This diabetic foot syndrome (DFS) is one of the most serious long-term complications of diabetes mellitus. The combination of nerve damage (neuropathy), circulatory disorders and increased susceptibility to infections leads to open wounds, ulcers and, in the worst case, amputations.
Causes and risk factors
The DFS usually arises from the interaction of several factors:
- Diabetic neuropathy (loss of pain and temperature sensitivity)
- Peripheral arterial disease (PAD – circulatory disorders)
- Incorrect loading due to foot deformities
- Poor long-term blood sugar control
- Smoking, old age and long duration of diabetes
Symptoms
Due to neuropathy, injuries are often noticed late:
- Redness, swelling or overheating of the foot
- Open wounds or pressure points (especially on the ball of the foot, toes, heel)
- Changed foot shape (hammer toes, Charcot foot)
- Infections with pus, fever or bad smell
Stage division according to Wagner
| stage | Clinical findings |
|---|---|
| Degree 0 | No ulcer, but foot at risk (e.g. neuropathy or deformity) |
| Grade 1 | Superficial ulcer |
| Grade 2 | Deep ulcer extending to tendons or bones |
| Grade 3 | Deep ulcer with abscess or bone inflammation (osteomyelitis) |
| Grade 4 | Partial amputation (toes or forefoot) |
| Grade 5 | Gangrene of the entire foot |
Therapy and prevention
The treatment is interdisciplinary and includes:
- Consistent pressure relief (special shoes, walking cast, wheelchair)
- Professional wound care and infection treatment
- Improving blood circulation (e.g. vascular surgery)
- Optimal blood sugar control
Prevention is crucial: Daily foot checks, suitable footwear and regular podiatry treatment significantly reduce the risk of amputation.
Further information:
→ Diabetes mellitus – knowledge and overview
→ Why hyporest
→ Diabetic neuropathy
Sources
- German Diabetes Society (DDG). S3 guideline “Diabetic foot syndrome”. As of 2025. Available at: www.deutsche-diabetes-gesellschaft.de/leitlinien.
- American Diabetes Association. Standards of Medical Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1). Available at: diabetesjournals.org.
- Robert Koch Institute (RKI). Federal health reporting – diabetes mellitus in Germany. Berlin 2024.
- International Diabetes Federation (IDF). IDF Diabetes Atlas. 11th edition. Brussels 2025. Available at: diabetesatlas.org.
Important note:
The information in this encyclopedia article is intended solely for general and non-binding information. They do not replace medical advice, diagnosis or therapy. If you have any health questions or complaints, please always consult a doctor or qualified healthcare professional. The content was created with the greatest possible care, but errors cannot be completely ruled out.
Last updated: February 26, 2026
