Good foot care (healthy skin, nail care, and proper footwear) is very important for anyone with diabetes, because you have a greater risk of having problems with your feet (such as skin that is dry and cracked, sores, changes in foot shape). This is because diabetes damages your nerves and reduces blood flow (circulation) to your feet, which can cause serious foot problems. About 1 in 5 people with diabetes who go to the hospital do so for foot problems.

But if you inspect and take care of your feet every day, you can prevent many of these problems. This information explains what you can do to keep your feet healthy.

Foot care is even more important if you have any:

• loss of feeling, numbness, or tingling in your feet
• changes in the shape of your feet or toes
• sores, cuts, or ulcers on your feet
• pain or cramps in your lower legs

If you have any of these problems and they don’t get looked after you could develop an ulcer (wound) which could lead to an amputation. ​Good foot care can lower the chances of amputation.

​​​It’s helpful to understand why you might have problems with your feet and what you can do about it. There are 2 conditions that you should know about that can cause foot problems when you have diabetes.

Loss of protective sensation (LOPS)

LOPS is when diabetes causes you to lose feeling (sensation) in your feet. When you lose feeling, you might not feel a pebble inside your shoe or a blister on your foot. You have no warning that your skin is being hurt. If you lose protective sensation you might not be able to feel pressure, pain, or changes in temperature. When this happens, you have a higher risk of foot problems, like sores (wounds) that can become infected.

Your healthcare provider will test the feeling in your feet and tell you the results.

If you are not able to see your healthcare provider in person, you can do the ​"Touch the toes test" in your home, which is a quick and easy test to assess if you have sensation in your feet. You will need someone to touch your toes and write down the results. Click here for step-by-step instructions: Touch-the-toes-test. You can also watch this video: Testing for sensitivity in your feet | Diabetes UK

If you don’t have feeling in your feet, you need to watch for:

• Shoes that are too tight, or rub because they’re loose. They can cause pressure areas or blisters.
• Stones or other objects in your shoes can also damage your skin and can turn into a wound.
  
• Sharp objects on the floor or ground. If you step on a sharp object it may cause a wound. Wounds on your feet can be hard to heal.
• Hot and cold temperatures that can cause a burn or frostbite. You can burn your feet if bath water is too hot. You can get frostbite if your feet are too cold in the winter.

If you don’t have feeling in your feet, you need to:

• Check and protect your feet daily.
• Always check for objects inside your shoes before you put them on. People find things in their shoes more often than you would think.
• Wear shoes that fit well all the time, both inside and outside your home.
• Get professional nail care.

Peripheral artery disease (PAD)

PAD is very common in people with diabetes. It decreases the blood flow (circulation) to your feet. This can lead to pain in your lower legs (claudication). It can cause slower healing of sores that can lead to foot ulcers. If you do get a foot ulcer, you could be at risk for an amputation.

Your healthcare provider can check the blood flow to your feet, find any circulation problems, and decide how serious they are. The less blood flow you have to your legs, the higher your risk for other problems.

​​​Knowing your level of risk to have foot problems helps you know how to keep your feet healthy. Your healthcare provider will check your feet (do a foot screen or foot exam) to find out your level of risk.

You should have a foot exam at least once a year if you have no concerns and more often if you have concerns. It’s a good idea to make your own notes about your foot exam results every time you see your healthcare provider. To do this, you can print the document Diabetes Foot Health Self-Screening Tool, fill it out, and keep it for your records.

There are many factors that go in to your level of risk to develop foot problems. Your level of risk guides the care you need to give your feet. Depending on your needs, you might also be referred to different healthcare providers. Examples are:

• a high risk foot team
• a therapeutic footwear provider
• a professional nail care provider

Do you know your level of risk?

Each risk level is described below, along with tips to care for your feet based on your risk.

Low risk

Your foot exam shows you have a low risk of having foot problems. You have a normal foot, with no open sores, normal feeling, and no changes to the shape of your foot. There are no concerns with your toenails or nail care. If your healthcare provider tells you you’re low risk, here’s what you should do to protect your feet:

• Check your feet daily. Look between your toes, and at the top and bottom of your feet for any swelling, redness, sores, corns, or calluses. Use a mirror or ask someone to help if you can’t see your feet.You can also use a selfie stick with your smart phone camera, or a telescopic inspection mirror that can be found at most auto supply stores or online.
• Care for your feet daily. Wash your feet daily with warm water and mild soap. Dry well between your toes.
• Cut your toenails straight across and use a nail file to file any rough edges to the shape of your toes.
• Clean cuts and scratches with mild soap and water. After drying, cover them with a dry dressing that is good for sensitive skin.
• Apply a moisturizer (lotion) at the top and bottom of your feet every day. Do not put moisturizer between your toes. Ask your healthcare provider to recommend a moisturizer. If you have difficulty reaching your feet, you can get a lotion applicator, or you can use a plastic grocery bag. Put the lotion in the bag and use the handles of the bag to rub the lotion onto your skin.
• Have your healthcare provider check your feet once a year. If you feel numbness, tingling, or pain in your feet, or if your feet change shape, see your healthcare provider as soon as possible. Remember to remove your shoes and socks when seeing your healthcare provider.
• Wear shoes that fit well. Shoes should feel snug but not tight and have wiggle room for your toes. The heels should be lower than 5 cm (2 inches). You can learn more from about finding the proper shoe fit from Wounds Canada.
• If you smoke, try to quit or cut down. One cigarette reduces blood flow to your legs for up to 4 hours. If you want help quitting, try AlbertaQuits.ca.

Moderate risk

Your foot exam shows you have a moderate risk of foot problems. You’re at moderate risk because you have 1 or more of these:

• problems with your skin or nails (such as redness over a toe or other area, ingrown toe nail)
• corns or calluses (areas of thick, hard, skin on your feet due to poorly fitting shoes)
• problems with sensation and circulation (such as feeling numb or tingling in your legs and feet)

Your healthcare provider will talk with you about your extra care needs and any changes in your foot care that you need to do. You will likely be referred to other healthcare providers such as a:

• foot care nurse
• podiatrist (foot doctor)
• therapeutic shoe provider

If your healthcare provider tells you you’re at moderate risk, follow all the foot care advice for people at low risk and add the following:

• Have someone who is properly trained cut your toenails. This could be a foot care nurse or a podiatrist. A pedicure is never a safe option. If needed, ask your healthcare provider for suggestions.
• Use a moisturizer if your healthcare provider suggests one.
• Have your feet measured to make sure your shoes fit properly.
• Have your healthcare provider check your feet every 4 to 6 months.

Remember to take off your shoes and socks every time you visit your healthcare provider.

High risk

Your foot exam shows you’re at high risk for serious foot problems. You’re at high risk because you’re at moderate risk plus you have lost feeling in your feet, have reduced blood flow in your feet, or have a sore (ulcer) on your foot.

People at high risk need to see a foot care specialist or a high risk foot team. Your healthcare provider will refer you to one of these services.

If your healthcare provider tells you you’re at high risk, follow all the foot care advice for people at low and moderate risk and add the following:

• Stay off your foot with the sore as much as possible. You may need to use crutches or special footwear to keep your weight off the sore.
• Call your health care provider for an appointment right away if you notice any new changes in your feet.
• Follow the special directions from your healthcare provider for how to properly clean your feet.
• Eat a balanced diet to help your for wound heal faster.

​​​​​​​​Prevention is always the best medicine. You can do many things regularly to keep your feet healthy, including all of the following:

• Check your feet every day. This can be easier if you pick the same time every day to check your feet.
• Use the Diabetes Foot Health Self-Screening Tool to examine your feet at home. It will also help you keep track of the condition of your feet and learn how to care for your feet.
• ​Care for your feet every day. Follow the tips according to your level of risk for foot problems.
• Manage your blood sugars to stay within your target levels.
• Quit smoking or try to cut down how much you smoke daily. Smoking increases the risks to your feet.
• See your healthcare provider when you notice a change in your feet.
• Write down the dates of your appointments for your doctor, foot care nurse, and lab work. Using a calendar or smart phone for all your diabetes related appointments can be helpful as a reminder and as a reference.
• Write down questions you wish to ask your healthcare provider before your appointment.

Do’s and don’ts of foot care

Reproduced with permission from Diabetes Canada 2018 Clinical Practice Guidelines.

Do:

• Wear shoes that fit well. They should be supportive, have heels lower than 5 cm (2 inches), and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professionally fit your shoes.
• Buy your shoes in the late afternoon (since your feet swell slightly by then).
• Wear socks at night if your feet get cold.
• Put your feet up when you are sitting.
• Wiggle your toes and move your ankles around for a few minutes several times a day to help blood flow in your feet and legs.
• Activity every day to improve blood flow.
• Check your feet daily. Feel for differences in the temperature of your feet. You can also use a personal infrared thermometer (can be bought online and in pharmacies) to detect signs of temperature change that can alert you to early signs of infection or inflammation.

Don’t:

• Use over-the-counter medications to treat corns and warts. They are not safe for people with diabetes.
• Wear anything tight around your legs, such as tight socks or knee-highs. This is not good for your circulation.
• Go barefoot, even indoors. Consider buying a pair of well-fitting shoes that you only wear inside.
• Use hot water bottles or heating pads on your feet.
• Sit or cross your legs for long periods of time.
• Smoke. Smoking decreases blood flow and healing. It also increases the risks of amputation.
• Use over-the-counter insoles. They can cause blisters if they do not fit well.

​See your healthcare provider or go to your closest emergency department immediately if:

• Your foot becomes cold, painful, pale, blueish or red, and feels warm to touch.
• Your foot becomes red, hot, and swollen with or without pain.
• The area around your wound is swollen and your wound is draining a lot of fluid that might have an odour.

​​​​​​​MyHealth.Alberta.ca:

Diabetes Foot Health Self-Screening Tool

Diabetes: Taking Care of Your Feet

Diabetes: Checking Your Feet

Diabetes: Protecting Your Feet

Diabetes: Steps for Foot-Washing

Diabetes: Daily Foot Care (video)

Diabetic Foot Care for the Low Risk Foot

Diabetic Foot Care for the Moderate Risk Foot

Diabetic Foot Care for the High Risk Foot

Diabetes Canada:

Diabetes and Foot Care: A Patient's Checklist (Do's and Don'ts)

Foot Care: A Step Towards Good Health

Wounds Canada:

Diabetes, Healthy Feet and You

Finding the Proper Shoe Fit​

​For 24/7 nurse advice and general health information call Health Link at 811.