Footcare Advice
Contents
Introduction
Diabetes is a lifelong condition which can cause foot problems. Some of these problems can occur because the nerves and blood vessels supplying your feet are damaged. This can affect:
- the feeling in your feet (called ‘peripheral neuropathy’)
- the circulation in your feet (called ‘peripheral vascular disease’ or ‘ischaemia’).
These changes can be very gradual and you may not notice them. This is why it is essential that you have your feet screened every year. The screening will show whether you are at low risk, medium risk or high risk of developing an ulcer in your foot. You should then follow the advice given below for your level of risk.
Low risk
If your foot screening has shown that you do not have nerve or blood vessel damage then you are currently at low risk of developing foot ulcers because of your diabetes.
Controlling your diabetes, cholesterol and blood pressure, and having your feet screened every year by a trained professional will help to reduce the risk of developing an ulcer.
If you smoke, you are strongly advised to stop as smoking affects your circulation.
As your feet are in good condition, you may not need regular treatment from a podiatrist (chiropodist).
If you follow the simple advice given below, you should be able to carry out your own foot care unless you develop a specific problem.
Check your feet every day
You should check your feet every day for any blisters, breaks in the skin, pain or signs of infection such as swelling, heat or redness.
Wash your feet every day
You should wash your feet every day in warm water and with a mild soap. Rinse them thoroughly and dry them carefully, especially between the toes. Do not soak your feet as this can damage your skin.
Moisturise your feet every day
If your skin is dry, apply a moisturising cream every day, avoiding the areas between your toes.
Toenails
Cut or file your toenails regularly, following the curve of the end of your toe. Use a nail file to make sure that there are no sharp edges which could press into the next toe. Do not cut down the sides of your nails as you may create a ‘spike’ of nail which could result in an ingrown toenail.
Socks, stockings and tights
You should change your socks, stocking or tights every day. They should not have bulky seams and the tops should not be elasticated.
Avoid walking barefoot
If you walk barefoot you risk injuring your feet by stubbing your toes and standing on sharp objects which can damage the skin.
Check your shoes
Check the bottom of your shoes before putting them on to make sure that nothing sharp such as a pin, nail or glass has pierced the outer sole. Also, run your hand inside each shoe to check that no small objects such as small stones have fallen in.
Badly fitting shoes
Badly fitting shoes are a common cause of irritation or damage to feet. The person who screened your feet may give you advice about the shoes you are wearing and about buying new shoes.
Minor cuts and blisters
If you check your feet and discover any breaks in the skin, minor cuts or blisters, you should cover them with a sterile dressing and check them every day. Do not burst blisters. If the problems do not heal within a few days, or if you notice any signs of infection (swelling, heat, redness or pain), contact your podiatry department or GP.
Over-the-counter corn remedies
Do not use over-the-counter corn remedies. They are not recommended for anyone with diabetes as they can cause damage to the skin, which can create problems.
If you discover any problems with your feet, contact your local podiatry department or GP for advice.
Medium risk
You will be assessed as being at medium risk of developing foot ulcers if your foot screening has shown that you have one or more of the following risk factors:
- You have lost some feeling in your feet.
- The circulation in your feet is reduced.
- You have hard skin on your feet.
- The shape of your foot has changed.
- Your vision is impaired.
- You cannot look after your feet yourself.
Controlling your diabetes, cholesterol and blood pressure and having your feet screened every year by a trained professional will help to reduce the risk of developing more problems with your feet.
If you smoke you are strongly advised to stop as smoking affects your circulation.
As your feet are at moderate risk of developing ulcers, you will need to take extra care of them. You may need treatment by a specialised professional such as a podiatrist or podiatry technician.
If you follow the advice given below, it will help you to take care of your feet between visits to your podiatrist and should reduce the chance of developing more problems in the future.
Check your feet every day
You should check your feet every day for any blisters, breaks in the skin, pain or signs of infection such as swelling, heat or redness.
Wash your feet every day
You should wash your feet every day in warm water and with a mild soap. Rinse them thoroughly and dry them carefully, especially between the toes. Do not soak your feet as this can damage your skin. Because of your diabetes, you may not be able to feel hot and cold very well. You should test the temperature of the water with your elbow, or ask someone else to test the temperature for you.
Moisturise your feet every day
If your skin is dry, apply a moisturising cream every day, avoiding the areas between your toes.
Toenails
Cut or file your toenails regularly, following the curve of the end of your toe. Use a nail file to make sure that there are no sharp edges which could press into the next toe. Do not cut down the sides of your nails as you may create a ‘spike’ of nail which could result in an ingrown toenail.
Socks, stockings and tights
You should change your socks, stocking or tights every day. They should not have bulky seams and the tops should not be elasticated.
Avoid walking barefoot
If you walk barefoot you risk injuring your feet by stubbing your toes and standing on sharp objects which can damage the skin.
Check your shoes
Check the bottom of your shoes before putting them on to make sure that nothing sharp such as a pin, nail or glass has pierced the outer sole. Also, run your hand inside each shoe to check that no small objects such as small stones have fallen in.
Badly fitting shoes
Badly fitting shoes are a common cause of irritation or damage to feet. The person who screened your feet may give you advice about the shoes you are wearing and about buying new shoes.
Minor cuts and blisters
If you check your feet and discover any breaks in the skin, minor cuts or blisters, cover them with a sterile dressing. Do not burst blisters. Contact your podiatry department or GP immediately.
Over-the-counter corn remedies
Do not use over-the-counter corn remedies. They are not recommended for anyone with diabetes as they can cause damage to the skin, which can create problems.
Hard skin and corns
Do not attempt to remove hard skin or corns yourself. Your podiatrist will provide treatment and advice where necessary.
Avoid high or low temperatures
If your feet are cold, wear socks. Never sit with your feet in front of the fire to warm them up. Always remove hot water bottles or heating pads from your bed before getting in.
If you discover any problems with your feet, contact your local podiatry department or GP for advice immediately.
High risk
You will be assessed as being at high risk of developing foot ulcers if your foot screening has shown that you have one or more of the following risk factors:
- You have lost some feeling in your feet.
- The circulation in your feet is reduced.
- You have hard skin on your feet.
- The shape of your feet has changed.
- Your vision is impaired.
- You cannot look after your feet yourself.
- You have had ulcers before.
- You have had an amputation.
Controlling your diabetes, cholesterol and blood pressure will help to manage these problems.
If you smoke, you are strongly advised to stop as smoking affects your circulation.
As your feet are at high risk, you will need to take extra care of them. You will need regular treatment by a podiatrist. If you follow the advice given below it will help you to take care of your feet between visits to your podiatrist and should reduce the chance of developing more problems in the future.
Check your feet every day
You should check your feet every day for any blisters, breaks in the skin, pain or signs of infection such as swelling, heat or redness. If you cannot do this yourself, ask your partner or carer to help you.
Wash your feet every day
You should wash your feet every day in warm water and with a mild soap. Rinse them thoroughly and dry them carefully, especially between the toes. Do not soak your feet as this can damage your skin. Because of your diabetes, you may not be able to feel hot and cold very well. You should test the temperature of the water with your elbow, or ask someone else to test the temperature for you.
Moisturise your feet every day
If your skin is dry, apply a moisturising cream every day, avoiding the areas between your toes.
Toenails
Do not cut your toenails unless your podiatrist advises you to.
Socks, stockings and tights
You should change your socks, stocking or tights every day. They should not have bulky seams and the tops should not be elasticated.
Avoid walking barefoot
If you walk barefoot you risk injuring your feet by stubbing your toes and standing on sharp objects which can damage the skin.
Check your shoes
Check the bottom of your shoes before putting them on to make sure that nothing sharp such as a pin, nail or glass has pierced the outer sole. Also, run your hand inside each shoe to check that no small objects such as small stones have fallen in.
Badly fitting shoes
Badly fitting shoes are a common cause of irritation or damage to feet. The professional who screened your feet may give you advice about the shoes you are wearing and about buying new shoes.
Prescription shoes
If you have been supplied with shoes, they will have been made to a prescription. You should follow the instructions your podiatrist or orthotist (the person who makes the shoes) gives you. These should be the only shoes you wear. Shoes will normally be prescribed with insoles. These are an important part of your shoes and you should only remove them if your orthotist or podiatrist advises you to. Whoever provided your shoes will carry out all repairs or alterations to make sure that they match your prescription.
Minor cuts and blisters
If you check your feet and discover any breaks in the skin, minor cuts or blisters, cover the area with a sterile dressing. Do not burst blisters. Contact your podiatry department or GP immediately. If these people are not available and there is no sign of healing after one day, go to your local accident and emergency department.
Hard skin and corns
Do not attempt to remove hard skin or corns yourself. Your podiatrist will provide treatment and advice where necessary.
Over-the-counter corn remedies
Do not use over-the-counter corn remedies. They are not recommended for anyone with diabetes as they can cause damage to the skin that can create ulcers.
Avoid high or low temperatures
If your feet are cold, wear socks. Never sit with your feet in front of the fire to warm them up. Always remove hot water bottles or heating pads from your bed before getting in.
A history of ulcers
If you have had an ulcer before, or an amputation, you are at high risk of developing more ulcers. If you look after your feet carefully, with the help of a podiatrist, you will reduce the risk of more problems.
If you discover any problems with your feet, contact your podiatry department or GP immediately. If they are not available, go to your nearest accident and emergency department. Remember, any delay in getting advice or treatment when you have a problem can lead to more serious problems.
Useful resources
The College of Podiatry has launched a new app for people living with diabetes to promote awareness of what to expect at their annual foot screening. The app follows NICE (National Institute for Health and Care Excellence) and SIGN (Scottish Intercollegiate Guidelines Network) guidelines.
Search for the app in your app store by using the term ‘diabetic foot screening’.
Badly fitting shoes can cause various foot problems. For information on selecting suitable footwear if you have diabetes, see Footwear Advice.