The four-week rule and prevention with appropriate footwear

What is the four-week rule? The four-week rule is a clinical concept in diabetic foot care that states that if a diabetic foot ulcer has not reduced by at least 50% after four weeks of standard treatment, the likelihood of it healing within 12 weeks is very low. This approach is supported by a study showing that patients whose ulcer reduces by more than half in the first four weeks have a much higher likelihood of successful healing within three months.

Preventing Diabetic Foot Ulcers with Proper Footwear One of the most effective forms of preventing diabetic ulcers is wearing proper footwear. Diabetics should wear orthopedic or diabetic footwear that minimizes pressure on sensitive areas of the feet and prevents pressure sores and minor injuries that can lead to ulcers.

Features of suitable footwear for diabetics:

• Enough space – shoes should not be tight or put pressure on any part of the foot.

• Soft lining – eliminates friction and the possibility of abrasions.

• Shock-absorbing sole - helps prevent microtraumas.

• Seamless design - prevents pressure sores and minor injuries.

• Easy to fasten – makes putting on shoes easier and does not restrict blood circulation.

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What to do if the ulcer is not healing quickly enough? If the ulcer is not shrinking quickly enough after four weeks, your doctor should consider using advanced therapies. These include:

• Topical oxygen therapy – accelerates tissue healing.

• Collagen application – supports skin cell regeneration.

• Other modern healing methods – biomaterials, various types of bandages that promote healing.

Individual patient approach Although the four-week rule provides a useful clinical framework, it is important to remember that each patient is different. As such, treatment should be tailored to the individual patient’s needs and should include regular monitoring of wound progress.

Ensuring optimal diabetic foot care can significantly reduce the risk of amputation and improve patients' quality of life. In addition, appropriate footwear is a key factor in prevention and should be an integral part of daily diabetic foot care.