Conditions · Diabetes complications
Diabetic foot ulcers
Diabetic foot ulcers develop where reduced sensation, reduced circulation, and pressure combine — and most are preventable through risk-based screening and daily self-care. This page focuses on understanding your risk and preventing a first or repeat ulcer; if you already have an active wound, see our diabetic foot ulcer wound care page for treatment. Recurrence after healing is common — up to 40% within a year — which is why prevention doesn't stop once a wound closes.
Your diabetic foot risk pathway
Risk Assessment
Checking sensation, circulation, foot shape, and any history of a prior ulcer or amputation.
Determining Your Risk Category
Combining those findings into a standard risk category, not a single pass/fail check.
Setting Your Screening Frequency
Higher-risk categories are checked far more often than once a year.
Daily Self-Examination
A simple routine you do yourself, between clinical checks.
Footwear and Pressure Protection
Reducing pressure and friction on vulnerable areas day to day.
What to Do If You Notice a Problem
Acting early, rather than waiting to see if a small issue resolves on its own.
Symptoms
- A break in the skin on the foot that isn't healing
- Drainage or an unusual odor from a wound
- Redness, warmth, or swelling around a wound
- In advanced cases, visible tissue changes or exposed deeper tissue
Causes & risk factors
- Diabetic peripheral neuropathy (reduced ability to feel injuries)
- Peripheral vascular disease (reduced blood flow slows healing)
- Poorly-fitting footwear or unnoticed trauma
- Long-duration or poorly-controlled diabetes
Why foot ulcers happen
Foot ulcers rarely have a single cause — they typically develop where reduced sensation, reduced circulation, and ongoing pressure overlap on the same area. See our diabetic foot ulcer wound care page for the full explanation of this mechanism and how an active wound is treated.
Reduced sensation
Nerve damage can mean an injury goes unnoticed until it's already a wound
Reduced circulation
Reduced blood flow slows healing once skin is broken
Ongoing pressure
Repeated pressure on an area that can't feel it is often what breaks the skin
Your risk category, and how often you should be screened
Not everyone with diabetes needs the same screening schedule — your specific combination of risk factors determines how closely your feet should be monitored.
- This is the standard international (IWGDF) risk framework — ask your care team which category applies to you if you're not sure
| Risk category | Risk factors present | Recommended screening |
|---|---|---|
| 0 — very low | No loss of protective sensation, no reduced blood flow (peripheral artery disease) | Annually |
| 1 — low | Loss of protective sensation, or reduced blood flow, but not both | Every 6–12 months |
| 2 — moderate | A combination of risk factors together | Every 3–6 months |
| 3 — high | Loss of protective sensation or reduced blood flow, plus a history of a prior ulcer or amputation | Every 1–3 months |
How to check your own feet
Between clinical visits, a simple daily routine helps catch problems while they're still minor.
- Use an unbreakable mirror to see the sole of your foot, or ask a family member to check areas you can't see clearly
- Look for changes in skin texture, new calluses, cracks, redness, or swelling
- Check between the toes specifically, where early problems are easy to miss
- Check your nails for thickening, ingrown edges, or discoloration
- A simple routine that works well for many patients: check inside your shoes before going out, check your feet when you get home, and check between your toes before bed
Why prevention doesn't stop once a wound heals
This is worth understanding clearly, because it changes how healing is framed — as an important milestone, not a finish line.
Recurrence is common, not unusual
- Research consistently finds that roughly 40% of healed diabetic foot ulcers recur within a year, and recurrence rises to as much as 65% within 3 to 5 years
- This isn't a sign that treatment failed — it reflects that the underlying risk factors (nerve damage, circulation, pressure patterns) are usually still present after a wound closes
- This is exactly why ongoing risk-category screening and daily self-checks continue after healing, not just during active treatment
If you notice a new wound
Acting early matters more than almost anything else — a new wound is addressed the same day where possible, not watched for a few days to see if it improves on its own.
See our diabetic foot ulcer wound care page for what a full course of care involves, including wound classification, offloading, and infection management.
How it’s diagnosed
Diagnosis is clinical — a wound examination alongside an assessment of nerve function and blood flow to understand why the wound isn't healing on its own. Ongoing risk is also assessed between wounds, using a standard risk-category framework.
How it’s treated
Structured wound care, offloading pressure from the area, infection control where present, and addressing the underlying nerve and circulation issues. See the diabetic foot ulcer wound care treatment page for what a course of care typically involves. Between active episodes, prevention centers on risk-based screening and daily self-checks.
When to seek care
- Any new wound on the foot, especially if you have reduced sensation
- Signs of infection (redness, warmth, swelling, discharge, fever)
- A wound that hasn't started improving within a few days of home care
- New or worsening numbness, or a change in foot shape or swelling without an obvious injury
FAQ
Why do diabetic foot ulcers happen even from minor injuries?
Reduced sensation from neuropathy means minor injuries can go unnoticed, while reduced blood flow from vascular disease slows healing — together they let small wounds become serious ones.
What is the IWGDF risk category system?
A standard framework (categories 0 to 3) combining whether you have reduced sensation, reduced blood flow, and a prior ulcer or amputation history, to determine how often your feet should be professionally screened.
How often should I be screened based on my risk?
From annually (lowest risk) to every 1–3 months (highest risk, with a prior ulcer or amputation history) — your specific category determines your schedule.
How do I properly check my own feet?
Use an unbreakable mirror or a family member's help to see the sole, and look for changes in skin texture, new calluses, cracks, redness, swelling, or nail changes — checking between the toes specifically, where problems are easy to miss.
Why do foot ulcers come back after healing?
Because the underlying risk factors — nerve damage, reduced circulation, and pressure patterns — are usually still present after a wound closes. Healing addresses the current wound, not the underlying risk.
How common is recurrence?
Very common — roughly 40% of healed ulcers recur within a year, rising to as much as 65% within 3 to 5 years, which is why ongoing prevention matters even after successful healing.
Does a healed ulcer mean I'm no longer at risk?
No — a history of a prior ulcer actually places you in a higher risk category requiring more frequent screening, not a lower one.
What footwear reduces my risk?
Well-fitting, protective footwear that avoids pressure points and friction — your care team can advise on specialized footwear if your risk category calls for it.
Is a callus something to worry about?
It's worth mentioning at your next check — calluses can indicate a pressure point that, left unaddressed, can break down into a wound, particularly if sensation is reduced.
What is Charcot foot?
A condition where nerve damage leads to weakened bones and joints in the foot, sometimes causing swelling, warmth, or a change in foot shape without an obvious injury — it needs prompt evaluation rather than being mistaken for a minor sprain.
Should I trim my own calluses or corns?
This isn't advisable, particularly with reduced sensation — self-treatment with sharp instruments or over-the-counter callus removers carries real injury risk. Have calluses and corns managed professionally.
How is this page different from the wound care treatment page?
This page focuses on understanding your risk and preventing a first or repeat ulcer. The wound care page covers what happens once an active wound needs treatment — classification, offloading, infection management, and healing.
Can foot ulcers be prevented entirely?
Not with absolute certainty for every patient, but risk-based screening and consistent daily self-care meaningfully reduce the likelihood of a first or repeat ulcer for most people.
When should family members help with foot checks?
Particularly when you can't easily see the sole of your foot yourself, have reduced vision, or have reduced hand mobility — a second pair of eyes catches things a mirror alone sometimes misses.
Medical disclaimer: Content on this page is for general education and is not a substitute for individualized medical advice, diagnosis, or treatment. Outcomes vary between patients. Boston Diabetes Center is outpatient / day-care specialty centre with an on-site diagnostic lab and pharmacy — no inpatient beds; imaging and inpatient care are coordinated through partner facilities.