People with diabetes can prevent or delay diabetic foot problems by controlling glucose (blood sugar), blood pressure and cholesterol. People with diabetes have control over many factors that influence the condition of the feet and the risk of infections and other complications. These factors include skin care, toenail care, footwear and routine medical care.

All people with diabetes are advised to:

• Stop smoking to improve circulation.
  
  
• Follow their physician-recommended diet to help control glucose and cholesterol.
  
  
• Have a glycohemoglobin test every three months to monitor glucose control.
  
  
• Stay active. Patients should consult their physician before starting an exercise program. Some may need to avoid high-impact activities such as running and jumping, and instead try low-impact exercise such as walking, swimming, water aerobics, bicycling or chair exercises.

Skin care for the feet includes hygiene, daily inspections and related concerns. The National Institutes of Health (NIH), National Diabetes Education Program and other authorities advise people with diabetes to:

• Wash the feet daily with mild soap in warm (90 to 95 degrees Fahrenheit, about 32 to 35 degrees Celsius) but not hot water.
  
  
• Use a thermometer or elbow before bathing to ensure the water is not too hot.
  
  
• Avoid soaking the feet to keep them from drying them out.
  
  
• Dry the feet well, especially between toes, by patting with a towel, not rubbing.
  
  
• Use talcum powder or cornstarch to help keep the feet dry.
  
  
• Apply a moisturizer as recommended by a physician.
  
  
• Avoid use of lotion between the toes, where moisture forms.
  
  
• Inspect the feet daily for blisters, scrapes, cuts, sores and other wounds.
  
  
• If vision is impaired, examine the feet by touch from toe to heel.
  
  
• Use a hand mirror or floor mirror to help with inspections.
  
  
• Ask a relative or caregiver to help if self-examination is not possible.
  
  
• Avoid harsh chemicals such as Epsom salts, iodine and mercurochrome.
  
  
• Check with a physician before treating calluses, corns and bunions.

Toenail care can prevent ingrown nails, nicks, fungus and other problems when done properly:

• Clip the nails about once a week along the contour of the toe.
  
  
• Smooth the edges with an emery board if needed.
  
  
• Avoid cutting the corners to prevent ingrown nails.
  
  
• Trim the nails after bathing for easier cutting.
  
  
• Avoid nail fungus by using footwear in damp public areas such as showers and pools.
  
  
• Consult a podiatrist or other foot specialist for nail care if thick nails, poor eyesight, inability to reach or other problems interfere.

Proper footwear is essential. Self-injury caused by ill-fitting shoes is one of the most common and most preventable causes of minor foot trauma leading to amputation. Blisters, sores and other potentially dangerous problems can be avoided by ensuring a correct fit and addressing other areas of concern:

• Buy shoes in the evening. Feet tend to be smaller and less swollen in the morning.
  
  
• Consider regular use of athletic shoes made of breathable materials.
  
  
• Ask a physician about special diabetic shoes or orthotic inserts, often covered by Medicare or other insurance.
  
  
• Avoid footwear made of plastic, vinyl and other nonbreathable materials.
  
  
• Use shoes with laces or Velcro straps that allow adjustment for swelling or deformity.
  
  
• Alternate two or more pairs to let shoes dry between use.
  
  
• Avoid high heels, pointy toes and sandals, which cause pressure points.
  
  
• Consult as needed with a pedorthist, a medical specialist who fits shoes.
  
  
• Check inside shoes for gravel and other objects before putting them on.
  
  
• Wear padded, seamless socks with shoes to reduce risk of blisters and sores.
  
  
• Avoid socks with an elastic band that can impede circulation.
  
  
• Change socks daily.
  
  
• Never go barefoot. Use slippers, shower shoes or beach shoes as appropriate.

A wide range of foot care products are marketed to people with diabetes. Recent studies suggest that daily use of infrared skin thermometers may reduce recurrence of foot ulcers, that vibrating insoles may improve balance and that special double-layer socks might help prevent sores. Individuals interested in such products are advised to ask their physician which products can help and which may be ineffective or even harmful.

Medical care should routinely take the feet into account. Diabetic patients have the responsibility of immediately informing their physician of any foot problem. Patients also should ask the physician to:

• Visually inspect the feet at every visit.
  
• Do a complete annual foot exam, including assessment of sensation and circulation.
  
• Offer specific instructions on foot care.
  
• Prescribe special diabetic shoes or inserts if necessary.
  
• Provide a referral to a podiatrist or other foot specialist as needed.

Patients with diabetic foot problems are recommended to keep the blood flowing to the feet. Exercises that will increase circulation in the feet include:

• Leg lifts and knee bends while lying on the side or seated
  
• Moving the ankles up and down
  
• Wiggling the toes several times a day for several minutes at a time

Miscellaneous areas of foot care:

• Do not use heating pads or hot water bottles on the feet.
  
• Keep the feet away from radiators, campfires and other sources of heat.
  
• Prop up the feet when sitting.
  
• Avoid crossing the legs for long.
  
• Guard against frostbite in cold weather.

A physician can provide more information about diabetic foot care, including details about exercise, diet, hygiene, skin care, footwear and orthotic inserts. The U.S. government urges people with diabetes to avoid infections, ulcers, amputations and other complications by taking part in a regular program of foot care.