What are the best practices to prevent diabetic foot ulcers?

From the Guidelines

Preventing diabetic foot ulcers requires a comprehensive approach that includes daily foot inspection, proper foot hygiene, and appropriate footwear, as recommended by the most recent guidelines 1. To prevent diabetic foot ulcers, it is essential to:

• Examine your feet daily for cuts, blisters, redness, swelling, or nail problems, using a mirror if needed to see all areas
• Wash feet daily with lukewarm water and mild soap, drying thoroughly especially between toes
• Apply moisturizer to prevent dry skin but avoid putting it between toes
• Wear properly fitted shoes with adequate room for toes and cushioned soles, and never go barefoot
• Trim toenails straight across and file edges
• Maintain good blood glucose control, aiming for an A1C below 7%, as high blood sugar impairs healing and increases infection risk
• Regular exercise improves circulation to the feet, while smoking cessation is crucial as smoking constricts blood vessels
• Have a professional foot examination at least annually, or more frequently if you have neuropathy or previous foot problems These practices are essential because diabetes can cause nerve damage (neuropathy) that reduces sensation in feet, making injuries go unnoticed, while also impairing circulation needed for healing. Additionally, consider the following recommendations:
• If you have a foot deformity or pre-ulcerative sign, consider prescribing therapeutic shoes, custom-made insoles, or toe orthoses 1
• If you have a history of foot ulceration or lower-extremity amputation, screen for peripheral artery disease, foot deformity, and pre-ulcerative signs on the foot 1
• Provide integrated foot care, including professional foot care, adequate footwear, and structured education about self-care, to help prevent a first or recurrent foot ulcer 1 It is crucial to follow these guidelines to prevent diabetic foot ulcers, as they can lead to severe consequences, including amputation and decreased quality of life.

From the Research

Best Practices to Prevent Diabetic Foot Ulcers

To prevent diabetic foot ulcers, several best practices can be followed:

• Maintain good glycemic control, as hyperglycemia impairs healing of diabetic foot ulcers 2, 3
• Practice good foot care, including regular washing and drying of feet, trimming toenails carefully, and wearing comfortable shoes that fit well
• Conduct daily foot inspections to identify any potential problems early, such as cuts, bruises, or changes in skin color or temperature
• Wear shoes that fit well and provide adequate support and protection for the feet
• Avoid smoking, as it can reduce blood flow to the feet and increase the risk of foot ulcers

Risk Factors for Diabetic Foot Ulcers

Several risk factors can increase the likelihood of developing diabetic foot ulcers, including:

• Poor glycemic control 2, 3
• Diabetic peripheral neuropathy, which can cause loss of sensation in the feet and increase the risk of foot ulcers 4, 5
• Peripheral arterial disease, which can reduce blood flow to the feet and increase the risk of foot ulcers 6
• History of foot ulcers or amputations
• Obesity and physical inactivity

Treatment and Management of Diabetic Foot Ulcers

If a diabetic foot ulcer does develop, prompt treatment and management are essential to promote healing and prevent complications:

• Debridement of the ulcer to remove dead tissue and promote healing
• Use of dressings and topical treatments to protect the ulcer and promote healing
• Off-loading of pressure on the ulcer to reduce stress and promote healing
• Management of underlying conditions, such as diabetes and peripheral arterial disease, to promote healing and prevent recurrence
• Regular follow-up with a healthcare provider to monitor the ulcer and adjust treatment as needed 2, 6

Prevention Programs

Prevention programs can be effective in reducing the incidence of diabetic foot ulcers:

• Education on risk factors and prevention strategies, such as good foot care and regular foot inspections
• Screening for diabetic peripheral neuropathy and peripheral arterial disease
• Management of underlying conditions, such as diabetes and obesity
• Promotion of physical activity and healthy lifestyle habits
• Regular follow-up with a healthcare provider to monitor for potential problems and adjust prevention strategies as needed 4, 6