Promoting Healthy Skin - 5. Diabetic Foot Ulcers - C. Prevention

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5C: Prevention

Once you have learned how to assess and manage a diabetic foot ulcer, there are some important strategies that you can apply to reduce the risk of the ulcer from recurring. These may include the following:

Strategy	Explanation
Protect the client’s lower legs and feet	Protection of the lower legs and feet includes: Ensuring shoes are well-fitting, soft and comfortable Using leg protection devices to avoid injury (e.g. using limb protectors or long trousers) Protecting the toes and heels of clients with decreased mobility by using effective pressure relief devices such as foam or gel pads Being extremely careful when cutting toenails. Refer to a podiatrist where possible Avoiding soaking the client’s feet in hot water, using heating pads and applying harsh topical skin cleansers.
Have the client’s feet examined regularly	Clients with diabetes must have their feet checked regularly by a podiatrist.
Keep the client’s lower legs warm	Passive warming of the lower legs and feet, such as covering the legs with a blanket, improves blood supply (perfusion) and may be of benefit in preventing foot ulcers. However, do not use hot water bottles, electric blankets, foot spas or position the feet close to heating devices. This is because the client may not be able to feel if damage is occurring which risks burning of their skin.
Follow up regularly and perform skin checks	The key to preventing diabetic foot ulcers from occurring or recurring is to check the client’s skin daily. If a problem is detected, start treatment as early as possible.
Moisturise the client’s skin	Apply a pH neutral moisturiser to the client’s skin at least twice daily to keep the skin in good condition.
Encourage exercise	Clients should do lower limb exercises, at least every hour. Simple exercises may include drawing figures with their toes, pushing their toes towards the floor and then pointing them up towards their nose, stand on the balls of their feet, tiptoeing up and down, walking, or swimming. Any movement of the calf muscle helps to improve arterial blood flow.
Discourage the client from crossing his/her legs	Crossing the legs reduces arterial blood flow back to the lower limbs.
Discourage smoking	Smoking impairs blood flow.
Ensure the client maintains a healthy weight relative to their height	Ensuring a well-balanced diet and healthy weight reduces the risk of arterial disease.
Educate others	The education of clients, family members and other staff helps to ensure that problems are identified early and strategies are implemented to reduce the risk of a foot ulcer from occurring. It is especially important that the client does not walk barefoot, as they might tread on something and damage their skin and not be aware they have done so. Ensure socks are not too tight around the ankle because this affects circulation. Ensure that shoes are well-fitting. Shoes must be able to: accommodate an awkward foot shape or deformity have a broad front with plenty of room for the toes have low heels to avoid pressure on the toes have good laces, buckles or Velcro fastening to prevent movement and rubbing of the feet within the shoes. Therefore, avoid slip-on shoes and shoes with pointed toes or sandals.
Manage any underlying diseases	Ensuring that underlying diseases such as diabetes, heart disease or high blood pressure are well controlled helps to prevent complications such as diabetic foot ulcers.

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