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Diabetes

Foot Care for People with Diabetes

​​​​​​​Low, Moderate and High Risk Care Recommendations

Developed by Diabetes, Obesity and Nutrition Strategic Clinical Network™

diabetic-foot-care-toes ​​

​Why do I need to take care of my feet?

People with diabetes have a greater risk of problems (complications) happening with their feet. About 1 in 5 people with diabetes who ​go to the hospital do so for foot problems. Many of these problems can be prevented. This booklet explains important steps you need to take to keep your feet healthy. If you take care of your feet every day, you can lower your chances of having problems.

Diabetes causes damage to your nerves and reduces blood flow (circulation) to your feet. This can cause serious changes to your feet. You need to spot these changes and know what to do when they happen.

Good foot care is very important for anyone with diabetes. Foot care is 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 do not get looked after, it can lead to the loss (amputation) of a toe, foot, or leg. Good foot care can reduce the chances of amputation.

Work with your healthcare team to make a diabetes plan that fits your lifestyle and includes foot care. Your team might include:

doctor

physiotherapist

diabetes educator

foot doctor (podiatrist)

nurse

foot or nail care nurse

occupational therapist

offloading shoe specialist


You play the most important role
in taking care of your feet!

What keeps my feet healthy?

To help keep your feet healthy, you need to control your blood sugar, blood pressure, and cholesterol levels. Decide with your healthcare provider what levels you should aim for. It might help to write down results. You can make your own table to show your lab work and results over time. Here’s an example you could use:

Indicator

Present Level

Target Level

Blood sugar or A1C

  

Blood pressure

  

Cholesterol

  

Plan for date for foot exam next year: ___________

Prevention is always the best medicine. Know what your feet look like so you can tell if there are any changes. Schedule appointments every year with your doctor to have your feet checked (screened) for any concerns.

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: loss of protective sensation and peripheral artery disease.

Loss of protective sensation (LOPS)

Diabetes can cause you to lose feeling 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.

foot-wound

When this happens, you have a higher risk of developing foot problems, like sores (wounds) that can become infected.

If you do not have feeling in your feet, you need to watch for:

  • Shoes that are too tight, or rub because they are loose. They can cause pressure areas or blisters. Stones or other objects in shoes can also hurt your foot.
  • 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 have LOPS you need to:

  • Check and protect your feet daily.
  • Always check for objects inside your shoes before you put them on. Surprisingly, 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.

Your healthcare provider will test the feeling (sensation) in your feet during your foot screen and tell you the results. Loss of Protective Sensation puts your feet at higher risk for injury.

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 develop a foot ulcer, you become at risk for an amputation.

Your healthcare provider can assess the blood flow to your feet and identify the degree of circulation problems you might have. The less blood flow you have to your legs, the higher your level of risk for complications.

Follow this Daily Foot Care Checklist

Reproduced with permission from Diabetes Canada 2018 Clinical Practice Guidelines

Get everything together before you start. This includes nail clippers, a nail file, lotion, and a non-breakable hand mirror.

  1. Wash your feet in warm (not hot) water, using a mild soap. Do NOT soak your feet, as this can dry your skin.
  2. Clean cuts or scratches with mild soap and water. After drying, cover them with a dry dressing that is good for sensitive skin.
  3. Dry your feet. Make sure you dry well between your toes.
  4. Check the top and bottom of your feet and between your toes for cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.
  5. Trim your toenails straight across and file any sharp edges. Do NOT cut your nails too short.
  6. Apply a moisturizer (lotion) on dry or hardened skin at the top and bottom of your feet. Do NOT put moisturizer between your toes.
  7. Wear fresh clean socks and well-fitting shoes every day. If possible, wear white socks so if you have a cut or sore, the drainage will be easy to see. Think about buying Diabetic Socks.

Other Suggestions:

  • Put your legs and feet up when you’re sitting.
  • Do some exercises to help your circulation. Wiggle your toes, rotate your ankles, and point your toes up towards your nose, then down towards the floor.
  • Try not to cross your legs. If you do, cross at your ankles not your knees.
  • NEVER go barefoot.
  • Check the seams on your shoes before you put them on. Make sure the seams are not coming apart.

What is my level of risk?

Knowing your level of risk to have foot complications will help you know how to keep your feet healthy. Your healthcare provider will identify your level of risk when examining your foot. You should have a foot exam at least once a year if you have no concerns and more often if you have concerns.

There are many factors which determine your level of risk to develop foot problems. The 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 for additional assessment
  • A therapeutic footwear provider
  • A professional nail care provider

Do you know your level of risk?

Low

Moderate

High

Urgent

    

Each risk level is described below. You will find tips to care for your feet based on your level of 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. Follow the steps below to protect your feet.

How to Protect Your Feet:

  1. 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.
  2. Care for your feet daily. Wash your feet daily with warm water and mild soap. Dry well between your toes.
  3. Cut your toenails straight across and use a nail file to file any rough edges to the shape of your toes.
  4. Apply a moisturizer (lotion) on dry or hardened skin at the top and bottom of your feet. Do NOT put moisturizer between your toes. Use moisturizers suggested by your healthcare provider.
  5. Have your feet checked once a year by your healthcare provider. 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.
  6. 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). (For more information on how to fit a shoe go to: Wounds Canada https://www.woundscanada.ca and search for “Finding the Proper Shoe Fit”.
  7. 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, call Alberta Quits at: 1-866-710-QUIT (7848).

Moderate Risk

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

  • problems with your skin or nails (e.g., redness over a toe or other area, ingrown toe nail)
  • corns or calluses
  • problems with sensation (e.g., a feeling of numbness or tingling in your legs and feet, or pain in your legs when you are walking that goes away when you rest)

Your healthcare provider will talk with you about your extra care needs and any changes in your foot care that you need to do in the next month.

You will likely be referred to other healthcare providers such as a foot care nurse, a podiatrist, therapeutic shoe provider, or a vascular surgeon.

Follow all the foot care steps for people at low risk and add:

  1. Have someone who is properly trained cut your toenails. This could be a foot care nurse or a podiatrist. A pedicure is not a safe option when you are at moderate risk. If needed, ask your healthcare provider for some suggestions.
  2. Use a moisturizer if your healthcare provider suggests one.
  3. Have your shoes “professionally fitted”.
  4. Have your feet re-examined by your healthcare provider every 4 to 6 months.

Remember to remove your
shoes and socks at each visit!

High Risk

Your foot exam shows you are at high risk for serious foot problems. You’re at high risk because you are at moderate risk plus you have lost protective sensation (LOPS), have compromised circulation (PAD), or have an ulcer.

People at high risk need to see a foot care specialist or a High Risk Foot Team. Your healthcare provider will make a referral for you. You should expect a phone call to book an appointment in 1 to 2 weeks. If you do not get an appointment, call your healthcare provider to let them know you are still waiting for an appointment.

special-footwear

Follow all the foot care steps for people at low and moderate risk and add:

  1. Stay off your foot with the sore (ulcer) as much as possible. You may need to use crutches or special footwear to keep your weight off the sore.
  2. Call your health care provider for an appointment right away if you notice any new changes in your feet.
  3. Foot Care: If you have open sores or wound dressings that cover your ulcer, follow the directions from your healthcare provider to properly clean your feet.

Urgent Situations

See a healthcare provider or go to emergency immediately if:

open-wound 
  • 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.
  • You have new or increasing pain in your lower legs or feet.
  • The area around your wound is swollen and your wound is draining a large amount of fluid that might have an odour.
  • You feel unwell and your blood glucose levels are elevated.

Helpful Tips: The Do’s and Don’ts of Foot Care

Reproduced with permission from Diabetes Canada 2018 Clinical Practice Guidelines


Do

  • 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.
  • Do buy your shoes in the late afternoon (since your feet swell slightly by then).
  • Do wear socks at night if your feet get cold.
  • Do put your feet up when you are sitting.
  • Do 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.
  • Do activity every day to improve blood flow.
  • Do check your feet daily. Feel for differences in the temperature of your feet.

Do NOT

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

Managing Your Diabetes

Includes 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.
  • Care for your feet every day.
  • Manage your blood sugars to stay within your target levels.
  • Quit smoking or try to cut down the number of cigarettes 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 Day-Timer just 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. 

If you would like to make notes about your foot screen results, please use the attached document.

If you would like to track your appointment with doctors and clinics, please print off the attached document.

Trusted sources of information

Adapted from the New Brunswick Diabetes Foot Care Clinical Pathway​​

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

Current as of: December 27, 2017

Author: Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services