Diabetic foot care

Why feet need special attention

Over time, high blood sugar can damage the nerves in the feet (peripheral neuropathy) and narrow the arteries that supply them (peripheral artery disease). Without normal feeling, a pebble in a shoe, a burn or a tight shoe goes unnoticed; without good blood flow, the resulting wound heals slowly and infection can spread quickly.^[1,2] Foot deformities such as bunions, hammertoes and Charcot foot add pressure points where ulcers form.^[2]

Your annual diabetic foot exam

A comprehensive foot examination includes:

• Skin and nails: dryness, cracks, calluses, blisters, ingrown or fungal nails.
• Sensation: a monofilament test and a vibration test to detect neuropathy.^[5]
• Circulation: pulses in the feet, and further testing if they are weak.^[5,6]
• Foot shape and pressure points, and how your shoes fit.
• Your risk category, which sets how often you should be seen.^[3]

Protective care at the practice

• Risk-based check-ups: from yearly for low-risk feet to every one to three months for people with a history of ulcers or amputation.^[3,4]
• Routine nail and callus care by our team, which people with neuropathy or poor circulation should not do themselves.^[1]
• Footwear and inserts: properly fitted shoes and, for higher-risk feet, therapeutic shoes and custom inserts that reduce pressure.^[3] See custom orthotics.
• Education: how to check your feet, what to look for, and what to do if you find something.
• Early treatment of pre-ulcer signs such as blisters, bleeding calluses and cracked skin.^[3]

Daily self-care

Check both feet every day, including between the toes, using a mirror or a family member if needed. Wash and dry them carefully, moisturize the skin but not between the toes, never walk barefoot, check inside shoes before putting them on, and keep blood sugar in your target range.^[1] Our article on the daily diabetic foot check is a step-by-step guide.

Common questions

Does Medicare cover diabetic shoes?

For people with diabetes and significant diabetes-related foot disease, Medicare Part B covers therapeutic shoes and inserts each calendar year: either one pair of custom-molded shoes with two extra pairs of inserts, or one pair of extra-depth shoes with three pairs of inserts. The doctor treating your diabetes certifies the need, a podiatrist or other qualified doctor prescribes them, and they come from a Medicare-enrolled supplier. You usually pay 20% after the Part B deductible.^[7] Other plans vary.

Can I cut my own toenails?

If you can see, feel and reach your feet, trim the nails straight across and smooth them with an emery board. Have a foot doctor trim them if you can’t see, feel or reach your feet, or if your nails are thick or yellowed or grow into the skin; a small nick can become a wound you don’t feel.^[1] Our team trims nails and calluses as part of your regular care.

I have no foot problems. Do I still need a foot exam?

Yes. Everyone with diabetes should have a comprehensive foot exam at least once a year, because nerve damage and poor circulation can develop without symptoms.^[5] Up to half of people with diabetes have peripheral neuropathy.^[8]

What about socks and shoes?

Wear shoes and socks at all times, even indoors. Choose clean, lightly padded socks that fit well (seamless ones are best), check inside your shoes for pebbles or rough spots before putting them on, and wear new shoes for only a few hours at first, then check your feet for sore spots.^[1]

Numbness and nerve pain

If you have burning, tingling or numbness in your feet, we check whether it is diabetic neuropathy or a nerve compression that may be treatable (see nerve pain in the feet).

When to seek care