Ask the treatment expert: tips for determining if a foot wound is a diabetic ulcer or a pressure ulcer

Share this content:
What is xerosis?
What is xerosis?
Do you have any tips for determining if a foot wound is a diabetic (neuropathic) ulcer or a pressure ulcer?

Both diabetic ulcers and pressure ulcers can occur on the feet. The diabetic ulcer typically occurs over the plantar (bottom) surface of the foot on load-bearing areas such as the ball of the foot (the metatarsal heads) or under the heel. But diabetic ulcers also can occur on the top or between the toes.

Many patients with diabetic foot wounds also will have foot deformities, including hammertoes, Charcot foot and bunions. Characteristics of the diabetic wound include: even wound margins, a rounded or oblong shape, deep wound bed with necrotic tissue, moderate amounts of drainage, surrounding callus, and often painlessness due to decreased sensation in the foot (peripheral neuropathy).

According to F-tag 314, CMS guidance to surveyors in long-term care, the characterization of “diabetic neuropathic ulcer” requires that the resident be diagnosed with diabetes mellitus and have peripheral neuropathy.

A pressure ulcer can occur wherever pressure has impaired circulation to the tissue—most frequently over a bony prominence resulting in a circular shaped wound with regular edges. However, pressure ulcers take on the shape of the object that caused the wound and therefore can result in odd shapes that resemble a Foley catheter, oxygen tubing, transfer sling or ring of a toilet seat.

Deep pressure ulcers usually have a dark red wound base and do not bleed easily. Often, the periwound has non-blanchable erythema or, in dark-skinned patients, a deepening of natural color.

When choosing between the labels pressure ulcer or diabetic wound, always base your determination on the clinical characteristics, location and review of presenting risk factors.