Foot and Toe Ulcers: Treatment, Prevention, Repair & Causes (2024)

What are foot and toe ulcers?

An ulcer is an open wound or sore that will not heal or keeps returning. When you have ulcers on your feet and toes, it can be related to diabetes — specifically, a complication called neuropathy that causes you to lose feeling in your feet. A scrape, cut or puncture in your skin can turn into an ulcer, but you might not know it’s there if you have neuropathy.

Ulcers can lead to infections. Sometimes, the infection won’t go away and you may need to have part of your foot or toe surgically removed (amputated). About 15% of people with diabetes will get a foot or toe ulcer. Around 14% to 24% of people with diabetes in the U.S. need an amputation after they get an ulcer.

Who gets foot and toe ulcers?

Foot and toe ulcers can happen to many people but might be more common in Black, Native American and Hispanic people. If you have an eye, kidney or heart disease related to diabetes, you’re also at a higher risk. About 15% of people with diabetes will get an ulcer, typically on the bottom of their foot. Some of those people will be hospitalized because of complications.

You’re also at a higher risk of getting foot and toe ulcers if you have any of the following conditions:

• Blood circulation issues.
• Heart disease.
• Obesity.
• A foot condition like a bunion or hammertoe.
• Kidney disease.
• Lifestyle behaviors like using tobacco and alcohol can also increase your risk of developing ulcers on your feet or toes.

What do foot and toe ulcers look like?

Ulcers are open wounds in your skin that can take on almost any shape. Some shapes are more common than others on specific parts of your body. For example, ulcers on your foot or toe might be shaped like a crater or a wedge.

Foot and toe ulcers vary in color. The most common colors are:

• Yellow.
• Pink.
• Red.
• Grey.
• Black.

If your ulcer is black, that means cells in the tissues have died. This is called necrosis (gangrene).

How big are foot and toe ulcers?

There are many different sizes of ulcers. They start as small as 1 centimeter wide (about the size of a pea or a Cheerio) and can grow to the size of your entire foot if left untreated.

The depth of the ulcer can change, too. Several different classification systems exist to define the depth of an ulcer. The Wagner Diabetic Foot Ulcer Grade Classification System, for example, has six grades:

• Grade 0: Your skin is intact (undamaged).
• Grade 1: The ulcer is “superficial,” which means that the skin is broken but the wound is shallow (in the upper layers of the skin).
• Grade 2: The ulcer is a “deep” wound.
• Grade 3: Part of the bone in your foot is visible.
• Grade 4: The forefront of your foot (the section closest to your toes) has gangrene (necrosis).
• Grade 5: The entire foot has gangrene.

How can I tell if I’m getting an ulcer on my foot or toe?

When an ulcer is starting to develop on your foot or toe, you might notice changes in your skin like:

• Dry skin.
• Cracked skin.
• Scaly skin.
• Redness.
• Rashes.

As the ulcer gets worse, it can get wider, and longer and deeper — sometimes down to the bone. In advanced stages you might see:

• A callus.
• A halo (ring) around the center of the wound that feels harder than the skin around it.
• Drainage (you might see this in your socks when you take them off), which is a sign that you might have an infection.
• A brown discoloration.
• A strong odor.

How are foot and toe ulcers diagnosed?

Your healthcare provider can tell what type of ulcer you have based on four observations:

• The appearance of the ulcer.
• Location of the ulcer.
• The appearance of the borders.
• The appearance of the surrounding skin.

Your primary healthcare provider can diagnose an ulcer, but they might send you to a specialist for treatment. You might see a podiatrist, a provider who works with feet, or a wound specialist. For more complicated cases that require surgery, you might also see a plastic surgeon, anesthesiologist, orthopedic surgeon and/or vascular surgeon.

What tests are done to determine if I have a foot or toe ulcer?

To find out precisely how deep the ulcer goes, and to see if it caused an infection in a nearby bone, they might order a:

• MRI.
• CT scan.
• X-ray.

What are the types of foot and toe ulcers?

Two types of ulcers can affect your feet and toes:

• Neurotrophic (diabetes-related) ulcers.
• Arterial (ischemic) ulcers.

What are neurotrophic ulcers?

Neurotrophic ulcers occur primarily in people with diabetes, although they can affect anyone who has impaired sensation in their feet. They can be found anywhere on your feet, but they usually develop on the parts of your feet and toes that are most sensitive to weight (pressure points).

Neurotrophic ulcers don’t cause pain. But they can be serious if they aren’t treated promptly or they don’t respond to treatment.

A neurotrophic ulcer might be the following colors:

• Pink.
• Red.
• Brown.
• Black.
• Any combination of those colors.

The thin borders of the ulcers are “punched out,” meaning that they’re taller than the surrounding tissues.

What are arterial ulcers?

A condition called peripheral arterial disease can reduce blood flow to your extremities. When this happens, your foot tissue may start to die. The ulcers that form from reduced blood flow are called arterial ulcers.

The word “arterial” means “relating to arteries.” Arteries are blood vessels that transport blood from your heart to the rest of your body, including your feet and toes. Anyone can get an arterial ulcer, but people who smoke or have diabetes, high blood pressure or high cholesterol are at higher risk.

Unlike neurotrophic ulcers, arterial ulcers can form on many parts of your body, including:

• On your heels.
• On the tips of your toes.
• Between your toes (where your toes rub together).
• The bony parts of your feet and toes that rub against bed sheets, socks or shoes.
• The nail bed (if your toenail cuts into your skin, if your toenail was trimmed aggressively or if you had an ingrown toenail removed).

Arterial ulcers are:

• Yellow.
• Brown.
• Grey.
• Black.

Arterial ulcers don’t bleed. The borders and surrounding skin usually appear taller. If you have an infection or experience irritation, you might see swelling and redness around the base of the ulcer. The redness often turns to a pale white or yellow color if you elevate your leg. Arterial ulcers are typically very painful, especially at night.