Take Care of Your Feet: A Guide for People with Diabetes

Do you want to avoid serious foot problems that can lead to a toe, foot, or leg amputation? Take Care of Your Feet for a Lifetime tells you how. It's all about taking good care of your feet.

Foot care is very important for people with diabetes who have:

• Loss of feeling in their feet.
• Changes in the shape of their feet.
• Foot ulcers or sores that do not heal.

Nerve damage can cause you to lose feeling in your feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers which may lead to amputation.

Keeping your blood sugar (glucose) in good control and taking care of your feet every day can help you avoid serious foot problems.

Use this guide to make your own plan for taking care of your feet. Helpful tips make it easy! Share your plan with your doctor and health care team and get their help when you need it.

There is a lot you can do to prevent serious problems with your feet. Here's how.

1. Take care of your diabetes.

• Make healthy lifestyle choices to help keep your blood sugar close to normal. Keeping your blood sugar under good control may help prevent or delay diabetes-related foot problems as well as eye and kidney disease.
• Work with your health care team to make a diabetes plan that fits your lifestyle. The team may include: your doctor, a diabetes educator, a nurse, a dietitian, a foot care doctor called a podiatrist (pah-di'ah-trist), and other specialists. This team will help you to:
  • Know how and when to test your blood sugar.
  • Take prescribed medicines.
  • Eat regular meals that contain a variety of healthy, low-fat, high-fiber foods including fruits and vegetables each day.
  • Increase your physical activity each day.
  • Follow your foot care plan.
  • Keep your doctor's appointments and have your feet, eyes, and kidneys checked at least once a year.

2. Check your feet every day.

• You may have serious foot problems, but feel no pain. Check your feet for cuts, sores, red spots, swelling, and infected toenails. Find a time (evening is best) to check your feet each day. Make checking your feet part of your every day routine.
• If you have trouble bending over to see your feet, use a plastic mirror to help. You also can ask a family member or care giver to help you.

3. Wash your feet every day.

• Wash your feet in warm, not hot, water. Do not soak your feet, because your skin will get dry.
• Before bathing or showering, test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow.
• Dry your feet well. Be sure to dry between your toes. Use talcum powder to keep the skin between your toes dry.

4. Keep the skin soft and smooth.

• Rub a thin coat of skin lotion, cream, or petroleum jelly on the tops and bottoms of your feet.
• Do not put lotion or cream between your toes, because this might cause an infection.

5. Smooth corns and calluses gently.

• After bathing or showering, use a pumice stone to smooth corns and calluses. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.
• Do not cut corns and calluses. Don't use razor blades, corn plasters, or liquid corn and callus removers -- they can damage your skin.
• If you have corns and calluses, check with your doctor or foot care specialist.

6. Trim your toenails each week or when needed.

• Trim your toenails with clippers after you wash and dry your feet.
• Trim toenails straight across and smooth them with an emery board or nail file.
• Don't cut into the corners of the toenail.
• If you can't see well, or if your toenails are thick or yellowed, have a foot care doctor trim them.

7. Wear shoes and socks at all times.

• Wear shoes and socks at all times. Do not walk barefoot -- not even indoors -- because it is easy to step on something and hurt your feet.
• Always wear socks, stockings, or nylons with your shoes to help avoid blisters and sores.
• Choose socks made of cotton or wool. They help keep your feet dry.
• Check the insides of your shoes before you put them on to be sure the lining is smooth and that there are no objects in them.
• Wear shoes that fit well and protect your feet.

8. Protect your feet from hot and cold.

• Wear shoes at the beach or on hot pavement.
• Put sun screen on the top of your feet to prevent sunburn.
• Keep your feet away from radiators and open fires.
• Do not put hot water bottles or heating pads on your feet.
• Wear socks at night if your feet get cold. Lined boots are good in winter to keep your feet warm.
• Check your feet often in cold weather to avoid frostbite.

9. Keep the blood flowing to your feet.

• Put your feet up when you are sitting.
• Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs.
• Don't cross your legs for long periods of time.
• Don't wear tight socks, elastic or rubber bands, or garters around your legs.
• Don't smoke. Smoking reduces blood flow to your feet. Ask your doctor or nurse to help you stop smoking.
• If you have high blood pressure or high cholesterol, work with your health care team to lower it.

10. Be more active.

• Ask your doctor to help you plan an activity program that is right for you.
• Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet.
• Avoid activities that are hard on the feet, such as running and jumping.
• Always include a short warm-up and cool-down period.
• Wear athletic shoes that fit well and that provide good support.

11. Be sure to ask your doctor to:

• Check the sense of feeling and pulses in your feet at least once a year.
• Tell you if you are likely to have serious foot problems. If you have serious foot problems, your feet should be checked at every visit to your doctor.
• Show you how to care for your feet.
• Refer you to a foot care doctor if needed.
• Decide if special shoes would help your feet stay healthy.

12. Get started now.

• Begin taking good care of your feet today.
• Set a time every day to check your feet.
• Note the date of your next visit to the doctor.
• Cut out the foot care tip sheet in this booklet and put it on your bathroom or bedroom wall or night stand as a reminder.
• Complete the "To Do" list at the back of this booklet. Get started now.
• Set a date for buying the things you need to take care of your feet: nail clippers, pumice stone, emery board, skin lotion, talcum powder, mirror, socks, athletic shoes, and slippers.
• Most important, stick with your foot care program .... and give yourself a special treat such as a new pair of soft cotton socks. You deserve it!

Tips for Proper Footwear

• Proper footwear is very important for preventing serious foot problems. Athletic or walking shoes made of canvas or leather are good for daily wear. They support your feet and allow them to "breathe."
• Never wear vinyl or plastic shoes, because they don't stretch or "breathe."
• When buying shoes, make sure they are comfortable from the start and have enough room for your toes.
• Don't buy shoes with pointed toes or high heels. They put too much pressure on your toes.

Ask your doctor about Medicare coverage for special footwear.

You may need special shoes or shoe inserts to prevent serious foot problems. If you have Medicare Part B insurance, you may be able to get some of the cost of special shoes or inserts paid for. Ask your doctor whether you qualify for:

• 1 pair of depth shoes* and 3 pairs of inserts or,
• 1 pair of custom molded shoes (including inserts) and 2 additional pairs of inserts.

If you qualify, your doctor or podiatrist will tell you how to get your special shoes.

* Depth shoes look like athletic or walking shoes, but have more room in them. The extra room allows for different shaped feet and toes, or for special inserts made to fit your feet.

Source: National Diabetes Information Clearinghouse, National Institute of Health, November 1997