Summer Foot Care for the Diabetic: A Matter of Life and Limb

Summertime means hot humid weather, picnics, and outdoor activities. For a person with diabetes that means risk increases and extra caution needs to be taken with the feet.  Diabetes is the number one reason for non-traumatic amputations in the United States.  Of all nontraumatic lower extremity amputation, 50–70% are associated with diabetes .(1) Not only is that a shocking statistic, but:

Mortality following amputation ranges from 13-40% in 1 year, 35–65% in 3 years, and 39–80% in 5 years, being worse than most malignancies. (2)

Therefore, amputation-free survival is of grave importance. “Comprehensive foot care programs can reduce amputation rates by 45-85%” according to American Podiatric Medical Association (APMA) – flyer Diabetes By The Numbers.

Assessing the diabetic foot for problems is imperative. Supporting someone with diabetes is complicated as it is a progressive disease and health status can change with many different factors, such as high blood sugars, high blood pressure, smoking, obesity, and many other factors.  Foot and skin care can at times feel like “work” and that’s because it takes work to keep the diabetic foot healthy.  It is important to continually educate someone you support on healthy foot habits and document and/or notify any issues that may arise.

How can you help prevent foot problems? 

Several self-care practices will be covered in this article. One of the most impactful practices is to lead by example.  People may watch what you consume, what you wear, and what habits you have, such as smoking, and it may not be in their best interest.    

When supporting someone with diabetes the most important tool to prevent foot damage is to keep blood sugars at the levels the physician orders. The American Diabetes Association (ADA) recommendations for a person who has diabetes is to have the A1C less than 7, a fasting/before meals blood sugar of 70-130, and a blood sugar 2 hours after a meal less than 180. *Remember that this is the ADA recommendations and not all treating physicians may want these outcomes.  Please always check with the prescribing physician before changing or usurping medical orders.*   

High blood sugar damages cells, vessels, and nerves all over the body. The feet can be severely damaged due to blood sugars not being managed well. Keeping blood sugars managed takes a balance of diet and mobility.  Keeping someone on tract with their diet to prevent complications can be difficult.  It is important to know how many carbohydrates are in a meal, as well as how many fats,  cholesterols, sodium, and other nutrients.  Following the prescribed diet is of utmost importance to keep blood sugars under control. Being active is just as important, it helps the body use its own resources and keep blood sugars in control.

Because it is summertime, people tend to wear flip-flops and sandals.  A person with diabetes should always wear shoes and white socks that cover and protect the feet  when walking. Because leather shoes help absorb perspiration and keep the foot drier, they are a preferable foot covering for any diabetic.  Wearing shoes that expose the foot, exposes them to trauma and the chance of infection, and due to the fact that most diabetics have some form of diabetic neuropathy (a decrease sensation to pain, heat, or injury), they may have no idea that their foot has been traumatized.

Other self-care to avoid foot damage and reduce the risk of amputation:

• Assess the feet at least daily.  Look for any abnormal issues (redness, blistering, corns, breaks in the skin to mention a few) and report any concerns to the physician.
• Wash the feet with mild soap daily.  Pat dry and be sure to dry well between the toes.
• Keep feet moisturized but avoid perfumed lotions as they have alcohol incorporated and alcohol can dry the skin. Apply lotion to the foot, but NO LOTION BETWEEN THE TOES.
• When purchasing shoes, purchase in the afternoon.  Feet may swell during the day and if shoes are bought in the morning, they may be tight in the afternoon and/or evening.
• Wear comfortable shoes and break shoes in slowly. Purchase shoes that have good arch support and a wide toe box.  Check with the physician and ask for prescription diabetic shoes, as some insurances will assist with payment.
• Have a professional cut toenails and care for corns, callouses, or ingrown toenails. 
• Protect feet from heat.  As mentioned before always wear shoes because hot pavement can cause grave damage that may not be felt when the injury occurs. A person could actually burn their feet on hot surfaces.
• Shake shoes out before putting them on, something as small as a pebble can cause an injury.
• Always test bath water.  Diabetic feet can get scalded and burn very easily.  Keep hot water tank set at regulation temperature.
• Do not use foot soaks or heating pads. (unless ordered by a physician).
• No commercial pedicures.  

When supporting someone with diabetes, diabetic foot care is gravely important.  You cannot make someone change their habits, but you can help with education and being a good role model. 

Remember that all of these self-care suggestions can help but the importance of keeping blood sugars within normal values can’t be overstated to prevent damage.

Have a fun and safe summer, and keep those feet protected.

1: Information accessed from American Diabetes Association: Risk of Nontraumatic Lower-Extremity Amputations accessed on June 18, 2020:  https://care.diabetesjournals.org/content/31/8/1536

2: Information accessed from NCBI on April 22, 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC619716