Diabetic Foot Care

This is a site about wound care, but really we’d much rather that people never developed wounds  in the first place. With proper diabetic foot care, most people with diabetes can avoid ever having any serious foot problem. Here are some steps every diabetic should take.

The first is good control of the diabetes. Damage to the nerves in the feet (neuropathy) is a major underlying cause of foot problems. Among its many benefits, good diabetic control reduces the risk of developing neuropathy. Maintaining normal protective sensation helps prevent foot problems.

Well-fitting shoes are crucial. Any friction or a pressure point can cause a serious problem. Getting well-fitting shoes isn't always easy. Many diabetics develop foot deformities over time that require custom shoes to properly protect their feet.

Whether shoes are off the shelf or custom made, be sure to break them in carefully. Only wear them for a short period of time before checking to make sure that you aren’t developing any friction areas and switch back to an older pair of shoes that you know work well for you. Gradually increase the time in the new shoes to break them in.

As I mentioned, this is true even with custom molded shoes. Before we started emphasizing this to patients, we had several people we had worked with for months to get a wound healed who were back with the wound open again within a week of getting their custom molded shoes.

The problem was that they figured that because their shoes were custom made they were all set. They put them on in the morning and didn’t take them off ‘till that night. When they did, they discovered the wound back. The reason was that custom shoes still need to be broken in.

Also, the inserts often need adjustment despite the fact that they’re custom molded. As we point out to our patients, the molds are taken when they’re standing still. Different gait mechanics make a big difference in how effectively an insert works. Many inserts need to be adjusted before they properly protect the foot.

Whether the shoes are custom molded or not, it can help to switch into a different well-fitting pair every four hours or so. Each pair of shoes will destribute pressure slightly differently so changing shoes frequently helps avoid prolonged pressure on any one area.

Never go without shoes and socks, even indoors at home. Too many diabetics get into problems because they injure their foot while walking barefoot and don’t even realize it. As an extreme, we had one woman come in with a severe abscess of her foot. When we drained it we found one of the needles she uses for her insulin injections embedded in her foot. She had stepped on it and never felt a thing. She only came in when she noticed the redness and swelling.

Always check your shoes before you put them on to make sure there is nothing in them. We’ve had patients get a pebble in their shoe and wind up with a foot ulcer because they can’t feel it. We had one man who put his wrist watch in his shoe before he went to bed, and forgot about it in the morning. He put his shoes on and never felt it all day long. When he took his shoes off that evening, his toes were a mess. 

I tell people with diabetes to behave like they live someplace where they have to check their shoes for scorpions before the put them on in the morning.

Also protect your feet from temperature extremes. Because of the nerve damage you can get frostbite or a burn without being aware of it.

Be especially careful to check the temperature of foot soaks or bath water before you but your foot in it. It’s too easy to burn yourself if you don’t. Be as careful as you would if you were giving a baby a bath.

An experience in the early days of my surgical training impressed this on me. I saw a 47 year old diabetic woman in the clinic who had burned herself severely when she soaked her feet after a long day working as a waitress without checking the water temperature. It was hot enough out of the tap to burn her. She eventually needed an amputation of one leg.

For the same reason, do not use a heating pad or hot water bottle on your feet. It's too easy to burn your feet. This is especially true if you have circulation problems as well as diabetes.

If your feet are cold, warm them passively by using well-fitting, warm socks. Polar fleece socks work well for this because they are soft and warm.

In the summer, be careful about walking on hot pavement or on a beach. Again, never go barefoot.

Being out in the cold in winter puts you at risk for frostbite. Be sure to wear warm boots and socks, keep your feet dry and avoid being in the cold for too long.

Examine your feet at least daily to make certain you aren't developing any friction points, blisters or other irritations. Keep your feet clean and dry. Keep your toenails trimmed it straight across to avoid the risk of developing an ingrown nail. If you have trouble doing this safely yourself, schedule regular appointments with a podiatrist.

Also, it's best not to attempt to trim any corns or calluses yourself. I've seen too many serious problems begin that way.

These simple steps will go a long way toward protecting your feet and preventing any problems from ever developing.