The Foot at Risk: Protecting Your Feet with Diabetes

When you have diabetes you hear a lot about taking special care of your feet. Unless you've already had a serious foot ulcer or infection, you may not understand why this is such an important element of your care. The most critical protection for you feet and your health is working with your physician to control your blood glucose levels. Elevated blood sugar will damage nerves and blood vessels, which results in loss of vision, kidney failure, heart attack, stroke, and amputation of limbs.

It Takes a Team to Care for a Diabetic

Diabetes is a complex metabolic condition that has the potential to affect nearly every organ system in your body. Left uncontrolled there is much greater risk of damage to these organ systems. Regular monitoring from a team of specialist physicians is recommended for the care of a diabetic who has long standing disease or a history of any diabetes associated complications. You should always be aware of what your "HgA1C" values are and be able to report these to your medical care team. Below is a list of some of the more common members of the diabetic care team. There may be others needed if complications occur that require additional expertise. Vascular Surgeons become part of the team when arteries are blocked and wounds occur that will not heal.   

  • Internist/Primary Care Physician: This is home base. This physician is responsible for coordiating care with all of the specialist. He/She is also the one who will manage your routine care; monitor your blood pressure, your cholesterol, and your diabetes control. 
  • Endocrinology: Endocrinologist are specialists who diagnose and manage hormone conditions. Diabetes is a hormone condition because it is caused by problems with the way the body uses the the hormone insulin, or not producing enough insulin. A person with difficult to control diabetes, or insulin dependent diabetes is often referred to an endocrinologist to help manage their blood sugars.
  • Podiatry: Podiatrists are foot care specialist. Every diabetic should should have one on their team to manage regular foot care and prevent serious foot wounds. He/She can help fit you for special shoes or inserts for your shoes to prevent injury to your feet.
  • Ophthalmology: Performs regular eye exams to monitor and prevent changes that could lead to vision loss (diabetic retinopathy, cataracts).
  • Cardiology: Cardiologist are heart specialist. They perform screening tests (stress tests), and diagnostic exams (angiograms) to diagnose and monitor coronary artery disease and other disease of the cardiovascular system. 
  • Neurology: Neurologist are specialist that treat nerve (nervous system) problems. They may be needed to diagnose and treat complex diabetic neuropathies.
  • Nephrology: Nephrologist are kidney specialist that manage diseases of the kidneys. Diabetes can cause kidney function to decrease, and eventually fail.

Peripheral Neuropathy

Elevated blood glucose levels can eventually cause damage to your nerves and affect many of your body’s regulatory ability and daily functions. Peripheral neuropathy is the most common form of diabetic neuropathy and usually affects the nerves of your feet and legs first, and then it may affect your hands and arms as well. The damaged nerves may affect your sensation, your muscles in your feet and other important functions like glands. This can cause foot deformity which creates abnormal pressure on certain parts of the feet. When there is too much pressure over one area, the damage to the sensory nerves can prevent you from realizing that there is a problem and a blister or ulcer may form. Dry skin and thick callus formation is also a result of nerve damage to other nerves called autonomic nerves.  Special attention to this is important since diabetics are “at risk” for non-healing wounds. Routine follow up with your podiatrist is recommended to prevent problems.  Symptoms of peripheral neuropathy may include:

  • Numbness or decreased sensation
  • Extreme sensitivity to even light touch
  • A tingling or burning sensation in extremities
  • Sharp, stabbing pain that may be worse at night
  • Pain when walking
  • Muscle weakness and difficulty walking

Peripheral Arterial Disease

Diabetics also frequently have Peripheral Arterial Disease. Elevated glucose levels also cause damage to the cells lining the inside of blood vessels, resulting in poor circulation and arterial blockages. This condition delays wound healing and causes tissue death or gangrene.

How Can I Protect My Feet If I have Diabetes or PAD?

  • If you smoke, STOP NOW! Smoking cessation will help preserve your circulation and your limbs.
  • Every diabetic should see a podiatrist regularly to manage their foot care and cut any corns, calluses, or ingrown toenails. Do not attempt to cut or shave them yourself.
  • If you cut your own nails, only do it after bathing in warm water. The nails will be softer and easier to cut. Cut straight across. Don’t cut the corners. Use an emery board to smooth the edges.
  • Don't use any chemicals on your feet. They could damage your skin and create a wound problem.
  • Do not use hot water bottles, or heating pads on or near your feet or legs. These could cause a severe burn.
  • Wash and dry your feet daily using warm, not hot, water and mild soap. Gently pat your skin dry, and dry carefully between your toes.
  • Apply lotion to your feet and legs every day to prevent the skin from cracking. Do not put lotion between your toes. This can cause infection.
  • Examine your feet every day. Make sure you check the bottoms. If you can’t see them, have someone help you, or use a hand mirror.
  • NEVER GO BAREFOOT. Always protect your feet by wearing shoes or hard-soled slippers. PROTECT YOUR TOES. Avoid open toed shoes or sandals.
  • Wear special shoes if your health care provider recommends them. Make sure your shoes fit properly. Do not wear new shoes for more than an hour at a time until they are broken in.
  • Wear natural-fiber socks that help keep your feet dry. Make sure they don’t fit too tight, or have seams or holes that can cause pressure on your feet.