If you have diabetes you are more likely to have to foot problems. Diabetes can damage your nerves (See: Diabetic neuropathy). This, in turn, may make you less able to feel an injury or pressure on the skin of your foot. You may not notice a foot injury until severe damage or infection develops.

Diabetes changes your body's ability to fight infections. Damage to blood vessels because of diabetes results in less blood and oxygen getting to your feet. Because of this, small sores or breaks in the skin may become deeper skin ulcers. The affected limb may need to be amputated when these skin ulcers do not improve, get larger, or go deeper into the skin.

If you have diabetes, you should:

• Improve control of your blood sugar
• Stop smoking
• Get a foot exam by your health care provider at least twice a year and learn whether you have nerve damage.
• Check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.

DAILY CARE ROUTINE

Check your feet every day. Look carefully at the top, sides, soles, heels, and between the toes.

Wash your feet every day with lukewarm water and mild soap. Strong soaps may damage the skin.

• Test the temperature of the water with your fingers or elbows before putting your feet in warm or hot water. Because of your diabetes, you may not be able to sense if the water is too hot. Burns can easily occur.
• Gently and thoroughly dry your feet, particularly between your toes. Infections can develop in moist areas.
• Your feet may become very dry and may crack, possibly causing an infection. After bathing your feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your toes.

Ask your health care provider if it is okay for you to trim your nails. If it is, ask your health care provider to show you the safest way. If your toenails are not trimmed correctly, you may get a foot sore or ulcer.

• Soak your feet in lukewarm water to soften your nails before trimming.
• Cut the nail straight across, because curved nails are more likely to become ingrown.

Avoid sitting with legs crossed or standing in one position for long periods of time.

If you smoke, stop. It decreases blood flow to the feet.

TIPS ON SHOES AND SOCKS

Wear shoes at all times to protect your feet from injury. Otherwise, if you have poor vision and less ability to feel pain, you may not notice minor cuts or bumps.

• Check the inside of your shoes for rough areas or torn pieces that can cause irritation.
• Change your shoes after 5 hours of wearing them during the day. This changes the pressure points during the course of the day.

The type of shoes you wear when you have diabetes is important:

• Wear comfortable, well-fitting shoes that have plenty of room in them. Never buy shoes that do not fit properly, hoping the shoes will stretch with time. Nerve damage may prevent you from being able to sense pressure from improperly fitting shoes.You may need a special shoe made to fit your foot.
• Wear shoes made out of canvas, leather, or suede. Do not wear shoes made out of plastic, or another material that does not breathe. Do not wear thong sandals.
• Wear shoes you can easily adjust. They should have laces, Velcro, or buckles.
• Do not wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.

Socks may provide an extra layer of protection between your shoe and your foot.

• Wear clean dry socks or non-binding panty hose every day.
• DO NOT wear stockings with seams that can cause pressure points.
• Wear socks to bed if your feet are cold. In cold weather, wear warm socks and limit your exposure to the cold to prevent frostbite.

MORE HELPFUL TIPS

• DO NOT use antiseptic solutions on your feet because these can burn and injure skin.
• DO NOT apply a heating pad or hot water bottle to your feet. Avoid hot pavement or hot sandy beaches.
• Remove shoes and socks during visits to your health care provider. This is a reminder that you need a foot exam.
• DO NOT treat corns or calluses yourself using over-the-counter remedies. Make an appointment with a podiatrist to treat foot problems.
• If obesity prevents you from being physically able to inspect your feet, ask a family member, neighbor, or visiting nurse to perform this important check.

REPORT SORES OR OTHER CHANGES TO YOUR DOCTOR IMMEDIATELY. REPORT ALL BLISTERS, BRUISES, CUTS, SORES, OR AREAS OF REDNESS.

American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009; 32(Suppl.1):S13-S61.

Inzuchhi SE and Sherwin RS. Type 1 diabetes mellitus. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 247.

Inzuchhi SE and Sherwin RS. Type 2 diabetes mellitus. In: Goldman L, Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 248.