Types of Diabetic Wounds Every Clinician Should Know

Diabetes is a global health crisis, and wound care clinicians can make a difference.

As of 2024, 9.7 million adults have undiagnosed diabetes. This chronic condition leads to a variety of complications. And one of the most serious is the development of diabetic wounds, which can become a significant health concern when left untreated.

Diabetic wounds are a leading cause of hospitalizations, infections, and even amputations. These wounds occur primarily due to poor blood circulation, nerve damage, and high blood sugar levels, which affect a wound’s ability to heal effectively.

November marks National Diabetes Month. To raise awareness of this condition and its impacts, let’s explore the most common types of diabetic wounds to help patients and clinicians recognize the early signs and understand the importance of timely and effective care.

Types of diabetic wounds

Diabetes can make wounds manifest in different ways, often varying in severity depending on how well patients manage their blood sugar levels and other contributing factors.

Here are some common types of diabetic wounds:

Diabetic foot ulcers

The lifetime risk of diabetic foot ulcers (DFUs) is 19% to 34% among patients with diabetes, making it the most prevalent type of diabetic wound. Appearing as open sores, this wound typically develops on the bottom of the feet but can occur anywhere on the foot. DFUs are largely caused by two factors: peripheral neuropathy and peripheral arterial disease (PAD).

Peripheral neuropathy involves nerve damage, particularly in the feet, where patients lose sensation. This lack of feeling means that cuts, blisters, or injuries may go unnoticed, leading to worsening wounds. Conversely, PAD involves the restriction of blood flow to the upper and lower extremities, especially the feet. Without sufficient blood supply, the body struggles to repair damaged tissue. Both conditions can lead to prolonged wound-healing processes.

Some early signs of DFUs include the following:

• Redness
• Swelling
• Drainage
• Pain
• Numbness
• Calluses
• Open sores that don’t seem to heal

If left untreated, the wound can worsen and become infected, leading to severe complications to limbs and even life. In fact, DFUs precede about 85% of other lower limb amputations from patients with diabetes.

Venous stasis ulcers

Considered the most common type of wound in the lower leg, according to the National Library of Medicine, venous stasis ulcers are not exclusive to diabetic patients. However, this condition is frequently seen in individuals with diabetes who also experience venous insufficiency.

Known as chronic venous insufficiency (CVI), this condition occurs when the leg veins fail to properly return blood to the heart, causing blood to collect in the lower legs. The increased pressure can lead to the breakdown of skin and the development of ulcers on the lower limbs (typically above the ankle).

Compromised circulation and slower healing processes make venous stasis ulcers more difficult to manage. These wounds are often painful and prone to infection, requiring ongoing wound care and management to prevent complications.

Arterial ulcers

Arterial ulcers are one of the types of diabetic wounds that occur due to inadequate blood flow to the extremities, particularly the feet and toes. Also known as ischemic ulcers, these wounds can develop in patients with diabetes due to PAD, where narrowed or blocked arteries reduce blood flow. Unlike venous ulcers, arterial ulcers are often painful, especially at night or when the legs are elevated.

Appearing on lower legs, toes, or bony areas (like the heels), the skin around an arterial ulcer may look shiny or feel cold to the touch due to the lack of blood flow. Because of the poor circulation, these wounds are slow to heal and are at a higher risk of infection. Without intervention, these ulcers can result in tissue death (necrosis) and may require amputation.

Pressure injuries

Pressure injuries can develop in diabetic patients with reduced mobility or spend extended periods of time lying or sitting in one position. These wounds are caused by sustained pressure on the skin, particularly over bony areas such as the heels, sacrum, or hips. This pressure reduces blood supply to the affected tissue and can lead to skin breakdown.

For diabetic patients, the risk of developing pressure injuries is higher, particularly with comorbidities like neuropathy. Without regular repositioning or the use of pressure-relieving devices, these wounds can worsen, becoming deep and slow to heal.

Traumatic wounds

Traumatic wounds can result from accidents, falls, or injuries that break the skin. For those with diabetes, these wounds heal more slowly due to poor blood sugar control, impaired immune response, and circulation issues.

Considering these factors, small cuts, abrasions, scratches (excoriation), or blisters can become chronic wounds if not properly cared for. This is why diabetic patients must be vigilant in caring for even minor wounds to prevent them from becoming severe.

The importance of diabetic wound management

Proper management of all types of diabetic wounds is necessary for preventing serious complications. Left untreated, diabetic wounds can become infected, leading to sepsis, necrosis, or even the need for amputation.

The key to successful wound management in diabetic patients is maintaining blood sugar levels, monitoring wounds for signs of infection, and seeking early intervention. Wound care clinicians should work closely with patients to educate them about foot care, skin checks, and strategies to prevent wounds from developing or worsening.

By recognizing various types of diabetic wounds and using preventive care, clinicians can reduce complications and improve the quality of life for those living with diabetes.

Editor’s Note: This blog has been reviewed by Tara Call Triplett, RN, WCC, CHFN.