Will diabetic foot ulcers recur three years after healing?

Many diabetic foot patients believe that once a wound heals, the problem is completely solved and they can return to their previous lifestyle. However, clinical follow-up data tells a different story. The recurrence rate of diabetic foot ulcers within one year of healing is about 30% to 40%, the recurrence rate within three years is close to 50% to 60%, and the cumulative recurrence rate after five years can exceed 65%. This figure means that the healing of diabetic foot ulcers is more like the end of a phase than the elimination of risk. The skin of the healed foot is different from that of a healthy person in terms of structural strength and functional condition, and the risk of recurrence continues for the rest of their lives. Understanding the causes of recurrence and the need for continuous protection is the most important understanding that diabetic foot patients need to develop after their wounds have healed. 

Why do healed ulcers break open again after three years? 

After ulceration heals, the skin and subcutaneous tissue exhibit some structural weaknesses that cannot be fully restored. Under a microscope, the newly formed epidermis in the healing area may have a near-normal number of cell layers, but the density and barrier function of the stratum corneum are weaker than the original skin, resulting in a persistently high transepidermal water loss rate and making the skin more prone to dryness and cracking. The dermis beneath the epidermis is dominated by scar tissue during ulcer repair. The collagen arrangement in scar tissue is disordered, lacking the elastic network of the normal dermal papillae, and its tensile strength and shear strength are significantly lower than healthy skin. The subcutaneous fat pad and plantar fascia, which were damaged during ulceration, are often replaced by fibrotic tissue after healing. The original cushioning structure of the foot becomes hardened and thinner, allowing ground reaction forces to be transmitted more directly to the healing area during walking. These histological changes persist after healing, significantly lowering the threshold for re-damage at the same location under external forces. In addition, the underlying causes of the initial ulcer, such as peripheral neuropathy, vascular disease, and foot deformity, do not disappear as the ulcer heals. Many patients' metabolic control and foot pressure are even worse than before the initial ulcer. The combination of multiple factors makes recurrence a high-probability event rather than an accidental occurrence.

What should you pay attention to when observing the healed skin on your feet?

Checking your feet daily is the first line of defense against recurrence, with particular attention to the skin in the healing area. Look for abnormal redness, darkening, or discoloration at the healing site, and check for new small cracks or increased peeling at the edges. Compare the skin temperature of both feet by touching the back of your hand to the soles; if the healing area is significantly warmer than the corresponding area on the opposite side, be alert for deeper inflammation. Gently press the healing area to observe for hard lumps, fluctuations, or indentation after pressing, as these may indicate subcutaneous tissue abnormalities or early sinus tracts. The skin between the toes and under the calluses on the soles of the feet are the most common sites for recurrent ulcers. After showering, check your feet in good light using a mirror or with the help of a family member. If you find blisters, breaks, or abnormal coloring in the healing area, contact a diabetic foot specialist for evaluation within 24 hours. Do not apply ointments or bandages yourself and wait several days to observe.

What specific daily foot protection measures should be taken?

Choosing the right shoes and socks is crucial for preventing recurrence. After healing, avoid shoes with hard soles or poorly designed internal structures. Choose shoes with a wide, deep toe box, a thick, cushioned sole, and seamless internal construction, preferably specialized or custom-made insoles. Before each use, turn shoes upside down and tap the bottom to check for foreign objects. Reach inside the shoe to feel for sand or loose threads. These tiny objects may not cause damage to a normal foot, but they can trigger a new ulceration process in the fragile healing area. Wash your feet daily with water between 37 and 40 degrees Celsius, measured with a thermometer. After washing, pat dry with a towel, not rub. After thoroughly drying between the toes, apply moisturizer to the rest of the foot to prevent dryness and cracking. Trim toenails straight down, avoiding cutting the corners too short. File the edges of the toenails smooth. Avoid walking barefoot, and avoid prolonged outdoor walking in sandals or slippers. Wearing shoes is also recommended at home, as small, hard objects on the floor can easily puncture the healing skin. Perform simple lower limb and foot exercises daily to maintain joint mobility and muscle pump function, but gradually increase the intensity, avoiding high-impact activities such as jumping and prolonged brisk walking. For more information on Innomed® Silicone Foam Dressing, refer to the Previous Articles. If you have customized needs, you are welcome to contact us; You Wholeheartedly. At longterm medical, we transform this data by innovating and developing products that make life easier for those who need loving care.

Editor: kiki Jia