Diabetic foot ulcers may hurt severely even when feet feel numb

A foot affected by diabetes can still cause intense pain even when sensation is reduced. In a University of Gothenburg study, patients said they experienced sudden pain that disrupted sleep and made daily life harder to plan, despite numbness in parts of the foot.

Some participants said the staff treating their wounds seldom asked about pain, and they felt uncomfortable raising the issue themselves. The results suggest that asking directly about pain during wound care may reveal a problem that can be overlooked when attention is centered on healing.

Foot ulcers are open sores that can take a long time to heal. In people with type 1 or type 2 diabetes, poor circulation and nerve damage can contribute to ulcers, especially in pressure points such as the heel, toes and ball of the foot.

Loss of feeling can make it harder to notice an injury or pressure from footwear. The patients' accounts show that numbness and sharp pain can coexist in the same foot, sometimes at different times of day.

District nurse Anneli Ringblom examined these experiences in a doctoral thesis based on patient surveys and interviews. The research looked at how people described their pain, how it affected their lives and how they felt it was handled in health care.

Some patients described a dull ache, while others compared the pain to a cut on the sole of the foot. The timing could be just as disruptive as the severity, since pain could flare at night or just as someone was preparing to leave the house.

Managing diabetes together with foot problems also requires attention to blood sugar; related research has examined continuous glucose monitoring in type 2 diabetes.

That unpredictability made ordinary plans feel more difficult. Patients said they had to think carefully about whether they could garden, attend a social gathering or go for a walk, and whether they would have enough pain relief if symptoms worsened.

Even preparing for a walk could take significant effort. Some described putting on ointment, checking a dressing and examining shoes or socks for something as small as a wrinkle or a grain of sand.

Many patients spoke positively about the doctors, nurses and foot care specialists they met. At the same time, some felt they had to cope with pain between appointments, and a few said the suffering became so severe that they began to view amputation, a feared outcome, as a possible relief.

The thesis captures what patients experienced and how they remembered their care. It did not independently assess those appointments or compare treatments for ulcer pain, so it cannot determine which pain-relief strategies work best.

Ringblom's findings point to a practical adjustment for wound care teams. Asking when pain occurs and how it affects sleep and movement can give staff a fuller understanding of how the wound is affecting a person's life.

Source: University of Gothenburg.