Home › Diabetic foot
Diabetic foot: when an ulcer needs restored blood flow to heal
Diabetic foot (diabetic foot syndrome) is damage to the tissues of the foot in diabetes mellitus, with ulceration, infection and necrosis. In most cases two mechanisms combine: diabetic neuropathy, so the patient does not feel the injury, and arterial disease (angiopathy), so the wound cannot heal. In the ischemic and neuro-ischemic forms, healing without revascularization is impossible, so treatment begins with restoring arterial blood flow.
Why the ulcer does not heal
In diabetes, atherosclerosis affects above all the arteries of the lower leg and foot. The tissue around the ulcer receives too little oxygen, and local treatment gives no result until perfusion is restored. The second factor is neuropathy: loss of pain sensation leads to constant loading of the wound.
Diabetic foot symptoms: when to seek care
- An ulcer, wound or callus on the foot that has not healed for more than two weeks
- Redness, swelling, discharge or an unpleasant odour — signs of infection
- Necrosis (blackening) of a toe or of the skin of the foot
- A cold foot with thin, pale skin, absent hair growth and weakened pulses
- Night pain in the foot in a person with diabetes
Why timing matters
Infection in an ischemic foot spreads quickly, from a toe to the whole foot within days. The most common cause of major amputation in diabetes is late referral to a vascular surgeon.
Diagnosis at the Center
Duplex ultrasound of the arteries, toe pressure measurement, CT angiography. The wound, the blood flow and the infection are assessed together, and this defines the treatment plan.
Endovascular treatment
Arterial patency is restored through a puncture: balloon angioplasty of the arteries of the lower leg and foot and, if needed, stenting. The aim is direct blood supply to the part of the foot where the ulcer is located (the angiosome principle). This is followed by surgical wound care, minor toe amputation when indicated, off-loading of the foot and glycemic control. For patients with chronic kidney disease, CO₂ angiography without iodinated contrast is used.
Frequently asked questions
I was advised to have an amputation. Is there an alternative?
In many cases, yes. If the arteries can be recanalized, the ulcer can heal and amputation is limited to a toe or is not needed at all. A vascular surgeon's opinion should be obtained before an amputation.
Are the wound and the arteries treated at the same time?
Yes, in the correct order: revascularization first, then surgical treatment of the wound. Local treatment without blood flow is ineffective.
How long does healing take after revascularization?
It depends on the size of the ulcer and diabetes control, from several weeks to several months. What matters is that once blood flow is restored, healing becomes possible.
Is admission necessary?
Yes, for 1–3 days for the procedure. The work-up can be done as an outpatient.
Book a consultation
Vascular surgeon consultation at the Shalimov Center, 30 Akademika Shalimova St, Kyiv. Booking and questions go through the contact doctor, Yurii Vahis. Patients from other cities and abroad can arrange an online consultation.
+380 44 454 20 79