An ulcer is a medical term for an open sore. Foot ulcers can often take a long time to heal, especially in individuals with diabetes. People with diabetes often suffer with diabetic neuropathy, which can mean they do not feel pain from an injury to the foot, such as a cut or a blister. The injury might not heal without treatment and sometimes they need to offload the lower limb. Regular diabetic foot care is important, as the cut or blister might worsen and develop into an ulcer. If not diagnosed and treated promptly, diabetic foot ulcers can advance, leading to severe infection, gangrene or amputation. The image below illustrates how an ulcer can advance. The classification of the ulcers by stage of grade helps the medical team to evaluate the patient’s level of risk and determine the best course of treatment. Understanding these stages is essential for timely intervention and minimising the risk of serious complications such as amputation. Grade 0: The skin is intact The skin is in intact. This may describe a healed or pre ulcerative wound. The skin may be red, irritated or have some callus formation. Patients with diabetic neuropathy may not feel the discomfort, which means the lesions may worsen without detection. Regular foot checks and proper footwear are key in preventing progression to an open ulcer. Grade 1: Superficial ulcer This is a superficial ulcer which only affects the outer layers of the skin and hasn’t extended into deeper layers. The outer layers of the skin have broken down and formed an open wound. The ulcer may look like a red or yellow shallow sore. Without proper treatment, there is a risk of infection. Effective management might include cleaning the wound, relieving pressure from the affected area (offloading) and applying appropriate dressing to prevent further deterioration and promote healing. Grade 2: Deep ulcer This is a deep ulcer that may have extended to the tendon, bone or joint capsules. At this stage, the risk of infection is high. The individual might be experiencing pain, swelling and pus formation. Treatment may include debridement (removal of dead tissues) and antibiotics. Swabs may be taken to help with the choice of antibiotic treatment. Patients should be having regular foot examinations and if there is no improvement with standard care, specialist input should be sought. Imaging such as an x-ray may be necessary to consider the extent of the damage. To prevent further injury, weight redistribution using specialist footwear, orthotic devices, casts or walking boots may help. Grade 3: Ulcer affecting the deeper tissue At this stage, the ulcer involves the deeper tissues and may lead to complications such as abscess formation, osteomyelitis or tendinitis. An MRI might be carried out if osteomyelitis is suspected. Without proper and timely treatment, the ulcer might process to necrosis where surrounding tissues starts to die due to lack of blood supply and gangrene, characterised by blackened and foul smelling tissue. There is a significant risk of sepsis. Grade 4: Partial gangrene of the foot The forefoot may have become gangrenous, indicating severe tissue death. There continues to be a significant risk of sepsis. In addition to aggressive medical management, surgical intervention might be necessary. In severe cases, this might include partial foot amputation to remove the affected tissue and prevent further spread of infection. Grade 5: Gangrene of the whole foot Extensive gangrene affecting the entire foot indicates advance and irreversible tissue damage. Surgical intervention will be required and in many cases a below knee amputation to prevent the spread of infection and preserve overall health. Could my amputation have been avoided? This is a question that, as specialist amputation lawyers, we regularly get asked by clients. It is a key issue that we need to investigate, with independent medical experts, as part of a medical negligence claim. Factors such as lifestyle, underlying health conditions, the staging of a diabetic foot ulcer and the timing and extent of the treatment received, can all play a part. In some cases, it can be difficult to establish that the amputation would have been avoided, especially if the underlying condition was so severe that it could not be treated or reversed with treatment. In our experience, however, timely diagnosis and appropriate intervention for a diabetic foot ulcer can often prevent an amputation. If you or a member of your family would like to find out more about claiming compensation for an amputation caused by diabetic foot ulcer, contact one of our specialist solicitors by emailing claimsadvice@boyesturner.com.
