Prevent A Diabetic Foot Ulcer From Home: Podiatrists Guide
If you or a loved one has been diagnosed with diabetes, then you may already know that your feet are at risk. One of these risks is developing a diabetic foot ulcer. As podiatrists, we see first-hand the effects of foot ulcers on the lives, mobility (movement) and well-being of our patients and their families. Here are some important facts you need to know:1,2
- The consequences of diabetic foot ulcers include a decline in your functional status, infection, being hospitalised, needing a lower limb amputation, and death.
- The lifetime risk of getting a diabetic foot ulcer is 19% to 34%. This is already high, and the number is rising with the increased longevity and medical complexity of people with diabetes.
- Once you get a diabetic foot ulcer, you’re more likely to keep getting them. 65% of people will have another ulcer within 3-5 years.
- One in five people who have a diabetic foot ulcer will have an amputation over their lifetime.
- The five-year mortality (death) rate following an amputation for a diabetic foot ulcer is 50–70%.
- New data suggest overall amputation incidence has increased by as much as 50% in some regions over the past several years after a long period of decline, especially in young and minority populations.
- If you have other problems, such as heart health or circulation, your mortality risk is higher.
We don’t list the above points to scare anyone, but it is our professional responsibility to be clear: diabetic foot ulcers are serious. And taking preventative measures to avoid a diabetic foot ulcer, as well as preventing their recurrence if you’ve already had one, is extremely important.
Time for some good news: three out of four diabetic foot ulcers are preventable3 That’s huge! So, to help support your prevention efforts at home, today our podiatrists here at Merivale Podiatry have shared what you need to know regarding why diabetic foot ulcers develop and how to prevent one. We hope this information can help improve lives and ease the impact on the families of those affected. We’ve linked numerous studies and resources for you to continue learning if you like, but if you have any questions - please reach out.
What Causes Diabetic Foot Ulcers?
A foot ulcer is an open sore on your foot. Foot ulcers can vary in size and depth, depending on their severity. Several classification systems are used to classify ulcers, one of which is the Wagner classification of diabetic foot ulcers. You’ll notice as we go down the list, the ulcer gets more severe and complicated:
- Wagner Grade 0: the skin is intact with no open lesion or a pre-ulcerative lesion
- Wagner Grade 1: there’s a partial- or full-thickness ulcer (superficial ulcer)
- Wagner Grade 2: there’s a deep ulcer extended to ligament, tendon, joint capsule, bone, or deep fascia without abscess or osteomyelitis (bone infection)
- Wagner Grade 3: there’s a deep abscess, bone infection, or joint sepsis
- Wagner Grade 4: there’s partial-foot gangrene (tissue death due to a lack of blood flow or infection)
- Wagner Grade 5: there is whole-foot gangrene
Effectively managing diabetic foot ulcers means that you can prevent the ulcer from worsening down this scale and leading to serious complications. In most cases of gangrene and some cases of osteomyelitis, amputation is required.
When you have diabetes, your risk of developing a foot ulcer skyrockets because of the way that diabetes affects both your sensation and your circulation, hence the term diabetic foot ulcer.
- Your sensation: your sensation - better described as your ability to feel what is happening to and around your feet - is compromised because of the way that diabetes affects your nerves. This results in a problem called diabetic neuropathy, which affects up to 50% of patients with type 1 and type 2 diabetes.4 As you lose your ability to detect the sensations around your feet, you may miss the occurrence or development of wounds - even small ones like cuts, scratches or blisters. When a wound is undetected, it is left untreated and not cared for appropriately. This leaves it vulnerable to worsening, increasing in size, becoming infected and becoming an ulcer.
- Your circulation: your circulation, that is, your blood flow, is also impaired in diabetes due to the effect that diabetes has on your blood vessels. When your blood flow to your feet is compromised, you get less oxygen, nutrients and reparative cells to the area. This means that your wounds take longer to heal - and the longer they’re ‘open’, the longer they’re vulnerable to infection. If you develop an infection, your compromised circulation means that your ability to fight the infection is also impaired, leaving you more susceptible to ulceration.
How To Prevent A Diabetic Foot Ulcer
Now that you have a better understanding of why a person with diabetes is at risk of a foot ulcer, it’s important to know how to reduce your ulcer risk, both professionally and at home. We recommend:
At-home care and prevention tips
- Wash and dry your feet thoroughly every day, including drying well between the toes to prevent moisture from becoming trapped, which could otherwise macerate and break down the skin.
- Check your feet daily, including the top, bottom, and sides, as well as between the toes. Look for marks, spots, cuts, swelling, or redness that is new or unusual. If you can’t easily see the bottom of your feet, use a floor mirror so you can hold your feet up to it to check.
- If you have any concerns about your feet or notice something abnormal, let your podiatrist or GP know. If you can’t reach a health professional, let a family member know so they can check your feet and take it from there.
- Choose good shoes. This means shoes that are comfortable and well fitted, with good depth and width for the toes. Having good, supportive shoes minimises the risk of damage to the feet and hence reduces your ulcer risk. There are specific brands of diabetic-friendly shoes you can look into, such as the Dr Comfort range.
- Choose cotton socks with no elastic in the tops, as they will absorb sweat and reduce pressure at the top of the sock line. Seamless diabetic socks are also available.
- If you have any difficulty trimming your toenails or get corns or calluses, book in for podiatry nail and skin care every 6-12 weeks. During this time, your podiatrist will also be able to check for any warning signs related to your diabetes.
- Avoid walking around with bare feet. This reduces the risk of standing on something sharp without detection, which could lead to an ulcer.
- Don’t bring your feet in direct contact with heaters, hot water bottles, scalding hot showers/baths and electric blankets. If you have reduced sensation, you may not be able to detect the level of heat, increasing your ulcer risk.
Despite two people both being diagnosed with diabetes, they can have very different risk profiles when it comes to developing a diabetic foot ulcer. This is influenced by factors including your level of sensation, circulation and the presence of other diseases. This is why it is highly recommended to attend an annual diabetic foot health screening with your podiatrist. This is something our podiatrists offer, where we observe, test and document specific characteristics and features of your feet, any notable changes since your previous assessment with us, palpate your pulses to check blood flow around your feet, and complete some sensory testing to determine the level of sensation present in multiple areas around your feet. This can include monofilament testing, vibration sensation, hot/cold and sharp/blunt testing, reflex testing and other tests.5 We then give you the right information based on your results about how to best care for your feet and reduce your ulcer risk daily.
At your appointment, we can also discuss whether other therapies, such as foot orthotics, could be beneficial in your circumstances. Orthotics can help off-load high-pressure (and therefore high-risk) areas on the bottom of the feet, especially with prominent bones or bunions. The need and benefit of orthotics will be assessed on a case-by-case basis by your podiatrist and should not be a one-size-fits-all approach.
Our Diabetes Home Care Pack
We regularly get asked about the best way to care for feet with diabetes at home, including ulcer prevention. To help make it easier, we’ve put together a dedicated home care pack for diabetic feet that contains:
Our Dr Comfort Diabetes Support Socks are specially crafted to meet the unique needs of individuals with diabetes. With their seamless design and soft fabric, these socks provide unmatched comfort and protection for your feet. The non-binding top ensures optimal blood circulation, while the moisture-wicking properties keep your feet dry and healthy.
Gehwol Fusskraft Red is your ultimate foot cream, offering nourishing care for diabetic feet. Its rich formula contains valuable ingredients to keep your skin supple and protected. Regularly using this cream helps prevent skin problems, keeping your feet in top condition.
Our Mepore Island Dressings are a reliable choice for wound care and protection. These sterile and self-adhesive dressings create a safe environment for healing and help prevent infection. With five in the pack, you can ensure continuous wound care when needed.
Our Spirularin Skin Gel has powerful natural healing properties, providing soothing relief for your feet. Its gentle formulation is ideal for diabetic skin, promoting healthy healing and comfort.
A great shoehorn is a simple yet indispensable tool to make shoe application easier. Its ergonomic design ensures effortless use, minimising strain on your feet.
Get your diabetes home foot care pack at a discounted price here. If you’re looking for and dedicated team to help care for your feet and support their health and well-being for the long term, we’re here to help.
Book your appointment with our experienced podiatry team by calling us on 03 355 9481, book online here, or email our reception team at reception@merivalepodiatry.co.nz
1 Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers
3 Update on prevention of diabetic foot ulcer
4 Peripheral Neuropathy and the Diabetic Foot
5 Prevention of Diabetic Foot Ulcer