Prevention of wounds on a high-risk foot

Wounds on a high-risk foot are often preventable. Preventive care for patients with a high-risk foot includes:

  • education about appropriate foot care (see Advice for patients about foot care)
  • appropriate footwear advice (see Advice for patients about footwear)
  • treatment of calluses, corns, blisters or foot injuries
  • treatment of ingrown or thickened toenails
  • treatment of fungal infections in the skin or toenails
  • offloading abnormal pressure under the foot
  • care from a multidisciplinary team
  • a chronic disease management plan.

If appropriate retail footwear is not available, consider prescribing medical grade footwear. Footwear should be professionally fitted if possible, particularly in patients who have peripheral neuropathy.

Patients with high-risk feet (without a current foot wound), should perform daily self-checks, and professional foot examination should occur at least every 3 to 6 months. Always examine the patient's bare feet (ie with shoes and socks removed). A daily foot care checklist is available from Diabetes Feet Australia for patients to encourage appropriate foot care.

Figure 1. Advice for patients about foot care.

Patient information sheet

  • check feet every day for cuts, blisters, ingrowing toenails or changes in skin colour; use a mirror if required
  • avoid walking barefoot, or in thin-soled shoes (eg slippers) or socks
  • wash and dry your feet every day, especially between toes
  • moisturise feet on the top and bottom, but not between toes
  • cut toenails straight across and file nail edges, if possible
  • wear appropriate footwear as recommended by a healthcare professional
  • protect your feet from hot and cold; avoid using external heat sources (eg heaters) to warm feet
  • elevate feet when sitting
Figure 2. Advice for patients about footwear.

Patient information sheet

Shoes that support and protect your feet are recommended. Shoes should:

  • completely enclose the feet
  • be longer than the longest toe by 1 to 2 cm when standing
  • be deep enough to allow toes to move freely, avoiding pressure on the front of the foot
  • be wide enough to accommodate the foot shape
  • have a heel height of less than 2.5 cm
  • have laces or adjustable straps that fasten the shoe securely to the foot; the foot should not slide within the shoe
  • be made of comfortable material (eg leather) that lets the feet breathe
  • not have seams on the inside
  • be reviewed (preferably by your healthcare provider) and replaced regularly.

Wear seamless cotton socks to avoid friction and absorb moisture. Change socks daily.

Footwear may need to be different if you have a foot wound—check with your healthcare provider.