Diabetic Foot Ulcers: The Silent Threat That Can Lead to Amputation as You Age

If you are over 50, diabetes is no longer rare. It is one of the most common chronic diseases affecting older adults, and one of the most underestimated when it comes to long-term complications.

According to the Centers for Disease Control and Prevention's 2026 National Diabetes Statistics Report, an estimated 40.1 million Americans, roughly 12 percent of the U.S. population, are living with diabetes, diagnosed or undiagnosed. CDC data also show that an astonishing 115.2 million U.S. adults have prediabetes, a condition that greatly increases the risk of developing type 2 diabetes. Among adults age 65 and older, more than 1 in 3 either has diabetes or prediabetes.

In people with diabetes, high blood sugar over time weakens the immune system and impairs blood vessel function, making injuries harder to heal and more likely to lead to serious complications. — Dr. John V. Capotorto, MD, MBA, a Harvard-trained endocrinologist and past president of the American College of Endocrinology.

What makes diabetes especially dangerous as you age is not just elevated blood sugar, but what years of diabetes do to nerves, blood vessels, and your body’s ability to heal. Many of the most serious complications develop slowly and without pain, until the damage is already advanced.

Diabetes Can Lead to Serious Complications

Diabetes is a progressive disease. The longer you live with it, the greater the chance of complications.

The American Diabetes Association reports that more than half of people with diabetes will develop at least one major complication over time, particularly those diagnosed in midlife or earlier.

Common complications include:

• Nerve damage
• Poor circulation
• Vision loss
• Kidney disease
• Chronic foot wounds and infections

These conditions rarely occur in isolation. Instead, they reinforce one another, accelerating decline and increasing the risk of hospitalization and long-term care.

Neuropathy: The Silent Trigger Behind Foot Ulcers

One of the most common—and dangerous—complications is diabetic peripheral neuropathy.

Medical research shows that about 50 percent of people with long-standing diabetes develop neuropathy, with risk rising significantly after age 50 and with poor glucose control.

Neuropathy dulls your ability to feel:

• Pain
• Pressure
• Heat or cold
• Minor injuries

That loss of sensation is why diabetic foot ulcers often begin unnoticed. You may keep walking on an injury you cannot feel, turning a small problem into a serious wound.

Diabetic Foot Ulcers Are Dangerous for Older Adults

Diabetic foot ulcers are open sores that develop most often on the bottom of the foot. According to the American Diabetes Association, about 15 percent of people with diabetes will develop a foot ulcer during their lifetime, and the risk increases with age, duration of diabetes, and coexisting health conditions.

For older adults, the consequences are often more severe. Healing slows with age. Circulation worsens. Immune response weakens.

The Centers for Disease Control and Prevention reports that diabetes accounts for more than 60 percent of non-traumatic lower-limb amputations in the United States.

How Foot Ulcers Escalate to Amputation

A diabetic foot ulcer is not just a skin problem. Once the protective barrier breaks:

• Bacteria can enter deeper tissue
• Infection can spread to the muscle or the bone
• Blood supply may be too poor to support healing

When the infection cannot be controlled, amputation may become the only option to prevent life-threatening complications. For many people, this is the moment when independence changes permanently.

Prevention That Truly Makes a Difference

Preventing diabetic foot ulcers does not require complex technology, but it does require consistency and support.

Routine Foot Checks

You or a caregiver should inspect your feet regularly, ideally every day. In assisted living and home-care settings, routine foot checks should be part of standard care.

Watch for:

• Cuts or blisters
• Redness or darkened areas
• Swelling or warmth
• Changes in skin texture

Early detection can prevent hospitalization and amputation.

Safe Nail and Skin Care

Improper nail trimming, untreated calluses, and corns can create micro-injuries that develop into ulcers. Professional foot care by a podiatrist or other trained medical provider significantly reduces this risk.

Professional foot care, offered through multidisciplinary diabetes care teams, ensures that you or a loved one has safe management of the skin and nails to prevent complications.

Protective Footwear

Poorly fitting shoes are a major contributor to ulcers. Therapeutic diabetic footwear helps reduce pressure and friction.

Medicare Part B may cover diabetic shoes and inserts for people who meet specific criteria.

Why Team-Based Care Matters

The best outcomes come from coordinated care.

Effective prevention and treatment often involve:

• A primary care doctor managing overall health
• An endocrinologist addressing glucose control
• A podiatrist monitoring foot health
• A vascular specialist evaluating circulation
• Wound-care specialists managing complex ulcers

Even excellent wound care cannot succeed without good diabetes control.

Foot Deformities Increase Ulcer Risk

For people with diabetes, bunions, hammertoes, and other foot deformities are more than a comfort issue. These structural changes create abnormal pressure points that increase callus formation and skin breakdown.

When diabetes-related nerve damage reduces sensation and circulation is impaired, those pressure areas are far more likely to turn into ulcers that do not heal. Early evaluation and treatment, sometimes conservative, sometimes surgical, can reduce ulcer risk and improve mobility.

Services such as bunion surgery can restore normal foot mechanics, improve gait, and minimize the risk of future ulcers. Ignoring these issues increases the likelihood of infection, hospitalization, and long-term disability.

If untreated, a blister or small cut can become a diabetic foot ulcer, which is the biggest risk factor for amputation. Daily foot care and glucose control are essential, but proper foot care requires teamwork once you have a wound. — Dr. Lee C. Rogers, DPM, co-director of an amputation prevention center and national expert on diabetic foot care.

Caregivers Are a Critical Line of Defense

If you help care for an older adult with diabetes, your role is essential.

Caregivers often notice early changes before the person does. Training caregivers to recognize warning signs, maintain hygiene, and ensure prompt medical evaluation has been shown to reduce hospitalizations and amputations.

Professional caregivers are trained to notice these problems; untrained family caregivers often miss them.

When Diabetes Complications Lead to Long-Term Care Needs

A serious foot infection or amputation can suddenly create the need for help with:

• Walking and transfers
• Bathing and dressing
• Wound care and medication management

Medicare and health insurance cover only short-term skilled care, not extended personal care at home, assisted living, or nursing facilities.

Long-Term Care Insurance can provide guaranteed, tax-free resources to pay for the rising cost of extended care at home or in a facility of your choice, helping protect income, assets, and independence.

If a loved one needs help now, the LTC News Caregiver Directory can help you find vetted in-home care and long-term care providers quickly. If a loved one has an LTC policy, be sure to use the benefits promptly to improve quality of life.

LTC News partners with Amada Senior Care to offer free, no-obligation assistance with Long-Term Care Insurance claims. Their trained specialists can guide you through the process and help you access benefits correctly and without unnecessary delays — File a Long-Term Care Insurance Claim.

Protecting Your Feet Protects Your Independence

Diabetic foot ulcers are common, dangerous, and often preventable. Yet they remain one of the leading reasons older adults with diabetes lose mobility, independence, and quality of life.

Paying attention to your feet is not about fear. It is about staying in control. Are you doing enough today to prevent a complication that could change your life, or that of a loved one with diabetes, tomorrow?

This article is for informational purposes only and does not replace medical advice. Always consult your doctor for diagnosis and treatment.