People with diabetes are at risk for developing foot problems that potentially can be severe. All people with diabetes should make sure to monitor their feet regularly.

 

With a diabetic foot, minor injuries can become major emergencies. A wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes may also decrease your blood flow, so your injuries can be slow to heal, putting you at higher risk for infection. As a diabetic, your infection may spread quickly, and if you have any loss of sensation (neuropathy) you may not recognize that the problem is getting worse.

 

Inspecting Your Feet 

If you have diabetes, inspect your feet every day: 

 

• ​Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror. 

• Feel each foot for swelling. 

• Examine between your toes. 

• Check six major locations on the bottom of each foot: tip of the big toe, base of the little toes, base of the middle toes, heel, outside edge of the foot and across the ball of the foot. 

• Check for sensation in each foot.

 

If you find any injury -- no matter how slight -- don't try to treat it yourself. Go to a medical doctor right away.

 

Taking Care of Your Feet

• Wash your feet every day with mild soap and warm water. Test the water temperature with your hand first.

• Don't soak your feet.

• When drying them, pat each foot with a towel and be careful between your toes.

• Use quality lotion to keep the skin of your feet soft and moist -- but don't put any lotion between your toes.

• Trim your toe nails straight across. Avoid cutting the corners.

• Use a nail file or emery board. If you find an ingrown toenail, see your doctor.

• Don't use antiseptic solutions, drugstore medications, heating pads, or sharp instruments on your feet.

• Always keep your feet warm with warm socks and shoes. Don't put your feet on radiators or in front of the fireplace.

• Wear loose socks to bed.

• Don't get your feet wet in snow or rain.

• Don't smoke or sit cross-legged for long periods as both decrease blood supply to your feet.

 

Advice About Shoes and Socks

• Never walk barefoot or in sandals or thongs. 

• Choose your shoes carefully. Try on new shoes late in the day when your feet are larger, and buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel and sole. 

• Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. 

• Wear new shoes for only two hours or less at a time. 

• Don't wear the same pair of shoes every day. 

• Inspect the inside of each shoe before putting it on and feel inside it with your hand. 

• Don't lace your shoes too tightly or loosely.

• Wear clean, dry socks every day and avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toed socks will not squeeze your toes. 

• Avoid stockings with elastic tops. Seemless socks are available for those with neuropathy. Consider using compression stockings if your feet tend to swell.

 

Diabetic Foot Deformities

When your feet lose their feeling, they are at risk for becoming deformed or injured. One way this happens is through ulcers. Open sores may become infected. Another way is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn't hurt. 

A doctor may treat your diabetic foot ulcers and early phases of Charcot fractures with a total contact cast. The cast lets your ulcer heal by distributing weight and relieving pressure. If you have a Charcot foot, the cast controls your foot's movement and supports its contours if you don't put any weight on it. To use a total contact cast, you need good blood flow in your foot. Your doctor monitors it carefully. The cast is changed every week or two until your foot heals.

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A custom-walking boot is another way to treat your Charcot foot. It supports the foot until all the swelling goes down, which can take as long as a year. You should avoid putting your weight on a Charcot foot. Surgery is considered if your deformity is too severe for a brace or shoe, or if it is necessary to treat an ulcer.

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It is important to be treated by a medical doctor (MD or DO) if you have a foot ulcer or deformity. Medical doctors are trained to evaluate and treat the full spectrum of conditions that affect diabetic foot problems, which could include other causes of disease such as vitamin deficiencies and other metabolic conditions.

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Reference

The American Orthopaedic Foot & Ankle Society (AOFAS) , https://footcaremd.org/conditions-treatments#conditions

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