There exist specific symptoms of diabetic foot ulcer. Untreated, they lead to amputation of the limb
Neuropathic diabetic foot ulcer
Predominant symptoms
The patient does not feel the presence of a noxious stimulus such as a cut, burn, having too tight shoes or the presence of a foreign object in a shoe. Insensitivity to pain is a primary contributor to foot sole ulceration. A neuropathic diabetic foot is warm, flow in the arteries is preserved, but the joints and bones of the foot are deformed.
A subset of patients develop joint changes involving progressive degeneration of the small joints of the foot resulting in significant foot deformities. It is then necessary to wear special custom-made shoes. Wearing normal ill-fitting shoes very often leads to ulceration.
Ischaemic and angiopathic diabetic foot
Predominant symptoms
Patients mainly complain of pain, which is usually worse at night and is often accompanied by painful muscle spasms and a tingling and stabbing sensation in the leg. Depending on the level of stenosis and closure of the lower limb arteries, necrosis of different areas of the foot occurs. The most severe form of the disease is closure of the large arteries of the lower limb above the knee. This results in necrosis of the tissues of the foot and sometimes also of the lower leg. The toes are most often affected by necrosis. Ischaemic diabetic foot is characterised by the preservation of nerves while the blood supply to the limb is impaired.
Untreated diabetic foot ulcer leads to amputation of the limb.