If you or a loved one has experienced a diabetic foot ulcer, you know how serious — and stressful — the healing process can be. But here is something many patients are not told clearly enough: healing a foot ulcer is only half the battle. The risk of the ulcer coming back is remarkably high, and in some cases, recurrence can lead to infection, hospitalization, or even amputation.
The good news is that recurrence is largely preventable. With the right footwear, monitoring habits, and regular podiatric care, you can dramatically reduce your risk. Here is what the latest clinical evidence tells us — and what The Mayer Institute recommends.
The Recurrence Problem: By the Numbers
Research consistently shows that once a diabetic foot ulcer has healed, it is at high risk of returning. Studies published in Diabetes Care and reviewed in the 2023 International Working Group on the Diabetic Foot (IWGDF) guidelines report that:
- Approximately 40% of healed diabetic foot ulcers recur within one year
- That number rises to 65% within three to five years
- The lifetime risk of a lower-extremity amputation in people with diabetes is as high as 20%
- Five-year mortality after a major amputation ranges from 50 to 70%
These are sobering statistics — but they also underscore why post-healing prevention is just as important as the healing itself.
Why Do Ulcers Recur?
Diabetic foot ulcers do not return by chance. They recur because the underlying conditions that caused them in the first place — nerve damage (peripheral neuropathy), reduced blood flow, abnormal foot pressure, and structural deformities — are still present after the wound closes.
Without nerve sensation, you cannot feel areas of excessive pressure building up under the foot. Without proper footwear to redistribute that pressure, the skin breaks down again — often in the exact same location. Add poor circulation into the mix, and healing becomes slow while infection risk rises rapidly.
The 2023 IWGDF prevention guidelines identify five key pillars of diabetic foot ulcer prevention: identifying feet at risk, regular professional foot exams, patient education, appropriate footwear, and treating risk factors before they become wounds.
Pressure-Relieving Footwear: The Most Important Tool You Have
Of all the interventions available, therapeutic footwear with pressure-relieving properties has among the strongest evidence for preventing ulcer recurrence. A 2023 clinical study found that patients who wore therapeutic footwear had a recurrence rate of 27.8% — compared to 52.5% among those who did not. That is nearly a 50% reduction in risk.
A 2022 systematic review and meta-analysis published in PLOS Medicine confirmed that specially designed diabetic footwear significantly lowers the incidence of foot ulcers in high-risk patients. The IWGDF guidelines now specifically recommend that patients with a healed plantar foot ulcer be prescribed footwear with a demonstrated plantar pressure-relieving effect — and that they wear it consistently, both indoors and outdoors.
Key features of effective diabetic footwear include:
- Custom-moulded insoles that redistribute pressure across the entire foot
- Extra-depth construction to accommodate foot deformities
- Firm, rocker-bottom soles that reduce forefoot pressure during walking
- Seamless linings to prevent friction and skin irritation
One critical caveat: even the best footwear only works when it is worn. Adherence is essential. Studies show that the protective benefit of custom footwear disappears when patients wear it less than 80% of the time.
Daily Foot Temperature Monitoring: A Simple but Powerful Habit
Another evidence-based strategy is daily skin temperature monitoring. Inflammation in the foot — caused by repetitive stress or early tissue breakdown — raises local skin temperature before a visible wound appears. By catching this early warning sign, patients can take action before an ulcer develops.
The IWGDF recommends that people at moderate or high risk monitor foot skin temperature once per day. If the temperature difference between the same spot on each foot exceeds 2.2°C on two consecutive days, you should reduce your activity level and consult your podiatrist or healthcare provider promptly.
Infrared thermometers designed for home use make this practical and affordable. This simple habit has been shown in clinical trials to reduce the rate of foot ulcer occurrence by up to 71% in high-risk patients.
Regular Podiatric Care and Multidisciplinary Follow-Up
Prevention does not happen in isolation. Evidence strongly supports multidisciplinary care — involving podiatrists, vascular specialists, endocrinologists, and wound care nurses working together — as the gold standard for reducing amputation rates and ulcer recurrence.
Regular podiatric appointments allow your care team to:
- Assess and treat calluses, nail problems, and structural changes that increase pressure
- Update your footwear and orthotic prescriptions as your feet change
- Catch early warning signs of vascular compromise or neuropathy progression
- Reinforce self-care education and home monitoring habits
The Wound Healing Society (WHS) 2024 guidelines specifically note that consistent preventive care — including professional offloading and footwear strategies — can cut ulcer recurrence rates in half.
Taking Action: Your Prevention Checklist
If you have had a diabetic foot ulcer, here are the steps clinical guidelines recommend every patient follow:
- See your podiatrist regularly — at least every 1 to 3 months, depending on your risk level
- Wear your prescribed therapeutic footwear at all times, including at home
- Inspect your feet daily for redness, swelling, blisters, or temperature changes
- Monitor foot temperature with a home infrared thermometer
- Manage your blood glucose — poor glycemic control accelerates nerve damage and impairs healing
- Report any new skin changes immediately — do not wait for a wound to develop
References: Bus SA et al. IWGDF Guidelines on the Prevention of Foot Ulcers in Persons with Diabetes (2023 update). Diabetes/Metabolism Research and Reviews, 2024. | Lavery LA et al. WHS Guidelines Update: Diabetic Foot Ulcer Treatment Guidelines. Wound Repair and Regeneration, 2024. | Armstrong DG et al. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care, 2023. | Netten JJ et al. Prevention of Foot Ulcers in Persons with Diabetes at Risk of Ulceration: A Systematic Review and Meta-Analysis. Diabetes/Metabolism Research and Reviews, 2024.
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