Diabetic Foot Care
Whether you have been diagnosed with type 1 or type 2 diabetes, you are at an increased risk of developing foot problems. A minor cut, blister, or ingrown toenail can turn into an open sore (known as an ulcer) that doesn’t heal and can get progressively worse.
Ulcers can become infected and lead to hospitalization. And, in the most serious cases, amputation. About one-third of people with diabetes eventually experience a foot ulcer.
Fortunately, ulcers are usually preventable. The best course of action is to protect your feet, regularly check your feet, and be aware of your risk factors.
Why is foot care important for diabetics?
Diabetes can lead to a loss of feeling in the feet and reduced circulation—a dangerous combination. About half of people with diabetes have diabetic neuropathy—nerve damage—with the feet being the most commonly affected area.
When your feet lose feeling, you may not notice other changes. For instance, a blister, a pebble in your shoe (which can create a sore), or temperature changes that make your feet too hot or cold, which can lead to frostbite or burns.
In addition, poorly controlled blood sugar levels can damage blood vessels, reducing blood flow to the feet. Not having enough blood going to the feet can interfere with healing. Sores may then fester and put you at risk for a serious infection.
The most common misconception about diabetic foot ulcers is that “it can’t happen to me.” Each patient I have treated has a certain sense of disbelief when they find out that they have a non-healing ulcer, or a badly infected wound. This might be because their feet “feel” fine, they don’t hurt. (The nerves in the feet have lost function and are unable to send pain signals to the brain.) Or they practice good hygiene. But it can happen to anyone—it’s key to examine the feet regularly. —Dr. Debbie Dang
What are signs of diabetic feet?
If you’re at risk for ulcers, it’s important to call your doctor or a podiatrist (foot specialist) whenever you have a blister, sore, infected corn, ingrown toenail, or ulcer. Also, if you notice any of the below changes, see your doctor for an evaluation.
- Tingling, burning, or pain.
- Loss of sense of touch or the ability to sense heat or cold.
- Loss of hair on your toes, feet, and lower legs—it’s a sign of poor circulation.
- Dry, cracked skin.
- A change in your foot’s color and temperature.
- Fungus infections such as athlete’s foot between your toes.
What is diabetic foot care?
Make a list of the things you cannot control and the things that you can—like getting your blood glucose in a safe range, wearing proper shoes, checking feet each day (or having a loved one do), and seeing your doctor regularly. You’ll find that the list of things you can influence is much longer than those you cannot. —Dr. Dang
It is important to keep feet in good condition and catch potential problems as soon as possible. Small sores can quickly develop into serious ulcers.
- Check feet daily—including between toes—for cuts, cracked skin, very dry skin, redness, calluses, or any other changes. Use a mirror to look at the bottom of your feet. If you can’t get a good look at your feet, ask a friend or family member to check them for you.
- Wash your feet in warm (not hot) water daily, but don’t soak them. Dry feet thoroughly. Apply moisturizer to keep skin from cracking. Avoid getting between the toes. The area is often moist, making it prone to fungal infections.
- To keep blood flowing, put your feet up while sitting.
- Wiggle toes for a few minutes throughout the day—this is another way to encourage blood to flow all the way down.
- Avoid ingrown toenails, which can become a more severe infection. Trim toenails straight across. Avoid “rounding” the corners of the toenails. If you can’t trim your own nails, see a podiatrist who can trim them.
- Don’t walk barefoot, even at home, to avoid cuts and other injuries.
- Never remove corns or calluses yourself. It can cause small cuts or abrasions that then become infected. Instead, see a podiatrist for treatment.
- Schedule yearly foot exams with a doctor or podiatrist.
What are good shoes for diabetics?
Shoes for diabetic patients need to do two things: protect the foot and relieve pressure points. Choose shoes that are well-fitting, supportive, and not too tight. A wide toe box helps avoid pressure points.
Always break in new shoes slowly to avoid blisters. It’s best to have a couple of different styles so you can alternate to avoid putting pressure on the same areas. If you have foot deformities or foot ulcers, ask your doctor about customized shoes.
Common symptoms of a foot ulcer
Watch for signs of infection, such as fever, chills, nausea, vomiting, foul-smelling drainage from the wound, visible bone in the wound, a racing heartbeat, difficulty breathing. An infection that spreads to the rest of the body can become life-threatening. Call your doctor or go to the emergency room if you suspect you have a serious infection. —Dr. Dang
Signs and symptoms that you may be developing foot complications:
- Numbness in parts, or all, of the foot
- Deformities in the foot
- Other pressure points in the foot
- Sores that include various layers of skin or deeper tissue
- Drainage from the wound that may or may not be foul-smelling
- High blood sugar levels
- Signs of infection such as fever, chills, nausea, or vomiting
Treatment for foot ulcers
A foot ulcer that only involves the top layers of skin (as opposed to deeper into the muscle and bone) can be treated with wound care under your doctor’s guidance.
- Your doctor, or a wound specialist, will clean out the ulcer and remove dead skin—the procedure is called debridement. The ulcer will be covered with a dressing that you’ll change once or twice a day.
- If your foot is infected, you will need to take antibiotics.
- Elevate the feet when sitting or lying down—you want to do your best to keep weight off of it.
A foot ulcer that involves deeper layers (muscle and bone) may require surgical treatment to remove infected or dead tissue.
Risk factors for complications
Some people with diabetes are at increased risk of foot ulcers. Discuss your risk factors with your doctor.
Together come up with a prevention plan. It’s important to do all you can to avoid serious complications. Risk factors include:
- Poorly managed diabetes
- A foot ulcer in the past
- Nerve damage
- Poor circulation
- Foot deformities, which are sometimes caused by diabetic neuropathy
Dr. Debbie Dang, MD, PHD is a Orthopedic Surgery Specialist in San Francisco, CA and has over 8 years of experience in the medical field. She graduated from University of Rochester School of Medicine in 2012. Dr. Dang's professional interests include achilles tendon repair, ankle arthritis, and acute fracutre management.