If you or a loved one is living with diabetes, you’ve likely heard warnings about foot care. But many people don’t realize just how serious diabetic foot ulcers can be — or how much is now possible to prevent and treat them. The research is clear: early intervention saves limbs and saves lives.
The Scope of the Problem in Canada
Diabetic foot ulcers are one of the most serious — and underappreciated — complications of diabetes. In Canada, adults living with diabetes are over 20 times more likely to undergo a non-traumatic lower limb amputation than those without diabetes. Staggeringly, 85% of all diabetes-related amputations are preceded by a foot ulcer that could have been identified and treated earlier.
According to the Canadian Institute for Health Information (CIHI), approximately 7,720 lower limb amputations associated with diabetes occur annually in Canada. And the mortality statistics are sobering: the five-year mortality rate for someone with a serious diabetes-related foot wound is comparable to — or higher than — many common cancers. Up to 80% of people with diabetes who undergo an amputation die within five years.
The lifetime risk of developing a foot ulcer for someone with diabetes ranges from 15% to 25%, meaning hundreds of thousands of Canadians currently face this risk. The good news? Most diabetic foot ulcers are preventable with the right care.
Why Diabetic Feet Are So Vulnerable
Two main processes put diabetic feet at risk: peripheral neuropathy (nerve damage) and peripheral arterial disease (poor circulation).
Diabetic peripheral neuropathy affects up to 50% of people with diabetes — and half of those cases are completely asymptomatic. This means the nerves that normally signal pain, pressure, and temperature changes are damaged, so small injuries like blisters, cuts, or pressure sores go unnoticed. Without protective sensation, a minor wound can silently worsen over days or weeks.
Poor circulation compounds the problem. Reduced blood flow to the feet impairs the body’s natural healing ability and makes infections harder to fight. Together, neuropathy and vascular disease create conditions where a small skin break can escalate rapidly into a deep, infected wound.
The 2025 American Diabetes Association (ADA) Standards of Care recommends that all people with diabetes receive a comprehensive foot examination at least once a year — and more frequently for those at higher risk. For people with type 2 diabetes, screening for neuropathy should begin at diagnosis; for type 1 diabetes, five years after diagnosis.
What a Proper Foot Assessment Includes
A thorough diabetic foot evaluation goes well beyond a quick glance. At The Mayer Institute, our podiatric assessments include:
- Monofilament testing — a simple, painless test that checks for loss of protective sensation using a thin nylon filament
- Tuning fork or biothesiometer testing — to assess vibration perception, an early indicator of neuropathy
- Ankle reflexes and temperature perception — additional neurological markers
- Vascular assessment — checking circulation through pulses and, when needed, Doppler testing
- Structural evaluation — identifying deformities, calluses, pressure points, and nail pathologies that increase ulcer risk
These assessments allow us to classify risk and build a targeted prevention plan before an ulcer ever develops.
Modern Treatments: New Hope for Hard-to-Heal Wounds
For those who already have a diabetic foot ulcer, the field of wound care has advanced significantly. A 2024 review published in Frontiers in Clinical Diabetes and Healthcare outlined a range of emerging technologies transforming diabetic foot ulcer management:
- Biologic therapies — Skin substitutes, platelet-derived growth factors, and advanced wound dressings that stimulate tissue regeneration are now available and increasingly supported by clinical evidence.
- Anti-inflammatory biologics — Monoclonal antibodies targeting pro-inflammatory cytokines (like TNF-α and IL-6) are showing promise in clinical trials for reducing chronic wound inflammation.
- Stem cell and regenerative approaches — Including macrophage polarization therapies and VEGF-promoting agents to restore vascularization in poorly healing wounds.
- Offloading devices — Total contact casting and specialized therapeutic footwear remain gold-standard tools for redistributing pressure and protecting healing tissue.
According to the IWGDF (International Working Group on the Diabetic Foot) 2023 updated guidelines, a multidisciplinary approach — combining podiatric care, vascular assessment, infection management, and patient education — produces the best outcomes for ulcer prevention and healing.
What You Can Do Starting Today
Prevention is always the most powerful treatment. Here are practical steps every person with diabetes should take:
- Inspect your feet daily. Look for blisters, cuts, redness, swelling, or any skin changes — use a mirror or ask someone to help if needed.
- Never walk barefoot. Even indoors, always wear properly fitted footwear to protect your feet from injury.
- Moisturize regularly — but not between the toes, where excess moisture can lead to fungal infection.
- Keep blood sugar under control. Sustained high glucose accelerates nerve damage and impairs circulation. Work with your healthcare team on an optimal management plan.
- See a podiatrist regularly. Annual foot exams (or more frequent visits if you’re higher risk) can catch problems before they become crises.
- Don’t ignore small wounds. Any break in the skin that hasn’t improved within a few days warrants prompt professional evaluation.
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