DIABETIC FOOT ULCERS AND DIABETES ASSOCIATED PERIPHERAL ARTERIAL DISEASE
Diabetes can damage both the nerves and the arteries in your legs and feet. This raises the risk of foot sores (ulcers) that are slow to heal, and in severe cases gangrene. The most feared complication is amputation – which good care can usually prevent.
Diabetes Associated Peripheral Arterial Disease
In diabetes, high blood sugar gradually damages blood vessels and nerves throughout the body. Over time this can affect:
the eyes (retinopathy)
the kidneys (nephropathy)
the nerves (neuropathy – loss of feeling, often in the feet)
the arteries, speeding up hardening of the arteries and raising the risk of heart attack, stroke and poor circulation in the legs
Good control of your blood sugar – together with your blood pressure, cholesterol and not smoking – is the best way to slow or prevent these problems. Left unmanaged, diabetes can lead to serious harm, including foot sores that may turn to gangrene and lead to amputation.
Causes
The longer you have had diabetes, the higher your risk of these vascular problems. The risk is greater still if you also have high blood pressure, smoke, do not exercise, are overweight, or eat a high-fat diet.
Symptoms
Diabetes-related vascular problems can show up in several ways:
Blurred vision or floating spots
Swelling of the face or limbs, or sudden weight gain
Frothy urine
Foot sores (diabetic foot ulcers)
Loss of feeling, or burning, in the hands or feet
Leg pain when walking
High blood pressure or chest pain
Tests
I start with your history and an examination, and a blood test to measure your blood sugar and cholesterol. Depending on your symptoms, other checks may include:
Eyes – an eye examination for retinopathy.
Kidneys – a urine test for protein (albumin).
Leg circulation – an ankle-brachial pressure index (ABPI) compares the blood pressure at your ankle and arm, and a duplex ultrasound scan shows where the arteries are narrowed.
One important point: in diabetes the ankle arteries are often stiff and calcified, which can make the ABPI falsely normal. For this reason a toe pressure (toe-brachial index) is more reliable in people with diabetes.
Treatment Options
Optimal Medical Therapy
Treatment aims to control everything that damages your arteries: blood sugar (with insulin or glucose-lowering medication), blood pressure, and cholesterol (usually a statin). An antiplatelet such as aspirin or clopidogrel lowers the risk of clots.
Treat Peripheral Arterial Disease
When a foot ulcer develops, it is treated promptly with dressings and, if infected, antibiotics – while I check whether enough blood is reaching the foot for it to heal. Treating ulcers early matters, because if the tissue dies, part of the foot or leg can be lost.
If the circulation is poor, blood flow can be restored by angioplasty (a balloon, sometimes with a stent, to open the artery from the inside) or by bypass surgery (a vein or fabric graft that routes blood around the blockage). Sometimes the plaque is removed directly (endarterectomy). The best option depends on where the blockages are.
General Guidelines
You can do a great deal to protect yourself:
Stop smoking
Eat a healthy, low-fat diet and keep to a healthy weight
Exercise regularly
Check your blood sugar as advised
Inspect your feet every day, protect them from injury, and keep them clean and dry
References
Intersocietal IWGDF, ESVS and SVS Guidelines on Peripheral Artery Disease in People with Diabetes and a Foot Ulcer (2023).
IWGDF Practical Guidelines on the Prevention and Management of Diabetes-related Foot Disease (2023 update).
Our Services
Arterial
Procedures
Standard open arterial surgical procedures to repair or reconstruct blood flow to extremities.
Femoropopliteal bypass
Femoral endarterectomy
Femoropopliteal thrombectomy
Femorotibial bypass
Endovascular
Procedures
These less invasive procedures are the preferred technique and are often considered a first-line strategy.
Angioplasty with or without stent of
Superficial femoral artery
Popliteal artery
Tibial arteries
Peripheral arterial catheter directed thrombolysis
Hybrid
Procedures
Combined endovascular and open surgical procedures are selectively utilised to repair or restore blood flow to the extremities.
Femoral endarterectomy with peripheral angioplasty
Femoropopliteal thrombectomy with peripheral angioplasty with or without stent
Wound Care
We offer the whole range of conservative wound care modalities as well as advanced wound care modalities including surgical debridement, negative pressure wound therapy and / or hyperbaric oxygen therapy for complex wounds related to arterial insufficiency or peripheral neuropathy secondary to diabetes. For more information please visit www.wondsorg.co.za
Hyperbaric Oxygen Therapy
We have a top team of hyperbaric technologists who assist me in offering Hyperbaric Oxygen Therapy to patients with internationally accepted indications, including diabetic foot ulcers. For more information please visit www.hbo.co.za
If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.
Gregory Weir Vascular Surgery
The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
If you are experiencing a medical emergency, phone us. If you are not able to get through or if we are not available, please visit your nearest casualty department.
Consultation Rooms
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria
Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.