Foot Health and Diabetes

Nerve damage can cause you to lose feeling in your feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers which may lead to amputation.

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems.

Do you want to avoid serious foot problems that can lead to a toe, foot, or leg amputation? It's all about taking good care of your feet.

Signs and symptoms of poor foot health

Main Article: Common Diabetes Foot Problems

Foot care is very important for each person with diabetes, but especially if you have:

• Loss of feeling in your feet.
• Changes in the shape of your feet.
• Foot ulcers or sores that do not heal.

Ways to keep feet healthy

Take care of your diabetes

• Make healthy lifestyle choices to help keep your blood glucose (sugar), blood pressure, and cholesterol close to normal. Doing so may help prevent or delay diabetes-related foot problems as well as eye and kidney disease.
• Work with your health care team to make a diabetes plan that fits your lifestyle. The team may include your doctor, a diabetes educator, a nurse, a dietitian, a foot care doctor called a podiatrist (pah-DI-ah-trist), and other specialists. This team will help you to:

o Know when to get check your ABCs - A1C* (blood glucose), Blood pressure, and Cholesterol.

o Know how and when to test your blood glucose.

o Take your medicines as prescribed.

o Eat regular meals that contain a variety of healthy, low-fat, high-fiber foods including fruits and vegetables each day.

o Get physical activity each day.

o Stop smoking.

o Follow your foot care plan.

o Keep your doctor's visits and have your feet, eyes, and kidneys checked at least once a year.

o Visit your dentisttwice a year.

• A1C is a measure of your blood glucose over a 3-month period.

Check your feet every day

Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration.

• You may have serious foot problems, but feel no pain. Check your feet for cuts, sores, red spots, swelling, and infected toenails. Find a time (evening is best) to check your feet each day. Make checking your feet part of your every day routine.
• If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

Reminder: Make sure to call your doctor right away if a cut, blister or bruise on your foot does not begin to heal after one day.

Wash your feet every day

• Wash your feet in warm, not hot, water. Do not soak your feet, because your skin will get dry.
• Before bathing or showering, test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow.
• Dry your feet well. Be sure to dry between your toes. Use talcum powder or cornstarch to keep the skin between your toes dry.

Keep the skin soft and smooth

• Rub a thin coat of skin lotion, cream, or petroleum jelly on the tops and bottoms of your feet.
• Do not put lotion or cream between your toes, because this might cause an infection.

Put lotion on the tops and bottoms of your feet.

Smooth corns and calluses gently

Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.

• If you have corns and calluses, check with your doctor or foot care specialist about the best way to care for them.
• If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.
• Do not cut corns and calluses. Don't use razor blades, corn plasters, or liquid corn and callus removers - they can damage your skin.

Gently rub calluses with a pumice stone.

Reminder: Make sure to call your doctor right away if a cut, blister or bruise on your foot does not begin to heal after one day.

Trim your toenails each week or when needed

Cut toenails straight across.

Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatric physician for assistance.

• Trim your toenails with clippers after you wash and dry your feet.
• Trim toenails straight across and smooth them with an emery board or nail file.
• Don't cut into the corners of the toenail.
• If you can't see well, if your toenails are thick or yellowed, or if your nails curve and grow into the skin, have a foot care doctor trim them.

Trim your toenails straight across and smooth them with a nail file. Wear shoes and socks at all times.

Lose weight

Follow the healthy eating plan that you and your doctor or dietitian have worked out. People with diabetes are commonly overweight, which nearly doubles the risk of complications.

Stop smoking

Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.

Wear shoes and socks at all times

Socks made of an acrylic blend are well suited but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

• Wear shoes and socks at all times. Do not walk barefoot - not even indoors - because it is easy to step on something and hurt your feet.
• Always wear socks, stockings, or nylons with your shoes to help avoid blisters and sores.
• Choose clean, lightly padded socks that fit well. Socks that have no seams are best.
• Check the insides of your shoes before you put them on to be sure the lining is smooth and that there are no objects in them.
• Wear shoes that fit well and protect your feet.

Check the inside of your shoes before you put them on.

Protect your feet from hot and cold

• Wear shoes at the beach or on hot pavement.
• Put sunscreen on the top of your feet to prevent sunburn.
• Keep your feet away from radiators and open fires.
• Do not put hot water bottles or heating pads on your feet.
• Wear socks at night if your feet get cold. Lined boots are good in winter to keep your feet warm.
• Check your feet often in cold weather to avoid frostbite.

Protect your feet when walking on hot surfaces.

Reminder: Make sure to call your doctor right away if a cut, blister or bruise on your foot does not begin to heal after one day.

Keep the blood flowing to your feet

• Put your feet up when you are sitting.
• Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs.
• Don't cross your legs for long periods of time.
• Don't wear tight socks, elastic or rubber bands, or garters around your legs.
• Don't smoke. Smoking reduces blood flow to your feet. Ask for help to stop smoking
• Work with your health care team to control your A1C (blood glucose), blood pressure and cholesterol

Put your feet up when you are sitting.

Be more active

As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what’s best for you.

• Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet.
• Avoid activities that are hard on the feet, such as running and jumping.
• Always include a short warm-up and cool-down period.
• Wear athletic shoes that fit well and that provide good support.

Walking briskly is a good exercise.

Reminder: Make sure to call your doctor right away if a cut, blister or bruise on your foot does not begin to heal after one day.

Be properly measured and fitted every time you buy new shoes

• Proper footwear is very important for preventing serious foot problems. Athletic or walking shoes are good for daily wear. They support your feet and allow them to "breathe."
• Never wear vinyl or plastic shoes, because they don't stretch or "breathe."
• When buying shoes, make sure they are comfortable from the start and have enough room for your toes.
• Don't buy shoes with pointed toes or high heels. They put too much pressure on your toes.

New shoes should be comfortable at the time they’re purchased and should not require a "break-in" period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.

Don’t wear high heels, sandals, and shoes with pointed toes

These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

Don’t wear anything that is too tight around the legs

Pantyhose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, as can men’s dress socks if the elastic is too tight.

Foot Wound Healing

Ulceration is a common occurrence with the diabetic foot and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates.

The Role of Your Podiatric Physician

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

• Skin color changes
• Elevation in skin temperature
• Swelling of the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal
• Ingrown and fungal toenails
• Bleeding corns and calluses
• Dry cracks in the skin, especially around the heel

Ask your doctor about Medicare or other insurance coverage for special footwear

You may need special shoes or shoe inserts to prevent serious foot problems. If you have Medicare Part B insurance, you may be able to get some of the cost of special shoes or inserts paid for. Ask your doctor whether you qualify for

• 1 pair of depth shoes* and 3 pairs of inserts, or
• 1 pair of custom molded shoes (including inserts) and 2 additional pairs of inserts.

If you qualify for Medicare or other insurance coverage, your doctor or podiatrist will tell you how to get your special shoes.

• Depth shoes look like athletic or walking shoes, but have more room in them. The extra room allows for different shaped feet and toes, or for special inserts made to fit your feet.

Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

Get started now

• Begin taking good care of your feet today.
• Set a time every day to check your feet.
• Note the date of your next visit to the doctor.
• Print out the foot care tip sheet and put it on your bathroom or bedroom wall or nightstand as a reminder.
• Print out and complete the "To Do" list. Get started now.
• Set a date for buying the things you need to take care of your feet: nail clippers, pumice stone, emery board, skin lotion, talcum powder, plastic mirror, socks, athletic shoes, and slippers.
• Most important, stick with your foot care program... and give yourself a special treat such as a new pair of lightly padded socks with no seams. You deserve it!

Reminder: Make sure to call your doctor right away if a cut, blister or bruise on your foot does not begin to heal after one day.