Preventing Foot Ulcers: 19 Do’s and Don’ts

In the previous article in our ongoing series ‘A Comprehensive Guide to Diabetic Foot Problems: Diabetic Foot Ulcers’, we learned the basics of identifying, diagnosing, and treating foot ulcers. But what about preventing foot ulcers? Fortunately, there is quite a bit that diabetics can do to prevent these ailments.

Dr. Formanek’s top 19 tips to prevent diabetic foot ulcers:

• Swimming, bicycling, and other low impact exercises are ideal exercises for the diabetic foot
• Exercise such as prolonged walking, running, jogging, and use of the treadmill is not recommended for patients with diabetic neuropathy. 
• appropriate fitted diabetic protective footwear must be worn to limit pressure areas and to prevent severe burns from hot sand and poolside during exercise

Do control blood sugar!

Work closely with your physician (or team) to monitor your diabetes. Ask your doctor for a regular A1C blood test. Maintaining normal albumin levels, in addition to HbA1c, can help with healing in the event injury or ulceration occur. Watch your diet. 

Do inspect your feet daily for blisters, cuts, and scratches.

If vision impaired, ask a family member for help.

• Use a mirror to see the bottom of your feet; check for dryness, redness, tenderness, and localized areas that rub (hot spots). 
• Don’t forget to check between the toes! 

Do wash feet daily.

Dry feet carefully; especially between the toes.

Do not walk barefoot!

Your feet may be numb and may not feel an injury as it occurs.

Do avoid temperature extremes!

•  Test water with your hand or elbow before bathing. If feet feel cold at night, wear loose socks to bed. Do not apply hot water bottles or heating pads. 
• Do not walk on hot surfaces, such as sandy beaches or cement around swimming pools.
• Protect your feet against sunburn with sunscreen.
• Beware of car heaters on long trips

Do buy only comfortable well fit shoes; a professional should fit them for you.

• Walk around in them and be sure they are comfortable immediately. 
• People whose feet are numb tend to wear shoes that are too small, causing the rubbing spots.
• Buy new shoes late in the day. Feet enlarge due to swelling at the end of the day compared to waking up due to gravity. 
• Choose non-walking shoes with soft leather uppers that can mold to the shape of your feet
• Modern walking shoes are good choices for exercise
• Never buy sandals; particularly those with thongs between toes
• Do not buy or wear heels
• Do buy shoes that are wide enough across the toes
• shoes that are too long will bend in the wrong area of the forefoot and can create trauma or injury, creating thickened or dark toenails–due to trauma underneath the toenails.

Do have your podiatrist inspect new shoes to ensure proper fit and construction.

Do wear new shoes only two hours at a time.

• If they are tight in an area, wearing them for a short period of time will reduce the risk of skin breakdown
• Slowly increase wearing time over several days. Don’t wear any shoes for more than five hours at a time. 
• You should have one pair for the morning, one for the afternoon, and one for the evening around the house.

Do inspect the inside of the shoes daily for foreign objects, nail points, torn lining, and rough areas.

These could be sources of pressure and cause skin breakdown.

Do inform your podiatrist promptly if you develop a blister, puncture, sore, callus, or corn.

• Do not cut corns and calluses or reduce thickened, ingrown or problematic toenails. 

• Diabetics should never use commercial, chemical agents for the removal of corns and calluses
• Follow podiatrist’s instructions

Do not use strong antiseptic solutions.

Such as alcohol, hydrogen peroxide, etc. as it may dry out your feet excessively.

Do use foot pads or arch supports when properly fitted by a podiatrist.

If not appropriately fitted, they could create abnormal pressure areas. Do not use adhesive tape on your feet.

Do apply thin layer of lubricant after bathing.

Do not put oil, cream, or ointment between the toes; it may cause too much moisture in those areas and cause the skin to break down.

Do always wear clean loose-fitted socks or stockings: change daily.

• Inspect socks or stockings carefully before and after wearing them
• Wear properly fitted stockings. 
• Do not wear mended stockings. 
• Avoid stockings with seams which cause areas of pressure and rubs leading to skin breakdown. 
• Check with your podiatrist for socks or stockings specifically designed for diabetics
• Some synthetic socks and stocking can cause further dryness to the already dry diabetic foot
• Take special precautions in the wintertime by wearing wool socks and protective shoe gear

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Do see your podiatrist regularly.

Make sure that your feet are examined each visit. Inform any new podiatrist that you have diabetes.

A Comprehensive Guide to Diabetic Foot Problems: How you can avoid and treat diabetic ulcers.