatment in the same visit.

Non-surgical care

The cornerstone of diabetic ulcer care is consistent, structured wound management. Healing is not about a "magic" dressing — it's about doing the right things consistently over weeks:

• Sharp debridement at every visit to remove dead tissue and stimulate healing
• Total contact casting or specialized offloading boot for foot ulcers
• Advanced wound dressings selected to match wound stage (gel, foam, collagen, antimicrobial)
• Treatment of any infection — oral or IV antibiotics depending on severity
• Optimization of blood sugar control in coordination with primary care or endocrinology
• Vascular evaluation and revascularization if circulation is compromised
• Custom diabetic shoes and inserts to prevent recurrence
• Patient education on daily foot inspection and footwear
• Smoking cessation support if applicable

Surgical care

Surgical intervention is part of advanced diabetic ulcer care for selected patients. The goal is to remove infected tissue, correct mechanical overload, and preserve as much of the foot as possible.

• Wound debridement in clinic or in the operating room
• Bone biopsy and resection of infected bone (osteomyelitis)
• Tendon lengthening (Achilles, gastrocnemius) to reduce forefoot pressure
• Correction of bunions or hammertoes that are creating chronic pressure
• Skin grafting or flap coverage for selected large wounds
• Partial amputation when tissue is not salvageable — always as a last resort
• Revascularization (typically in coordination with vascular surgery) to improve blood flow

Diabetic wound healing is measured in weeks to months, not days. Most uncomplicated ulcers heal in 8–16 weeks with consistent care. Patients are typically followed weekly initially, then biweekly as the wound closes, then enrolled in a long-term diabetic foot care program to prevent recurrence.

When to see a specialist

• Any new wound, blister, or open sore on a diabetic foot — get it evaluated promptly
• A callus that has changed color or developed surrounding redness
• Drainage from a foot wound, or wound with odor
• Fever or chills with a foot wound (emergency)
• A wound that's not healing or appears to be getting larger
• Pain that's changed in character or intensity in a previously stable wound

Our diabetic foot program is led by Dr. Cara Beach at our Cedar Mill and Hoyt offices. Urgent evaluation is available at any of our 8 clinics. All of our board-certified podiatrists are trained in diabetic foot care, and patients with established ulcers are typically seen weekly for ongoing wound management.

Frequently asked questions

• Diabetic Neuropathy
  The underlying nerve damage that allows ulcers to develop unnoticed
• Corns & Calluses
  Diabetic calluses often precede ulcers — early treatment prevents progression
• Fungal Nail Infection
  Fungal infections in diabetics increase the risk of complications
• Ingrown Toenails
  Particularly urgent in diabetics — can rapidly progress to infection