Peripheral Neuropathy
Reduced sensation may prevent pressure, heat or injury from being noticed. Neuropathy can also change foot mechanics and create areas of excessive pressure.
Treatments → Diabetic Foot Care
Specialized diabetic foot care
Focused on healing and limb preservation.
Comprehensive vascular assessment and individualized treatment planning to control infection, restore blood flow when necessary, support wound healing and preserve functional tissue.
Coordinated careCirculation + infection + wound healing
Understanding diabetic foot disease
Several causes often need to be treated at the same time.
Diabetes can affect the nerves, blood vessels, skin and natural healing processes of the feet. Even a small blister or pressure point may develop into a serious wound if it is not recognized early. Care is therefore coordinated across vascular surgery, diabetology, wound care, podiatry, infectious diseases, radiology and other disciplines when appropriate.
How problems develop
Four factors that can place the foot at risk.
Reduced Blood Supply
Narrowed or blocked arteries limit the oxygen and nutrients needed for healing and infection control. Significant arterial disease may be present without obvious symptoms.
Infection
An open wound can allow infection to spread into deeper tissues, joints or bone—particularly when circulation is reduced or diabetes is poorly controlled.
Pressure and Deformity
Foot deformity, unsuitable footwear and repetitive pressure can cause wounds. Without effective pressure relief, ulcers may fail to heal or return after closure.
Conditions we assess and treat
From early ulcers to complex limb-threatening disease.
Diabetes-Related and Ischaemic Foot Ulcers
Ulcers may develop through neuropathy, pressure, poor circulation, injury, infection or a combination of factors. Prompt vascular assessment is important when reduced blood flow may be limiting healing.
- A cold or pale foot
- Pain in the foot or toes at rest
- Pain that becomes worse at night
- Dark or damaged tissue
- Weak or absent pulses
- A wound that is not healing
- Gangrene in advanced cases
Infected Foot Ulcers
Increasing redness, warmth, swelling, discharge, odour or tissue discolouration may indicate infection. Serious infection can be present without significant pain in patients with neuropathy.
Osteomyelitis
A deep or long-standing ulcer may extend into bone. Diagnosis can require clinical assessment, blood tests, X-rays, MRI or a bone sample in selected cases.
Gangrene and Tissue Loss
Tissue may die because of critically reduced blood flow, severe infection or both. Early assessment helps determine whether circulation can be improved and viable tissue preserved.
Charcot Foot and Neuropathic Deformity
A warm, swollen or changing foot shape in a person with neuropathy requires prompt assessment, even when there is little or no pain.
Recurrent Ulcers and High-Risk Feet
Previous ulceration, amputation, severe neuropathy, foot deformity or peripheral arterial disease increases future risk and requires structured surveillance and preventive care.
Comprehensive assessment
Identifying what is preventing healing.
The wound, circulation, sensation, infection risk and foot mechanics are assessed together so that treatment can be prioritized safely.
Medical consultation
The history of the wound and relevant health factors are reviewed.
- Development and duration of the wound
- Previous ulcers, infections or amputations
- Diabetes treatment and glucose control
- Previous vascular procedures
- Medication, kidney disease and smoking history
- Mobility, footwear and previous wound care
Examination of both feet
Both feet are checked for wounds, pressure points, callus, infection, deformity, tissue loss, colour and temperature differences.
Neurological and vascular assessment
Sensation and blood supply may be assessed using pulses, Doppler, ankle or toe pressures, transcutaneous oxygen measurements and duplex ultrasound.
Wound and infection assessment
Location, size, depth, tissue quality, drainage and signs of infection are documented. Microbiological samples may be taken when clinically useful.
Imaging
X-rays or MRI can investigate deep infection. Duplex ultrasound, CT or MR angiography and selected catheter angiography can define arterial disease and guide treatment.
The limb-salvage approach
Preserving a stable, functional limb.
Limb salvage is more than avoiding amputation. A plan may combine several coordinated steps. In advanced situations, major amputation may still be the safest option when infection cannot be controlled, damage is irreversible or repeated treatment would be unsafe.
01
Control of infection
02
Restoration of adequate blood flow
03
Removal of non-viable tissue
04
Protection and preparation of the wound
05
Pressure relief
06
Reconstruction when appropriate
07
Rehabilitation and preventive follow-up
Treatment journey
Clear priorities, regular monitoring and prevention.
Initial assessment
The wound, circulation, sensation, infection risk and foot structure are assessed. Urgent problems are identified and prioritized.
Diagnostic planning
Vascular tests, wound investigations and imaging are arranged according to the clinical findings.
Individual treatment plan
The treatment sequence may combine infection control, offloading, wound care, restoration of circulation and surgical care.
Monitoring, rehabilitation and prevention
Healing is reviewed regularly. After closure, footwear, pressure protection, foot surveillance and risk-factor control remain important.
Prevention
Protecting the feet after healing.
Because neuropathy may mask pain, regular inspection and early assessment of any change remain essential.
01
Check both feet and between the toes every day
02
Wear suitable footwear and inspect shoes before use
03
Avoid walking barefoot
04
Protect the feet from heat and cold
05
Keep skin clean and appropriately moisturized
06
Do not self-treat calluses, corns or ingrown nails
07
Attend regular diabetic and vascular reviews
08
Follow individualized footwear and offloading advice
09
Seek early assessment for blisters, cracks or wounds
10
Ask a caregiver for help when vision or mobility is limited
Frequently asked questions
Clear answers for safer foot care.
The correct treatment depends on circulation, infection, pressure, tissue damage and the patient’s overall health.
Is every diabetic foot wound caused by poor circulation?+
No. A wound may be caused by neuropathy, pressure, injury, infection, reduced circulation or several factors together. A complete assessment identifies the main causes.
Why does the wound not hurt?+
Diabetic neuropathy can reduce or remove protective sensation. The absence of pain does not mean that a wound is minor or safe to ignore.
Does every diabetic foot ulcer require vascular surgery?+
No. Vascular treatment is considered when reduced blood supply contributes to poor healing or threatens the limb. Other patients may primarily need offloading, wound care or infection treatment.
Can blood flow be improved without open surgery?+
In suitable patients, arteries may be treated using balloon angioplasty, sometimes with a stent. Other patients may benefit more from bypass surgery. The decision depends on anatomy and the overall clinical situation.
Will antibiotics heal an infected ulcer?+
Antibiotics treat infection but do not correct pressure, dead tissue or poor circulation. Successful treatment may require several coordinated measures.
Can an amputation always be avoided?+
No treatment can guarantee limb preservation. Early assessment and coordinated care can improve the opportunity for limb salvage, but some severely damaged or infected limbs cannot be safely preserved.
Can a healed ulcer return?+
Yes. Recurrence is possible when neuropathy, pressure, deformity or vascular disease remains. Long-term footwear, surveillance and preventive care are essential.
When to seek assessment
Do not wait for pain to develop.
- A new blister, crack or open wound
- A wound that is not healing
- Increasing redness, warmth or swelling
- New discharge or unpleasant odour
- A change in foot colour or temperature
- New rest pain in the foot or toes
- A black or dark area of skin
- A warm, swollen or changing foot shape
The information on this page is intended for general patient education and does not replace an individual medical assessment.