Do diabetic foot ulcers always hurt?

No. Diabetic ulcers are often painless because of decreased feeling in the feet, and redness, warmth and tenderness are often absent because of nerve damage. That’s why daily looking matters more than waiting to feel something.

No, and painless is the usual case rather than the exception. Diabetic ulcers are often painless, because of decreased feeling in the feet.

Often. Not occasionally.

The same gap runs through the warning signs. During a daily foot check, look for dry and cracked skin, blisters or sores, bruises or cuts, redness, warmth, or tenderness, and firm or hard spots. But redness, warmth, or tenderness are often absent because of nerve damage.

So two of the things most people would rely on to tell them something is wrong are often missing.

That is the whole reason to look rather than wait to feel. Check your feet every day. Inspect the tops, sides, soles, heels, and between your toes. If you cannot see well, ask someone else to check your feet.

Here’s what the gap can lead to: if you get a blister, you may not notice, and it may get worse. Even small sores or blisters can become big problems if an infection develops.

The practical conclusion is uncomfortable but simple. A foot ulcer that does not hurt is not a foot ulcer that is doing well, and pain is not the thing to wait for before reporting a change.

What to watch for

Check your feet every day, inspecting the tops, sides, soles, heels, and between your toes. Ask someone else if you cannot see well.

Contact your provider right away about any foot problems, and don’t try to treat them yourself.

Signs of infection to contact a provider about: redness, increased warmth, or swelling around the wound; extra drainage; pus; odor; fever or chills; increased pain; increased firmness around the wound. Also if a foot ulcer is very white, blue, or black.

Pain is not the threshold. Finding nothing that hurts is not the same as finding nothing.

Wound Wizard is general education and cannot assess your feet. Your own clinician is the right person to ask.

What we look at

  • Testing sensation with a monofilament
  • Examining the feet for injury the person cannot feel
  • Checking the pulses in the feet
  • Advising a daily checking routine

Sources

  1. Diabetes - foot ulcers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000077.htm
  2. Diabetes - taking care of your feet — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000081.htm