Diabetes and Your Feet: Prevention and Management

Diabetes Mellitus (DM) is a lifelong chronic disease that is caused by high levels of sugar in the blood. It can also decrease the body's ability to fight off infections and cause damage to the nervous system, which is especially harmful to the feet.

Type 2 Diabetes

Most of the diabetic patients we see at the Foot and Ankle Center, have Type 2 DM (adult onset). This form of diabetes is typically related to family history, obesity, lack of exercise, and a diet high in fats and sugars. The increased body fat causes the muscles and other tissue to become resistant to insulin. As a result, glucose stays in your blood causing high blood sugar.

Diabetic Peripheral Neuropathy

About half of all people with diabetes develop Diabetic Peripheral Neuropathy, a condition which causes damage to the nervous system. With this condition, a person loses their ability to properly feel their feet. Minor injuries can go unnoticed leading to many foot problems including infections and diabetic foot ulcers. In addition, normal sweat secretion and oil production that lubricates the skin of the foot is impaired, which can lead to very dry skin which can break down and cause ulcers.

Symptoms of Diabetic Neuropathy

People with Diabetic Peripheral Neuropathy can experience tingling, pain or numbness in their feet. In addition to ulcers, diabetics with this condition can develop red spots, sore spots, dry skin, blisters, corns, and calluses.

Factors Increasing Risk of Diabetic Foot Problems

Many of the factors that increase the risk of foot problems for people with diabetes can be resolved.

Poorly fitting shoes—this is one of the biggest culprits of diabetic foot complications. Fortunately, Medicare provides access to new diabetic shoes each year to help prevent these symptoms from occurring.
Common foot abnormalities such as bunions and hammertoes. These foot problems need to be resolved to prevent them from causing diabetic foot complications.
Poor circulation – quitting smoking, exercise, compression stockings, and stress reduction can help with poor circulation.
Trauma to the foot—dropping a heavy object on the foot or running into furniture, punctures to the skin by a foreign object, tight shoes, and toenails that are too long are some typical examples. These are all issues that can be prevented. Patients should avoid going barefoot, wear proper shoes that fit, and eliminate environmental factors that could lead to foot trauma.
Infections—resolving the first two problems will greatly reduce the chance of infection.
Smoking—people with diabetes who smoke increase their risk of diabetic foot complications. The best thing to do is quit.
Fungal toenails--see below

Fungal Toenails and Diabetes

Diabetic patients are at greater risk for developing a fungal nail infection due to lack of sensation in the feet. For example, wearing shoes that are too tight (which may go unnoticed) can cause the nail to lift and letting in fungus. Once the nails are infected the fungus often spreads to the surrounding skin and can cause cracks and ulcers in the skin.

In one study, there was a 15% rate of secondary infections in diabetic patients with fungus toenails compared to a 6% rate in diabetic patients without fungus toenails. In addition, diabetic patients with toenail fungus, had three times greater risk of developing a foot ulceration (wound).

Patients with diabetes and thickened fungal toenails, should obtain treatment to resolve this problem. Learn more about how we treat fungal toenails here.

Management of Diabetic Feet in Seattle

Comprehensive Diabetic Foot Exam (CDFE)

The American Diabetes Association now recommends that all patients with diabetes obtain an annual Comprehensive Diabetic Foot Exam (CDFE). This exam helps the podiatrist identify problems to prevent foot complications from diabetes.

Self-Exam and Other Recommendations

Inspect your feet daily. Check for cuts, blisters, redness, swelling, or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything.
Wash your feet in lukewarm (not hot!) water. Keep your feet clean by washing them daily. Use only lukewarm water – the temperature you would use on a newborn baby
Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting, and carefully dry between the toes.
Moisturize your feet – but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But DON’T moisturize between the toes – that could encourage a fungal infection.
Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor.
Never treat corns or calluses yourself. No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment.
Wear clean, dry socks. Change them daily.
Wear thick, soft socks without seams.
Avoid the wrong type of socks. Avoid tight elastic bands (they reduce circulation). Don’t wear thick or bulky socks (they can fit poorly and irritate the skin). Don't wear cotton socks. Ask your podiatrist about purchasing diabetic socks. Learn more about diabetic socks here!
Wear socks to bed. If your feet get cold at night, wear socks. NEVER use a heating pad or hot water bottle.
Shake out your shoes and feel the inside before wearing. Remember, your feet may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.
Keep your feet warm and dry. Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter.
Never walk barefoot. Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.
Take care of your diabetes. Keep your blood sugar levels under control.
Don’t smoke. Smoking restricts blood flow in your feet.
Get periodic foot exams. Seeing your foot and ankle surgeon regularly can help prevent the foot complications of diabetes.
Exercise daily to improve your circulation and to manage weight. Make sure you choose an exercise you like to do and that you wear well-fitted shoes.
Obtain new shoes that fit properly - if you qualify you can obtain new shoes annually through your podiatrist's office.

Am I Eligible for Diabetic Shoes?

As a result of the CDFE, the podiatrist will determine if you need to obtain therapeutic shoes provided through a special Medicare Therapeutic Shoe Program. Sometimes your podiatrist will also recommend custom orthotics to help prevent protect your feet.

If you have diabetes, it is important to prevent foot problems before they occur, recognize problems early, and seek the right treatment when a problem does happen.

More Information About Management of Diabetes

A person with diabetes should have a podiatrist who specializes in evaluating and treating diabetic feet. Complete the contact form on this page or call our office at 206-368-7000 to schedule an appointment with Dr. Berg.

Most new patients are seen within 1-2 week's time. During your initial visit, Dr. Berg will spend up to 30 minutes getting to know you, your podiatry complaints, and your goals so that he can recommend the treatment best meets your needs. Don’t wait—contact us today.

North Seattle Foot & Ankle Specialist Dr. Rion Berg offers compassionate podiatry care for all foot and ankle problems to those living in Seattle Washington and the surrounding areas. Call us today at 206-368-7000 for an immediate appointment or request an appointment online.