Preventing Diabetic Foot Ulcers

Written by: Amy Beckner, FNP-BC
Nurse Practitioner

At Restore First Health, we care for many types of chronic wounds, including diabetic foot ulcers (DFUs). DFUs typically occur because of nerve damage and/or changes to blood flow in the lower extremities that is caused by high blood sugar levels in the body over a prolonged period. Nerve damage, or neuropathy, can prevent a person from feeling the beginning of a sore, which can lead to worsening of the ulcer before it is even noticed. Decreased blood flow leads to weakened skin and slows the healing process of ulcers.

Studies show that approximately 80% of amputations that are related to diabetes start with an ulcer. As they say, an ounce of prevention is worth a pound cure. There are many simple steps a person with diabetes can take to prevent the development of a foot ulcer.

1. Try to maintain your hemoglobin A1c at 7.0% or less.
2. Check your own feet every day for broken skin, reddened areas, blisters, and calluses. If needed, you can use a mirror to help see the bottom of your feet.
3. Get a foot exam at least yearly by a medical provider, or more frequently if you have neuropathy. They will check for nerve damage, decreased blood flow, calluses, broken skin, and foot deformities.
4. Keep toenails trimmed straight across and do not cut the cuticles.
5. Wear proper fitting footwear, including those with a wide toe box and well-cushioned soles to prevent friction and injury.
6. Keep your feet clean and dry. Wash them daily with lukewarm water and mild soap, dry in between the toes after washing. Wear clean, well-fitted cotton socks.
7. Quit smoking if you do smoke. Smoking leads to decreased blood flow to your feet.

If you do develop a DFU, there a several things you should expect from your medical provider to help heal the ulcer.

1. Off-loading refers to the method that is used to keep pressure off of the ulcer. This may include something called a total contact cast or fixed ankle walking boot. It is important to keep the pressure off the ulcer for healing.
2. Regular debridement, or removal of dead tissue from the wound. This will be done by a wound care provider and helps healthy tissue to grow in the wound.
3. Regular dressing changes over the wound. This helps prevent infection and encourages healthy wound healing

Resources:

Hingorani, A., LaMuraglia, G.M., Henke, P., Meissner, M.H., Loretz, L., Zinszer, K.M., Driver, V.R., Frykberg, R., Carman, T.L., Marston, W., Mills Sr., J.L., and Murad, M.H. (2016). The management of diabetic foot: A clinical practice guideline by the Society of Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. Journal of Vascular Surgery, 63(2S): 3S-21S.

Wexler, D.J. (2023). Patient education: Foot care for people with diabetes (Beyond the Basics). UpToDate. Retrieved 5/7/2024 from https://www.uptodate.com/contents/foot-care-for-people-with-diabetes-beyond-the-basics