People with both type 1 and type 2 diabetes are at a very high risk for foot problems. According to the American Diabetes Association and The Cleveland Clinic, foot problems may include peripheral neuropathy, peripheral vascular disease, skin changes, calluses, foot ulcers and amputation.(1,2) Reduction of these risks should be a top priority for all people with diabetes. Let’s discuss these problems and what you can do to help have healthy, happy feet.

five related foot problems when you have diabetes1. Peripheral neuropathy - The definition of peripheral neuropathy is nerve damage to the parts of the body that is away from the center. This includes arms, legs, feet and hands. It is thought that as many as 70 percent of people with diabetes have peripheral neuropathy.(3) The National Diabetes Information Clearinghouse (NDIC) lists some of the symptoms (which may worsen at night) as:
•    numbness or insensitivity to pain or temperature
•    tingling, burning, or prickling sensations
•    sharp pains or cramps
•    extreme sensitivity to touch, even light touch
•    loss of balance and coordination (4) 

It is recommended that people with diabetes have an annual comprehensive foot exam. If neuropathy is found, more visits may be required. An exam should include checking all parts of the foot for peripheral neuropathy. The health care professional may use a nylon monofilament to test for the ability to sense pressure in specific areas of the foot. When a person cannot sense pressure, they are at great risk for developing foot sores. (4) It is advised for a person with diabetes to check their feet daily especially if they have neuropathy. Properly fitting shoes and never walking barefoot are also recommended.

Some physicians teach and ask their patients (or family members) to test their feet with a monofilament between visits. Visit the Health Resources and Services Administration for instructions on self-testing with a monofilament.  For people in the United States, you can also order a monofilament from The U.S. Department of Health and Human Services. Ask your doctor if this information is what he/she wants you to use.

When people with diabetes have long periods of time with elevated blood glucose levels, there is a greater chance of damage to nerve fibers which cause neuropathy. Smokers with diabetes are at even greater risk.(3) If you smoke, get help to stop. To help prevent neuropathy, keep your blood glucose within goals given to you by your health care team. 

2. Peripheral vascular disease in the feet – This is poor blood flow to the legs and feet.(2) If infections occur in a person with peripheral vascular disease, blood and nutrients may not get to the wound area as needed and gangrene (tissue death) may develop. When this happens, a surgeon may need to do an amputation to keep the infection from spreading.(2)

Prevention of peripheral vascular disease may include the following:
•    Do not smoke or use tobacco and avoid second hand smoke
•    See your dietitian for a healthy meal plan that includes healthy fats and nutritious carbohydrates. Keep a healthy weight.
•    Treat lipid disorders as necessary
•    Control blood glucose levels and blood pressure
•    Exercise according to your physicians orders
•    Moderate alcohol restriction (If you drink alcohol, ask what your limits should be)(5)

The American Diabetes Association (ADA) cautions against using heating pads or hot water to warm cold feet. Due to problems sensing heat, you may burn yourself. Recommendations include wearing warm socks. Improving circulation may include a walking program approved by your medical team. Make sure to wear approved shoes and inspect your feet and shoes before exercise.(1) 

3. Skin Changes - Diabetes may cause your feet to be dry due to neuropathy. Nerves control the body’s ability to provide moisture to the skin to prevent cracks and flaking.(1) Ask your physician what brand of cream you should use to help prevent these problems. It is not recommended to put creams and lotions between your toes. Ask your physician for help showing you how to properly take care of your feet and remember to check your feet every day. Visit the Joslin Diabetes Center website for a detailed checklist for daily foot checks

4. Calluses - When there is friction and pressure on your skin, a hard layer of skin may form which is called a callus.(6)
The usual spot for foot calluses to form is on the bottom, the forefoot or the heel. The build-up of skin between the toes or near a bone is usually referred to as a corn.(7) People with diabetes should get their feet checked for calluses. The American Diabetes Association recommends that you go to your healthcare provider to look at your feet and treat corns and calluses. Do not treat them yourself. If they are not treated they may get thick, breakdown and get infected or turn into ulcers.(1) You may cause an infection if calluses are not treated by a qualified professional. Ask your doctor for advice on how you should help to prevent calluses. Your doctor may recommend special shoes for prevention.

5. Foot Ulcers and Amputation - According to The American Podiatric Medical Association, approximately 15 percent of people with diabetes will develop an opened wound or foot ulcer on the foot. Up to one fourth of the people who develop a foot ulcer will need an amputation. It is very important to seek podiatric medical care immediately upon discovery of an ulcer. Your podiatrist will provide proper care for the ulcer which usually includes debridement, medications, the correct dressings and treatment to restore blood flow. If the ulcer is infected, immediate treatment is essential. Keeping pressure off the ulcer is required and a brace or cast may be necessary. Some ulcers need to be treated in the hospital with surgery.(8)

Careful and frequent foot inspection is a top way to decrease the incidence of diabetic foot ulcers. You need to make and keep appointments with your podiatrist. Make sure you understand from your podiatrist how to properly inspect your feet. Ask for recommendations for brands of moisturizers and the proper footwear for you.(9) Your podiatrist can call you choose appropriate shoes and socks. Care must be taken to inspect shoes for pebbles and debris that may not be felt in a shoe if neuropathy is present.  

Other ways to reduce ulcer risk include, keeping blood glucose and cholesterol under control and not smoking. Drinking alcohol also increases risk. Take your shoes and socks off at every doctor’s visit. Ask for a foot inspection.(10) By reducing ulcer risk you also reduce amputation risk. Pay attention to studies that are taking place. An example is “Smartsox”. Experiments are taking place with this product which uses textiles with fiber optics and sensors to measure temperatures in the foot, pressures and joint angles. Studies need to take place to see if this product can be used to predict and manage foot ulcers.(11) 

Quick facts to help you:
  • Wash and inspect your feet daily or have another person help you. Make sure you test the water for temperature so you do not scald your feet. Dry your feet completely. Use foot lotion as recommended by your podiatrist or diabetes educator. Make sure you understand how to do this and what you need to look for.
  • Make sure you make appointments as necessary with your podiatrist. They will cut your toe nails for you or teach you how to do this to avoid cutting yourself.
  • Do not smoke, keep your blood glucose and cholesterol under control.
  • Medicare or your insurance may pay for prescription shoes. Call your insurance and ask your podiatrist to see what is covered.
  • Visit The Joslin Diabetes Center website for a list of the best shoes for people with diabetes
Take good care of your feet so they can take you many more miles!