If you have diabetes you are more prone to foot problems, because the disease can damage your blood vessels and nerves. This, in turn, may make you less able to sense injury or pressure on your foot. You may not notice foot injury until severe infection develops.

Diabetes also alters the immune system, decreasing the body's ability to fight infection. Small infections may rapidly progress to death of the skin and other tissues (necrosis), which may require amputation of the affected limb to save the patient's life. Foot problems can be prevented in part with improved blood sugar control.

If you have diabetes, you are at higher risk for developing foot problems if you:

• Have had diabetes more than 10 years
• Are male
• Have poor glucose control
• Have eye, kidney, or heart problems

All diabetics should get regular foot exams -- at least twice yearly -- by their health care provider and should learn whether they have nerve damage.

To prevent injury to the feet when you have diabetes, you should adopt a DAILY routine of checking and caring for your feet, 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. Inspect 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 before putting your feet in, because the normal ability to sense hot temperature is usually impaired in diabetics. Burns can easily occur.
• Gently and thoroughly dry the feet, particularly between the toes, because infections can develop in moist areas.
• Because of skin changes linked with diabetes, the feet may become very dry and may crack, possibly causing an infection. After bathing the feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your toes.
• Ask your health care provider to show you how to care for your toenails. Soak your feet in lukewarm water to soften the nail before trimming. Cut the nail straight across, since curved nails are more likely to become ingrown.
• Exercise daily to promote good circulation. Avoid sitting with legs crossed or standing in one position for prolonged 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.
• Wear comfortable, well-fitting shoes. Never buy shoes that do not fit properly, expecting the shoes to stretch with time. Nerve damage may prevent you from being able to sense pressure from improperly fitting shoes.
• Check the inside of your shoes for rough areas or torn pieces that can cause irritation.
• Change your shoes after 5 hours of wearing during the day to alternate pressure points.
• Avoid wearing thong sandals or stockings with seams that can cause pressure points.
• Wear clean dry socks or non-binding panty hose every day. Socks may provide an additional layer of protection between the shoe and your foot.
• 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

• Avoid using antiseptic solutions on your feet since these can burn and can injure skin.
• Avoid applying a heating pad or hot water bottle to the feet. Avoid hot pavement or hot sandy beaches.
• Report sores, changes, or signs of infection to your doctor immediately. Report all blisters, bruises, cuts, sores or areas of redness.
• Remove shoes and socks during visits to your health care provider. This is a reminder that you need a foot exam.
• Make an appointment with a podiatrist to treat foot problems or to have corns or calluses removed. Never attempt to treat these yourself using over-the-counter remedies.
• If obesity prevents you from being physically able to inspect your feet, ask a family member, neighbor, or a visiting nurse to perform this important check.

Zarrintaj A, Ezell OL. Preventing and treating diabetic foot ulcers. Clinical Advisor. March 2004:28-32.

American Diabetes Association. Standards of medical care in diabetes—2007. Diabetes Care. 2007; 30(Suppl.1):S4-S41.