Diabetic Foot Ulcer Prevention

As a diabetic, ulcers are a large concern because it can lead to something much more serious, like an amputation. In Canada, 15% of the population are diabetic (Diabetes Canada). When we look at amputations, 70% of amputations in the hospital are from diabetes and 85% of these are from a foot ulcer (Diabetes Canada). Implementing measures for foot ulcer prevention in diabetics is a good way to prevent serious issues from arising.

Why do ulcers develop?

There are many complications that a diabetic can develop. The conditions that affect the feet are peripheral arterial disease (PAD) and peripheral neuropathy.

How a Diabetic Foot Ulcer Starts

Peripheral neuropathy can be a source of blame for the start of a diabetic foot ulcer. This is when the nerves are damaged and there is compromised feeling in the feet.

Normally, when there is irritation in the foot, your brain will avoid the irritation either consciously or subconsciously. This can be from a sharp object in your shoe or from the way you are walking.

The sharp object in your shoe is an easier example. It could be a rock or a tack that fell inside the shoe. In terms of the way you are walking, these points first show up as calluses. Over time, the calluses can become so large that they are painful.

If these irritation points are not resolved, by either removing the object or changing the pressure points, they can become an injury that punctures the skin. A diabetic with peripheral neuropathy may not feel these pressure points, and therefore, won’t resolve the irritation point. The longer these points go unnoticed, the worse the injury gets.

How a Diabetic Foot Ulcer Forms

Once there is an injury in the foot that has punctured the skin, that is when the ulcer begins to form. An ulcer is when this injury doesn’t heal properly, and it becomes infected.

Peripheral arterial disease (PAD) prevents the appropriate healing because it disrupts the blood flow to the feet. Blood flow is necessary to circulate fresh blood into the feet, which heals the injury.

This means when PAD is present, it is very hard to heal an injury once the skin has been punctured.

How to Prevent a Diabetic Foot Ulcer

To prevent these diabetic foot ulcers from starting, it is important to address any source of pressure.

Daily Routines

Adding a few checks into the daily routine can prevent an injury before it starts.

Before putting on any slippers or shoes, always look inside them before putting them on. This is an inspection for foreign objects that could injure the foot (ex. rocks, tacks, etc.). Look AND feel inside the shoe as well as under the insole for any objects.

At the end of the day, look for signs of pressure. These signs are redness, calluses, corns or pressure lines. If there are any signs of pressure, find the cause and address it as quickly as possible.

Offload Pressure Points

Once pressure points have been detected, the cause may not always be apparent. In a lot of causes, it can be pressure from footwear or the way you are walking/the way your feet are.

If shoes are too tight, the shoe needs to be wider, the toe box needs to be more curved and less pointed and/or the shoe is too small in the length. Getting your shoes fit properly through a professional such as a Pedorthist, is the best way to avoid these spots.

When the way you are walking, or the way your feet are, is causing a pressure point, a custom foot orthotic is a great device to use. These devices offload pressure points by redistributing weight, cushioning specific areas, and supporting/correcting where necessary. A custom device is typically better than an over-the-counter device for diabetics, because it is better targeted to the pressure points for each specific foot.

Preventative Measures

To get ahead of the pressure points before they are noticeable, proper shoes, orthotics, and regular footcare are great preventative measures.

Orthotics

As mentioned above, custom foot orthotics are great for offloading pressure points specific for each foot. Orthotics can be used even without signs of pressure. As a preventative device, the Canadian Certified Pedorthist can recognize problem areas. We would look at what areas could be a potential cause of concern.

Shoes

Proper fitting shoes can go a long way in preventing pressure points. Issues can arise from a shoe that is too tight as well as a shoe that is too loose. A Canadian Certified Pedorthist can find the best shoe for each person and make changes when necessary. Orthopaedic shoes provide a lot of great features, but they can be modified when they don’t provide all the features we need. A Pedorthist will also make these modifications, and understand when a custom shoe would be appropriate.

Regular footcare

Getting your feet looked at, nails trimmed, and corns and calluses addressed on a regular basis from a footcare nurse, is a great way to address issues before they arise.

Footcare nurses are trained to recognize when there are issues that need to be addressed. They also make sure nails are trimmed and corns and calluses are removed properly. When doing this yourself, there can be a risk of cutting the nails too short or filing these pressure points too thin. The risk of this, are ingrown toe nails or cutting yourself.

Conclusion

It is important to take care of the feet as a diabetic. The risk of a foot ulcer becoming an amputation is a real one and the best treatment is prevention!

If you have any questions, or would like to start taking care of your feet, you can book an appointment online.