How do you prevent a diabetic foot ulcer?
What are the key take-home messages?
Prevention is always the best remedy. And even if you don’t have a problem right now, remember that a person with diabetes is always at risk of complications.
Prevention messages to keep in mind:
To ensure healthy feet and avoid complications, you should :
- adopt good habits such as proper footwear and foot care;
- do regular inspections of your feet;
- detect problems before they appear or worsen.
Just because you don’t have any symptoms or discomfort at the moment doesn’t mean you don’t have a diabetic foot. Once you have been diagnosed with diabetes, you need to pay extra close attention to your feet. There is a risk that problems will develop, especially in certain areas. The following image shows you the main areas to look out for. They are indicated by arrows.
Places on the feet more at risk of developing sores.
You should see a foot care specialist regularly, at least once or twice a year. If you have poor circulation or have had a foot wound or amputation in the past, you should see a health professional even more often. And if you ever notice a change in your foot that raises a doubt or concern, don’t hesitate to ask your health professional for support.
How to inspect your feet
Did you know that 80% of all diabetic foot complications, such as plantar ulcers or amputations, can be prevented by doing the following three things?
The foot inspection routine
If necessary, ask a friend or carer to help you inspect your feet. Here are the main rules to follow to help keep your feet healthy:
- Inspect your feet every day. You can use a mirror to examine them better or ask someone to do it for you. Look at the bottom, top and sides of both feet and check between the toes.
- Check the skin on your feet. Do you see any tears, redness, calluses, cuts, bruises, scrapes, cracks, blisters, ulcers or anything else that looks different, new or unusual?
- Look at your toenails. Do you see any cracks in the nail plate, uneven edges, discolouration, injury, debris or bruising under or around the nail, for example a black, bluish or reddish appearance?
- Look for signs of infection such as heat, redness, pain, swelling or discharge from the nails, skin or lesions.
- Do you see any changes in the appearance or shape of your feet, such as a sunken arch (your foot becomes flat), hammertoes or bumps on your feet?
Keep a journal
Get into the habit of writing down your observations in a journal. You can take it with you when you see a health professional. It will serve as a reminder allowing you to provide better information regarding the changes you have observed.
Write down things that are important to you; for example, new shoes, an accident, a fall, or a return from a trip during which you walked a lot. This information will help you to understand why your feet have developed certain problems and at the same time identify your limitations. A picture is worth a thousand words – don’t hesitate to take pictures of your feet and show them to the health professional.
What a journal looks like
Daily foot inspection journal
Make copies of this worksheet and follow these instructions to keep a record of the health of your feet every week.
A. Examine all parts of your feet, including between the toes. Check the top, bottom and both sides of your feet every day. If needed, use a mirror to help you inspect the bottom of your feet.
B. Examine your toenails. Make sure they are cut to the right length and that there are no rough or pointed edges.
C. Measure the temperature of your feet using an infrared personal thermometer. Temperature changes can alert you to potential complications.
- Note any changes in appearance, such as redness, calluses, scratches.
- Note any changes in the shape of your feet.
Using the table provided:
- Mark red areas with an R.
- Mark areas with calluses with a C.
- Mark scratches, blisters and ulcers with a U.
- Mark changes in shape with an S.
Download the journ al template
How should you take care of your feet day-to-day?
By looking after the health of your feet, you can avoid serious and often painful problems. Keeping your blood sugar levels within the normal range will also help ensure your feet stay healthy.
Regular physical activity, a proper diet rich in fruits and vegetables and low in salt, and moderate alcohol consumption are all good lifestyle habits that not only improve your overall health but also that of your feet.
You are responsible for your daily hygiene. Always remember that by looking after the skin and nails of your feet, you are protecting them. While daily foot care requires a small investment of your time, your health will benefit greatly, not to mention the fact that you’ll have beautiful feet. Here are some foot-care tips that we recommend:
- Clean your feet with a mild soap every day. Gently rub them all over, including between the toes, and rinse them with warm water. Ideally the water should not exceed 37 degrees Celsius, which is the same temperature as your body.
- Check the temperature of the water with your hand before putting your feet in.
- Do not soak your feet, as foot baths cause the skin to dry out or crack.
- Do not rub your feet vigorously to clean them, as this may damage the skin.
- Dry your feet thoroughly with a clean, thin, soft cloth. Don’t forget between the toes.
- Apply moisturizing lotion or cream to the top and bottom of the foot. Do not apply between the toes. Avoid using too much cream and avoid irritating or overly scented products.
- Avoid applying heat to your feet. Do not use hand warmers, foot warmers or heating pads such as Magic Bags.
- Do not use any medication, natural or chemical products, or instruments for calluses, nails, fungus, skin or warts without consulting a health professional.
- Keep your feet clean and dry.
- Change your socks or stockings every day.
- Trim your toenails straight across, without rounding the corners too much. Avoid cutting them too short and leaving sharp corners. Use your own instruments and avoid sharing them with others. You can clean them with warm water and mild soap and disinfect them with 70% isopropyl alcohol. If you can’t see clearly or have trouble reaching your toes, don’t try to cut your nails alone.
The right way to cut your nails.
How do you choose the proper footwear?
It can sometimes be very difficult to choose shoes or boots that are well adapted to our feet. So don’t hesitate to talk to people who are qualified to guide you.
How do you choose the right shoes?
Here are some practical tips to help you choose and purchase your shoes. Keep in mind that shoes that fit your feet properly will reduce the risk of diabetic foot complications.
- Choose shoes that are the right size and shape for your feet. Your shoes should be one to two centimetres longer than your feet. They should leave ample room for your toes. Make sure they are big enough to allow you to wear medium thickness socks and to add a cushioned insole if needed.
Make sure that the whole foot has enough space to avoid too much pressure on the skin.
- Don’t hesitate to have the width, height and length of your feet measured in order to help you select the proper shoe size. Many specialized shoe stores use a measuring device to determine the right size shoe for your feet.
- Try on your shoes. If they don’t feel comfortable after a few steps, don’t buy them. They won’t get more comfortable over time. Only buy shoes that feel 100% comfortable when you try them on.
Click here if you would like more information on the different components of shoes.
- Choose footwear that will adequately protect your feet no matter what the situation: cold, sun, or risks associated with a job or activity.
- Buy shoes that offer good ventilation, such as sports shoes, or that are made of natural materials like leather. Avoid shoes made of synthetic materials such as leatherette or plastic, especially if your feet tend to sweat a lot.
- Pay special attention to the soles of your shoes. They should be non-slip and cushioned enough to absorb shocks.
- Choose a stable and firm heel with a height of three centimetres or less.
- Choose a shoe that can be adjusted with straps, buckles, laces, elastics, ties or Velcro. This will keep you comfortable even if your feet are swollen or you are wearing thicker socks.
- Choose a shoe that allows room for your toes.
- Avoid shoes that don’t offer enough support or don’t have a heel piece, such as clogs, sandals or Crocs-style shoes.
- If you choose a shoe with a built-in arch support, make sure it doesn’t put too much pressure on your foot.
- If you have diabetes, install a cushioned insole in your shoes to reduce shocks and vibration.
- Look for shoes equipped with a shank. This is a long, invisible piece of leather, wood, plastic or carbon inserted in the sole that prevents it from bending and increases its resistance to twisting.
- Choose shoes with a cradle-type sole.
Shoe with a cradle type sole.
Presence of a shank in the shoe.
What should you watch out for when wearing your shoes?
For a person with diabetes, it’s not just about finding “the right fit,” but also about taking precautions to prevent injury. Here are a few tips:
- Always wear socks or stockings in your shoes. Change them every day to protect your feet and make shoe care easier. Wear well-fitting light-coloured socks and inspect them for blood or clear or yellowish fluid that would indicate a blister has bursts.
- Remember that comfort is key and takes precedence over appearance.
- Avoid walking barefoot. Both indoors and outdoors, it is more prudent to wear your shoes.
- Check the inside of your shoes before putting them on in case an object such as a rock or a piece of wood or glass has slipped in.
- Look for signs of wear on your shoes, such as warped soles, rough seams or holes in the lining that could injure your feet.
- Don’t overextend the life of your shoes. Replace or repair them as soon as you see that they are worn or broken.
- Inspect your feet when you take off your shoes. Look for new marks on your skin, such as redness, calluses or blisters.
- If your feet are severely deformed, consider getting custom-made or orthopedic shoes.
- If you have new shoes, put them on at home for at least 20 minutes. Then inspect your feet. Do you see any redness? Did you feel pressure in any areas? If you felt any discomfort in that time, return the shoes to the store and choose another pair. You can also seek professional advice.
- Remember to wear shoes that are appropriate for your activities.