Diabetic Foot Ulcers

Common Symptoms

• An open wound, most commonly on the bottom of the foot or over a pressure point, that may be painless due to nerve damage
• Drainage, odor, or surrounding redness, which can signal infection
• Slow or stalled healing despite standard wound care
• Surrounding skin changes such as callus or thickened skin

Why It Happens

Diabetes can damage peripheral nerves (reducing protective sensation, so injuries go unnoticed), impair blood flow to the feet, and impair the body's normal wound-healing response, all of which combine to make foot ulcers more likely and slower to heal once they develop.

Why It Can Become Persistent

The combination of reduced sensation (so ongoing pressure or injury may go unnoticed), impaired circulation (limiting the delivery of oxygen and nutrients needed for healing), and elevated blood sugar (which impairs normal wound healing) together make diabetic foot ulcers notoriously slow to heal without comprehensive, coordinated care.

Who Commonly Gets It

Diabetic foot ulcers are more common in people with longer-standing diabetes, peripheral neuropathy, peripheral artery disease, and a prior history of foot ulceration.

How It Is Usually Diagnosed

Diagnosis is clinical, but comprehensive evaluation includes assessing the wound, blood flow to the foot (sometimes with specialized vascular testing), infection status, and blood sugar control, generally coordinated by your physician or a wound care/podiatry specialist.

Traditional Treatment Options

• Blood sugar management: Optimizing glucose control is foundational to wound healing in diabetes.
• Wound debridement and dressing: Regular, specialized wound care by a physician or wound care specialist.
• Offloading (pressure relief): Specialized footwear, casting, or devices to keep pressure off the wound.
• Infection management: Antibiotics when infection is present, guided by careful monitoring.
• Vascular evaluation and treatment: Addressing impaired circulation when present, since adequate blood flow is essential for healing.

Why Someone Might Start Looking for Another Option

Because diabetic foot ulcers can be slow to heal even with comprehensive standard care, and carry serious risks if they don't, there's substantial research interest in adjunct treatments, including shockwave therapy.

Where Shockwave Therapy May Fit

A systematic review and meta-analysis pooling 8 randomized trials (672 patients) found shockwave therapy, added to standard wound care, was associated with significantly higher complete-healing rates than standard care alone, with low variability between the pooled studies (a sign of fairly consistent results). This is a genuinely solid evidence base for a wound-healing adjunct. We want to be clear this is exactly that — an adjunct to comprehensive standard diabetic wound care, not a replacement for blood sugar management, offloading, infection monitoring, or vascular evaluation, all of which remain essential.

How Shockwave Treatment Works for This Area

Shockwave therapy would be coordinated with your physician or wound care specialist as an addition to your comprehensive diabetic foot ulcer care plan, not pursued as a stand-alone treatment separate from that oversight.

What the Treatment Feels Like

Your provider will discuss the specific treatment approach and what to expect, taking into account any reduced sensation you may have in the area.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone not already under comprehensive medical or wound-care-specialist management for their diabetic foot ulcer
• Active, uncontrolled infection, which needs to be addressed first
• Significant untreated peripheral artery disease, which needs its own evaluation
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.