About one in three people with diabetes will develop a foot ulcer in their lifetime, but most of these ulcers are preventable. Prevention comes down to a combination of daily habits, proper footwear, blood sugar management, and regular professional foot checks. Each of these layers reduces risk on its own, and together they can dramatically lower the chance of an ulcer forming or, if one does form, progressing to something more serious.
Why Diabetic Feet Are Vulnerable
Foot ulcers in diabetes don’t appear out of nowhere. They develop through a predictable chain of events, and understanding that chain makes prevention much more intuitive.
The two main culprits are nerve damage (neuropathy) and poor blood flow (peripheral artery disease). Neuropathy strips away your ability to feel pain, pressure, and temperature in your feet. That means a blister from a tight shoe, a pebble in your sock, or a small cut can go completely unnoticed. Without pain as an alarm system, minor injuries keep getting worse with every step you take. Poor blood flow compounds the problem by slowing healing and starving tissues of oxygen. Roughly one-third of diabetic foot ulcers involve both nerve damage and reduced circulation at the same time, which makes them especially difficult to heal once they start.
Keep Blood Sugar in a Safe Range
Chronically high blood sugar is what drives the nerve damage and blood vessel disease that set the stage for ulcers. The landmark DCCT and UKPDS trials established that every 1% drop in HbA1c translates to roughly a 21% reduction in all diabetic complications, including the neuropathy and vascular disease that lead to foot problems. Conversely, HbA1c levels at or above 8% are associated with a significantly higher likelihood of lower extremity amputation if an ulcer does develop. At levels above 10%, the risk of severe, deep ulcers climbs sharply.
This doesn’t mean you need perfect numbers to benefit. Even modest, sustained improvements in blood sugar control slow the progression of nerve damage and help preserve circulation to your feet. Work with your care team on a realistic HbA1c target, and treat blood sugar management as the foundation of foot ulcer prevention, not a separate issue.
Daily Foot Checks
Because neuropathy can eliminate the pain signals that would normally alert you to a problem, your eyes have to do the job your nerves no longer can. A daily visual inspection takes about two minutes and is one of the most effective prevention habits you can build.
Look at the tops, bottoms, sides, and between each toe. You’re scanning for redness, blisters, cracks, cuts, swelling, calluses that are changing color, or any area that looks different from the day before. If you can’t easily see the bottom of your feet, use a mirror on the floor or ask someone to help. Pay special attention to areas where shoes tend to rub: the sides of the big toe, the ball of the foot, and the heel.
Temperature Monitoring
One of the more useful early warning signs is a temperature difference between your feet. Inflammation from repetitive stress causes localized warming before any visible damage appears on the skin. In a clinical trial published in Diabetes Care, patients who checked foot skin temperatures with a handheld infrared thermometer twice daily and reduced activity when one spot was more than 4°F warmer than the same spot on the opposite foot had significantly fewer ulcers than those who relied on visual checks alone. Inexpensive infrared thermometers designed for this purpose are available without a prescription.
Moisturize, but Not Between the Toes
Dry, cracked skin on the feet is more than a cosmetic issue. Cracks in the skin create entry points for bacteria, which can quickly lead to infection in a foot with compromised blood flow. A scoping review of foot skin care for ulcer prevention found that creams containing urea (around 5%) or a combination of 15% glycerol with soft paraffin were the most effective at restoring skin hydration when applied twice daily for at least two weeks.
Apply moisturizer to the tops, bottoms, and sides of your feet after bathing, but avoid the spaces between your toes. Moisture trapped between the toes creates a warm, damp environment that encourages fungal infections and skin breakdown, both of which can become entry points for deeper problems.
Choosing the Right Footwear
Shoes are either your feet’s best protection or their biggest threat. Poorly fitting shoes are the single most common trigger for ulcers in people with neuropathy, because you can’t feel the friction or pressure that would normally make you kick them off.
Therapeutic shoes for people at risk of ulcers are built differently from standard footwear. They feature extra depth (at least 3/16 of an inch more than a standard shoe when the insole is removed) to accommodate custom inserts without crowding the toes. They come in full and half sizes across at least three widths, so the sole matches the actual shape and size of your foot rather than forcing it into a generic mold. For higher-risk feet, custom-molded shoes are constructed over a positive model of your foot, ensuring total contact and proper pressure distribution.
Custom inserts (orthotics) are equally important. These are molded directly to your foot or a model of it and use multiple densities of material to redistribute pressure away from vulnerable areas. If you have Medicare or equivalent coverage and meet the criteria (diabetes plus at least one qualifying condition like neuropathy, poor circulation, or a history of ulcers), therapeutic shoes and inserts are typically a covered benefit.
Beyond therapeutic options, some general rules apply to all footwear: never walk barefoot, even indoors. Always check inside your shoes before putting them on, feeling for pebbles, bunched-up lining, or rough seams. Break in new shoes gradually, wearing them for only an hour or two at first, and inspect your feet afterward.
Professional Foot Care
Calluses on the bottom of the foot might seem harmless, but they act as pressure concentrators. High plantar pressure is a direct risk factor for ulceration, and callus buildup amplifies that pressure further. Professional debridement (careful removal of callus tissue by a podiatrist using a scalpel) has been shown to reduce peak plantar pressures and is considered an important ulcer prevention strategy. This isn’t something to attempt at home with a pumice stone or razor. A podiatrist can remove callus safely without damaging the tissue underneath.
How often you need professional foot exams depends on your risk level. Current international guidelines from the IWGDF recommend risk-based screening: people with no neuropathy and no circulation problems may only need annual checks, while those with neuropathy, foot deformities, or a history of ulcers need exams every one to three months. Your provider should assess sensation, circulation, skin condition, and foot structure at each visit, and adjust your prevention plan accordingly.
The Power of a Care Team
Preventing foot ulcers isn’t a solo effort, and research strongly supports a team-based approach. A systematic review and meta-analysis found that multidisciplinary care teams (typically combining a podiatrist, endocrinologist, vascular specialist, wound care nurse, and orthotist) reduced major amputation rates by 39 to 56%. These teams catch problems earlier, coordinate treatment faster, and ensure that no single aspect of prevention falls through the cracks.
If your current care only involves a primary care physician, ask about referral to a podiatrist or a dedicated diabetic foot clinic, especially if you have any neuropathy, circulation issues, or a previous ulcer. A prior ulcer is the strongest predictor of a future one, so the intensity of your prevention plan should match your level of risk.
Everyday Habits That Add Up
Several smaller habits reinforce the strategies above:
- Trim toenails carefully. Cut straight across, not curved at the edges, and file sharp corners. If you have thickened nails or trouble seeing your feet, have a podiatrist handle nail care.
- Wear clean, well-fitting socks. Seamless socks with moisture-wicking fabric reduce friction and keep skin drier. Avoid socks with tight elastic bands that restrict circulation.
- Protect feet from temperature extremes. Don’t use heating pads, hot water bottles, or electric blankets on your feet. Test bath water with your elbow or a thermometer before stepping in. Neuropathy can prevent you from sensing a burn until damage is done.
- Stay active within safe limits. Regular physical activity improves circulation and helps with blood sugar control, but monitor your feet after exercise. If temperature monitoring reveals a hot spot, reduce activity on that foot until the inflammation resolves.
- Don’t smoke. Smoking accelerates blood vessel damage and reduces blood flow to the extremities, compounding the vascular problems diabetes already causes.
None of these habits is complicated on its own. The challenge is consistency, doing them every day, not just when something looks wrong. By the time a foot ulcer is visible, the underlying damage has often been building for weeks. Prevention works best when it’s built into your daily routine rather than treated as a response to a problem.