For people with diabetes, the smallest blister, bug bite or foot sore could lead to a difficult-to-heal foot infection, a skin ulcer and even the possibility of amputation. Risks are high – with diabetes, your lifetime risk for a foot ulcer is 25%.1 And between 9 and 20% of foot ulcers lead to amputations in the US..2
The causes: Nerve damage due to peripheral diabetic neuropathy that can rob you of protective skin sensations plus circulation problems and high blood sugar that can interfere with rapid healing.
That is why diabetes experts recommend that everyone with type 1 or type 2 diabetes protect their feet with daily foot checks, smart choices in socks and shoes, and comprehensive foot exams by a healthcare practitioner at least once a year.
These strategies could save your feet: In one study of 352 people with diabetes from the Regenstrief Institute for Health Care in Indianapolis, those who learned and practiced good self-care for their feet for a year were 59% less likely to have a serious foot wound than those who didn’t .3 And they’re recommended for everyone with diabetes, not just people who already know they have nerve damage. The reason? Diabetic peripheral neuropathy can cause a dangerous loss of protective sensation before you realize it. In an Australian study of 32 people with diabetes, researchers found that just one in four could detect a foot injury like a small blister -- but 78% of study volunteers thought their feet were still sensitive to small problems.4
Do a Daily Foot Check. Sit down, take off your shoes and socks and check the top, bottom and all parts of the toes of both feet every day. Use a mirror or ask your spouse or partner to help if you have trouble seeing all areas of your feet.
If you notice any problems, call your doctor right away.3
Take Care of Feet and Toe Nails. Wash your feet in luke-warm water—don’t use hot water, which could burn your skin. Check water temperature with your hand or forearm. Dry gently, including between your toes, with a soft towel. Rub moisturizer on the top and bottom of your feet; find a brand that works for you to keep feet from drying and cracking. (Don’t use lotion between toes, this can raise risk for athlete’s foot infections.) If you can reach your toes and see them clearly, trim your toenails straight across, then file edges slightly with an emery board. Don’t round the corners, this can raise risk for ingrown toenails.
Your doctor or a foot-care specialist can trim your toenails as well as corns and calluses for you.
Choose shoes wisely. Skip the high heels, flip-flops and going barefoot (sockless). Comfortable, supportive shoes that fit well and with dry socks will help protect your feet from damage. Here’s what to look for and when to wear your footwear:
Go for comfort. Visit a shoe store where the staff will carefully measure your feet, such as a store that sells comfort shoes or athletic shoes. Have both feet measured and buy shoes that fit your larger foot. Don’t buy shoes that you’ll have to break in. Leather and natural fibers are good choices. Wear shoes all the time – except when you’re in bed or bathing. (It’s OK to wear flip-flops for a few seconds at the pool or beach (though water shoes you leave on may be a better choice at a beach or lake). Check your shoes – inside and out -- every day for problems that could harm your feet such as small pebbles, a torn lining or tacks or nails stuck in the bottom.
Choose foot-friendly socks. Look for socks without seams (these can rub and cause skin breaks) and that isn’t tight. Change your socks once a day, more often if your feet get sweaty. Toss socks with holes in them.
Get a Comprehensive Foot Exam, It is important to visit your health practitioner at least once a week to have your feet checked.
Be sure to take off your shoes and socks when you get into the exam room at your doctor’s office – that will remind both of you that you need a foot check. Your doctor or another healthcare practitioner will look for circulation problems, nerve damage, skin changes, and deformities (like hammer toes, bunions or other foot changes).4 He or she will ask you about symptoms, your home care routine and about your shoes and socks, too.
You may need more frequent foot checks; in some cases, your doctor may also recommend exams and care from a foot specialist. The American Diabetes Association and the American Association of Clinical Endocrinologists recommend foot exams every 3-6 months if you’re losing protective sensation in your feet, every 2-3 months if you have loss of protective sensation plus peripheral artery disease, and every 1-2 months if you have a history of foot ulcers or have had an amputation.5
1. Boulton, AJM, et al. Comprehensive Foot Examination and Risk Assessment. A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008; 31(8): 1679–1685.
2. Litzelman DK et al. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1993; 119(1):36-41.
3. McAra S. Patient awareness of loss of protective sensation in the diabetic foot: an opportunity for risk reduction? J Foot Ankle Res. 2011; 4(Suppl 1): P37.
4. American Diabetes Association: Foot Care. Last updated October 10, 2014. Available at: http://www.diabetes.org/living-with-diabetes/complications/foot-complications/foot-care.html. Accessed April 11, 2017.
5. McCulloch David K, et al. Patient education: Foot care in diabetes mellitus. updated February 27, 2017. Available at: www.uptodate.com/contents/foot-care-in-diabetes-mellitus-beyond-the-basics. Accessed April 11, 2017.