The power of foot self-care: Practical tips for preventing DFUs
Prevention – Tips for preventing DFU
(Self-care techniques for diabetic foot: off-loading, footwear selection)
Appropriate preventive measures are crucial for diabetic foot ulcer (DFU) patients1Regardless the presence of DFU, patients should always prevent the occurrence or worsening of ulcers.
Maintain a Good Lifestyle, Monitor Risk Factors
Patients with DFU should always maintain a healthy lifestyle and learn about foot care. Acquiring clear, practical, and proactive information can improve the understanding of foot care and motivate behavioral changes2.
Techniques of Foot Self-care
- Basic wound care
Effective wound care is not only about healing the wound but also involves maintaining overall health. Regularly checking the feet for ulcers can effectively prevent DFU! The image below shows areas of the foot where ulcers are more likely to occur3, which should be given special attention：
- The importance and methods of off-loading
Off-loading is critical for the prevention and treatment of ulcers. Improper plantar pressure or foot deformities increase the incidence and recurrence rate of DFUs, and even in limbs with normal blood perfusion, inadequate off-loading can delay wound healing4.
The strategy of "off-loading" is to increase the plantar contact area to further redistribute the weight-bearing of the foot and relieve pressure5. The most effective off-loading method, considered the gold standard, is the non-removable Total Contact Cast (TCC), which is relatively inexpensive and allows limited foot mobility. It can effectively off-load the forefoot and midfoot while reducing foot edema3,4,6.
When a Total Contact Cast (TCC) is not an option, it is recommended to use a removable off-loading device (e.g., Removable Cast Walker, abbreviated as RCW), or felted foam combined with appropriate footwear for off-loading. If all conservative methods are ineffective, surgical off-loading (such as Achilles tendon lengthening, metatarsal osteotomy, or arthroplasty) should be considered as a last resort3,4,6.
- Wearing appropriate footwear：
According to the guidelines of the International Working Group on the Diabetic Foot (IWGDF), for patients with a risk level of 1 or above, wearing inappropriate footwear or walking barefoot is a major cause of foot trauma and subsequent DFUs. Therefore, patients should wear appropriate footwear both indoors and outdoors3：
- The internal length of the shoes should be 1-2 centimeters longer than the foot, not too tight or too loose.
- The internal width should be equal to the width of the metatarsophalangeal joints (or the widest part of the foot), and the height should allow enough space for all toes. As shown
in the figure：
- When assessing the suitability of footwear, it should be done while the patient is standing, preferably in the afternoon or evening (when the feet are relatively swollen).
- If there are no ready-made shoes available on the market, therapeutic footwear should be used, including custom shoes and insoles.
- Never wear the shoes that caused a DFU before..
- Wear seamless or smooth-seamed socks; do not wear tight compression stockings unless medically advised.
- Cut toenails straight across：
If you try to round off your toenails, not only could you injure the flesh during the process, but it is also easy to create hangnails that get embedded in the surrounding soft tissue. These hangnails may grow into the tissue as the nail grows8.
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Reference：
- van Netten JJ et al. Diabetes Metab Res Rev. 2016;32 Suppl 1:84-98.
- Coffey L et al. Int Wound J. 2019;16(1):183-210.
- Schaper NC et al. Diabetes Metab Res Rev. 2023;e3657.
- Alexiadou K et al. Diabetes Ther. 2012;3(1):4.
- Lim JZ et al. R Soc Med. 2017;110(3):104-109.
- Bus SA et al. Diabetes Metab Res Rev. 2023;e3647.
- WoundEducator- Total Contact Casting: https://woundeducators.com/total-contact-casting/. Accessed in Dec 2023
- Eekhof JA et al. Cochrane Database Syst Rev. 2012;(4):CD001541.