Preventing Diabetic Foot Ulcers: Recommendations for Healthy Feet

By Irina Vella, FNP-BC

Proper foot care can prevent the occurrence of new diabetic foot ulcers (DFUs) and recurrence of previous ulcers in patients with diabetes.

Risk Factors for diabetic foot ulcers include:

• Previous foot ulcers
• Loss of peripheral sensation¹
• Poor circulation from peripheral arterial disease
• Smoking
• Calluses or corns
• Poor control of blood sugar²
• Foot deformities like bunions, Charcot joint², or hammertoes.¹

It is important to have a comprehensive foot assessment by a provider at least once a year¹. For individuals considered to be at higher risk, a professional foot exam may be required more often. In between exams, diabetics can help reduce their risk of foot injury and ulceration by performing daily feet self-examination, following safe foot and nail care, and wearing appropriate footwear.

Daily Inspection

The American Diabetes Association (ADA) recommends patients with diabetes should perform daily self-inspection of both feet. Carefully inspect feet for wounds, open areas, swelling, redness, changes in color, callus formation, or structural abnormalities². When examining the feet it is important to also exam areas that are difficult to see such as the bottom of the foot and in between toes which are common areas for ulcers to occur. If you cannot visualize these areas directly, ADA recommends using a shatterproof mirror or asking another person (family member, friend, or caregiver) to inspect your feet¹. Notify your primary care provider or other healthcare professional of cuts, sores, blisters, or broken skin that does not heal after one day.

Footcare

Wash feet daily with warm water and dry the skin thoroughly, remembering to dry the skin in between the toes. The American Diabetes Association recommends the use of talcum powder or cornstarch to keep the skin between your toes dry¹. If your vision is impaired, it is important to see a foot specialist for help trimming toenails and smoothing calluses to prevent any accidental cuts or injuries during foot care. Use an emery board to smooth toenails and sharp edges that can lead to breaks in the skin or ingrown toenails.

Footwear

Your doctor may recommend or prescribe custom diabetic footwear or orthotics that help with off-loading pressure and reduce impact of ulcerated or vulnerable areas of the foot when walking. If you do not have diabetic footwear, it is important to wear comfortable walking shoes or athletic footwear. Avoid walking barefoot. Many DFUs are preventable and begin as minor breaks in the skin that go unnoticed because of decreased sensation in the feet from diabetic neuropathy ³. Small cuts or injuries can be slow to heal and allow bacteria to penetrate the skin and cause infection. Keep feet warm and wear socks and warm shoes during the winter to prevent frostbite.

By following diabetic footcare guidelines, individuals with diabetes can significantly reduce their risk of foot complications and avoid infection, hospitalization, amputation, recurrent foot ulceration, and mortality from diabetic foot ulceration ³. Patients can take care of their feet by performing daily self-examinations of their feet, keeping feet clean and dry, and wearing appropriate footwear to help with off-loading and prevent injury.

References

1. American Diabetes Association Professional Practice Committee (2022). 12. Retinopathy, Neuropathy, and Foot Care: Standards of Medical Care in Diabetes-2022. Diabetes care, 45(Suppl 1), S185–S194. https://doi.org/10.2337/dc22-S012
2. Smith, C., Beahrs, T., & Weatherford, B. (2022, May). Diabetic (Charcot) Foot – OrthoInfo – AAOS. Www.orthoinfo.org. https://orthoinfo.aaos.org/en/diseases–conditions/diabetic-charcot-foot/
3. Wexler MD, D. (2024). Evaluation of the diabetic foot. Uptodate.com. https://www.uptodate.com/contents/evaluation-of-the-diabetic-foot?search=foot%20wear%20diabetes&source=search_result&selectedTitle=8%7E150&usage_t ype=default&display_rank=8#H18