Diabetic Foot Care Guidelines
What is diabetes?
Diabetes is a condition in which your body is either unable to
produce insulin (a hormone that helps the body process sugar), or
your tissues don’t respond to the insulin that’s produced. This
leads to too much sugar in the blood, which, in turn, can damage
blood vessels, nerves, kidneys, the heart, the eyes, and (always of
paramount importance) the feet.
Unfortunately, damage to your nerves means that you may not notice
when, say, you step on a tiny piece of glass from the jar of jelly
your daughter dropped yesterday. Or, you might not be aware that
your toes are becoming really irritated with being jammed into that
shoe with pointy toes. Or, if your nerve damage is quite bad, you
might not notice that you fractured your foot, so you keep walking
on it. For a long time. In turn, ulcers might develop from that
irritated skin, or from skin that’s under significant pressure, and
fractures are always a bit of a problem. But things can get even
Diabetes also damages blood vessels, so the circulation to and in
your foot may become quite poor. Because it takes good bloodflow to
stimulate the healing of wounds, those ulcers and fractures may not
heal up very nicely. In fact, they may not heal at all. Or, if you
get an infection (in an ulcer or even just a small cut on your
foot), your blood isn’t able to adequately deliver the power to
fight it off, so it might spread to your bones, or the rest of your
What you can do
It’s kind of a frightening picture, isn’t it? Fortunately, there’s a
lot you can do to manage the care of your feet when you have
diabetes. Early identification and treatment of problems is the key
to preventing serious complications with your feet. Here are a few
things you can do to keep those complications at bay.
- Keep blood sugar level in target range – Your primary care
physician can assist you with this, but it’s vital that you monitor
your blood sugar level closely between visits. Remember that it’s
problems with your blood sugar level that can cause the damage to
blood vessels and nerves that can be so detrimental to your overall
health (and your feet). Keeping that level in check can prevent a
whole host of other problems.
- Daily foot inspections – Inspecting your foot daily may not
sound like the most exciting use of your time, but it’s essential in
finding problems to your foot early on, particularly if you have
nerve damage. (If it helps to make it seem less boring, you can
begin your inspections by donning a Sherlock Holmes type of cap,
putting a pipe (an unlit one, of course) firmly between your teeth
and using a wonderfully large magnifying glass.) If you can’t see
your foot well, or if you have trouble reaching it, have a friend or
family member assist you, or use a mirror (the magnifying ones are
best) to check those hard-to-see places (like the bottom of your
foot). (You can also use the mirror to tell yourself what a
wonderful person you are, and compliment yourself on your excellent
self-care of your feet.)
- Pay particular attention to the soles of your foot and
between your toes, since this is where problems can often
- Check your skin for any sign of irritation or injury. Look for
scrapes or cuts (however small), blisters, rashes, signs of
infection like redness, swelling, drainage, or a bad smell, or
possibly changes in skin color, or loss of hair on your foot or
- Check your nails for problems. Do they look yellowed or have
other changes in color? Are they thickened, deformed, striped, or
just not growing?
- Look for signs that you may have fractured your foot. Check your
foot overall for redness, see if it’s warm or hot to the touch,
swollen, or has changed in size, shape or direction.
- If you notice any of the above on your feet, see your podiatrist
as soon as possible. Don’t assume that the problem will go away on
its own, and don’t try to just wait it out. Getting problems treated
early is a MUST in diabetic foot care. Doing so can significantly
reduce your chance of developing a severe complication.
- Set a specific time for your foot inspection every day, just to
be sure you don’t forget.
- Pay particular attention to the soles of your foot and
- Clean your feet – Wash your feet every day with lukewarm water
and mild soap. Be sure to test the water temperature with your hand
(or elbow if your hand doesn’t have great sensation either) just to
make sure it isn’t too hot, or have someone test the water for you.
Dry your feet thoroughly but gently using a soft towel, paying
particular attention to the skin between your toes. You can use
talcum powder (aka baby powder) to wick moisture away from your
skin, but be sure to get rid of any residue, particularly between
your toes. Don’t soak your feet unless your podiatrist advises you
to do so.
- Use proper shoes – Because they may expose your feet to harm,
cause significant pressure, or may position your foot unnaturally,
it’s important to avoid wearing certain types of shoes, such as
sandals (especially those with a thong between the toes), slippers,
and shoes with high heels. Instead, wear comfortable, well-fitting
shoes with soft leather uppers that can mold to the shape of your
feet. (Running or walking shoes may fit the bill nicely.) Wear socks
with your shoes, but avoid socks or stockings with seams in them,
since this can cause irritation (and potentially an ulcer). (You can
ask your podiatrist about special shoes and socks designed for
diabetic patients.) Always check the insides of your shoes before
wearing them and after taking them off, making sure that the lining
of the shoe is smooth and that there are no foreign objects (like
rocks or (shudder) spiders) inside.
- Lubricate dry skin – Apply a thin film of moisturizer (Cetaphil
cream is recommended) to the soles of your feet while they’re still
wet. Avoid getting the cream between your toes, since this can
foster a fungal infection.
- Trim nails – Cut your nails straight across. Rounding corners
down can lead to ingrown toenails, which can become infected.
Keeping your nails properly trimmed can also reduce pressure within
your shoe and help you avoid other complications.
- Lose weight – This one may make you groan a bit. And you may not
be overweight. But the truth is that an overwhelming majority of
diabetic patients are also not at a healthy weight. While improving
your health in general, weight loss can also take pressure off your
feet, thus preventing future problems. Weight loss plans should
always be discussed with your doctor, particularly if you are
- Exercise – Along with reducing weight, exercise can help improve
circulation and condition your feet. Walking is often the best
exercise for diabetics. However, you should consult with your
primary care physician as well as your podiatrist before adopting an
exercise regimen. (Also, be sure to ask your podiatrist about the
best kind of shoes to wear while exercising. He or she is sure to
have some good ideas.)
- Promote circulation to your foot – You can help blood flow more
easily to your foot by putting up your feet while sitting. (Putting
up your feet while standing isn’t likely to work well.) You can also
try little foot exercises like wiggling your toes and moving your
foot up and down at the ankle for five minutes at a time. Try doing
this about two or three times a day.
- See your podiatrist – See your podiatrist at least twice a year,
and be sure to tell him or her that you have diabetes. See your
podiatrist immediately if you notice any blisters, punctures, pain
in your feet or legs (leg pain may be a sign of a blocked artery),
change in skin or nail color, loss of sensation, or if there’s an
area of your foot with increased or decreased temperature.
What you should avoid
Diabetic foot care isn’t all about things you should do. There’s
also a list of things that you really should avoid if you have
diabetes, particularly if you have nerve damage. Please pay close
attention to the list below:
- DON’T go barefoot – Whether in your house or out of it, your
feet may encounter things on the ground that cause damage, like
small plastic toys, bits of glass, nails, or very sharp rocks.
(Although you should also keep your floors free of these potentially
dangerous bits of things.) Because you may not notice when you step
on something like this, (and thus damage your foot as you continue
to walk on your injury), you can avoid the problem entirely by
wearing shoes (WITH socks) pretty much all the time. Except in bed.
Your feet are usually pretty safe there. (Although you can wear
socks in bed for warmth.)
- DON’T put tight things around your legs – Foot or leg-wear like
garters or knee-high stockings (or elastics to hold UP the
stockings) can reduce circulation to your foot, thus exacerbating
your bloodflow problems. Panty girdles, thigh highs, and even
sometimes men’s socks can also be problematic if the elastic is too
- DON’T expose feet to extreme heat/cold – Again, because of nerve
problems, you may not be able to feel when the skin of your foot is
too hot or too cold, and thus be unaware when extreme heat or cold
causes damage. In order to avoid problems, don’t walk on hot
pavement, never use a hot water bottle or heating pad on your feet
(wear socks instead if your feet are cold), be careful of car
heaters on road trips, and don’t put ice on your feet if they feel
hot. Also, apply sunscreen to your feet to avoid sunburn.
- DON’T cut corns or calluses yourself – If you try to perform
“bathroom surgery” on your corns or calluses, you run the risk of
cutting too much off, or getting an infection. If you need them
removed, your podiatrist is very skilled at taking corns and
calluses off. He or she can also instruct you how to work on
calluses (the ones that aren’t too thick) using pumice stones or
emery boards, but only if you promise to follow their instructions
carefully. NEVER use medicated callus or corn removers, since these
can eat into healthy skin and cause infections.
- DON’T use commercial foot supports – Your podiatrist may wish to
prescribe orthotics for your use, but avoid over-the-counter arch
supports or foot pads.
- DON’T smoke – Smoking can further reduce your circulation,
causing even more complications with healing. Quit smoking as soon
as possible to avoid these complications.
- DON’T drink excessively – Just as smoking can further damage
your circulation, so alcohol can speed up the damage to your nerves
already caused by neuropathy. This increases the likelihood that
you’ll be unable to detect injury or other problems with your foot.
Avoid drinking in excess.
- DON’T cross your legs – Crossing your legs while sitting (or
even lying down) can compromise the circulation in your legs and
feet. You may look great while doing it, but remember that it’s your
health that’s most important, not your appearance. (Yes. Despite
what the fashion industry may tell you.)
Always remember: the key to diabetic foot care is early
identification and treatment of problems. See your podiatrist
immediately if you notice any danger signs, and always do a daily
foot-check. Doing so can save you a lot of trouble, possible
amputation, and it may even save your life (and those are a lot of
things worth saving).
Call 719-543-2476 today to schedule your appointment!