Diabetic Foot Ulcer - Prevention

Prevention

Steps to prevent diabetic foot ulcers include frequent chiropody review, good foot hygiene, diabetic socks and shoes, as well as avoiding injury.

• Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions.

• Footwear.

All major reviews recommend special footwear for patients with a prior ulcer or with foot deformities. One review added neuropathy as an indication for special footwear. The comparison of custom shoes versus well-chosen and well-fitted athletic shoes is not clear.

A meta-analysis by the Cochrane Collaboration concluded that "there is very limited evidence of the effectiveness of therapeutic shoes". The date of the literature search for this review is not clear. Clinical Evidence reviewed the topic and concluded "Individuals with significant foot deformities should be considered for referral and assessment for customised shoes that can accommodate the altered foot anatomy. In the absence of significant deformities, high quality well fitting non-prescription footwear seems to be a reasonable option". National Institute for Health and Clinical Excellence has reviewed the topic and concluded that for patients at "high risk of foot ulcers (neuropathy or absent pulses plus deformity or skin changes or previous ulcer" that "specialist footwear and insoles" should be provided

The one randomized controlled trial that showed benefit of custom foot wear was in patients with a prior foot ulceration. In this trial, the number needed to treat was 4 patients.