Foot care habits. In addition to inspecting your feet every day, practice these healthy foot care habits. Like your blood glucose control regimen, foot care is a daily process. Don’t forget to keep up your foot care even when your routine changes, such as when you’re on vacation, a time when you may be tempted to walk barefoot in the sand or by the pool.
Evaluating footwear. Shoes or slippers should always be worn to protect your feet; however, many foot ulcers start with rubbing from ill-fitting shoes, so it’s important that your shoes fit well and don’t cause any abnormal pressure on your feet. It may be helpful to have your feet measured every time you buy shoes because feet change in size and shape over time. It’s also better to be fitted for shoes in the afternoon or evening rather than first thing in the morning; walking around all day causes your feet to spread, so getting fitted when your feet are at their largest can help you to ensure a comfortable fit.
Properly fitted shoes should fit both the width and length of your feet, allow room for the free movement of your toes, and be well-cushioned. High-heeled footwear or shoes with pointed toes can constrict or place undue pressure on parts of the foot, so they should be avoided. Sandals with straps between the toes can cause irritation or injury. Walking or athletic shoes, which offer padding and support, can be good choices, but people with diabetes who have complications that affect their feet may need special assistance selecting shoes or may need custom-made shoes.
If you have any lack of sensation in your feet (because of neuropathy, for example), it may be difficult to judge how well your shoes fit or sense whether any areas of your feet are being rubbed or irritated by shoe (or even sock) seams. You may want to seek the help of a certified pedorthist in selecting shoes. (See “For More Information” for help in locating a certified pedorthist.)
Some people with lack of sensation in the feet, other changes in the feet caused by diabetes, or a history of foot ulcers may be candidates for orthotics, or specially designed insoles that are worn inside the shoes. Such insoles can be customized and modified to help control the way your foot moves or support the foot to avoid pain and pressure in a certain area. Some special shoes have extra depth to accommodate the placement of inserts. If orthotics don’t do the trick, it may be necessary to get custom-made shoes. Many health insurance plans, including Medicare Part B, offer some coverage for orthotics or custom-made shoes. To qualify for depth-inlay shoes, custom-molded shoes, or shoe inserts under Medicare Part B, your physician must certify that you have diabetes and are being treated, that you need the insert or shoe because you have diabetes, and that you have a condition such as an amputation, foot ulcers, calluses, poor circulation, or foot deformity.
Socks should always be worn with shoes to prevent blisters. People with diabetes should wear socks that fit well (tight socks impair circulation) and are seamless (to prevent blisters). Socks should be made of breathable material such as cotton or wool, ideally blended with a material that draws moisture away from the skin, such as acrylic. (The nylon in stockings or pantyhose is not a breathable fabric, so these should be worn as little as possible.)
Diabetes and foot problems
Even common foot problems such as small cuts, calluses, or ingrown toenails can open the door to serious problems in a person with diabetes, particularly if his blood glucose is not in control. Because such problems can lead to infections and even foot ulcers, don’t ignore even seemingly minor wounds, and don’t hesitate to seek the advice of your health-care provider if a wound doesn’t heal promptly.