14. Foot Care and the Prevention of Recurrent Ulcers

Diabetic foot ulceration is a common complication of diabetes that affects approximately 1 in 20 patients but is largely preventable. The risk factors for ulceration include having had a previous foot ulcer, peripheral neuropathy (insensitivity), dry or cracked skin, deformity (claw toes, prominent metatarsal heads/high metatarsal arch), abnormal biomechanics, high plantar foot pressures, callus formation and peripheral arterial disease.

As well as the above poor-fitting footwear, self-neglect, with poor foot hygiene and walking barefoot increase the risk of foot damage. The United Kingdom National Institute of Health and Clinical Excellence (NICE) advises that extra vigilance should be used in patients who have poor vision, live alone, who smoke, who are over 70 years of age, and who have had long duration of diabetes, or are socially deprived.

This suggests that with regular foot care (which assumes that access to such care is readily available), a reduction of foot pressures, patient education/empowerment and good control of diabetes, the prevention of recurrent foot ulceration should be an achievable aim.