A guide to diabetes foot care

For plan members, sponsors and administrators

While we might not regularly think about our feet, for many of us they play an important role in our balance, movement, and how we interact with the environment — and as a result, they can be prone to small injuries, which can lead to bigger problems for people with diabetes.¹

Regular at-home foot care, along with attending all your doctor’s appointments, can help most people with diabetes reduce the risk of serious foot problems. ¹

Why is foot care for diabetes so important?

Foot care for people with diabetes is important in preventing common complications in the feet.¹ Prolonged levels of high blood sugar associated with diabetes can cause nerve damage in the hands and feet, known as diabetes-related neuropathy.¹

Signs of diabetes-related neuropathy include:¹

• Numbness,
• Diminished ability to sense hot or cold,
• Darkened skin in the affected area,
• Loss of hair in the area,
• Pain,
• Tingling.¹

Because of the numbness and reduced sensation to the feet, this can lead to unnoticed cuts or sores which, if untreated, can quickly lead to an infection or wound that can be difficult to heal.¹

Luckily, there are some steps people with diabetes can take to help reduce the risk.¹

Managing diabetes: good practices for diet, exercise, and care

Best practices in foot care for people with diabetes

For people with diabetes, a good foot care routine can make a positive impact on your health and help prevent complications and infections.¹ A thorough check of your feet can help you identify risk factors that could make your feet more vulnerable to infections and wounds.¹

Here are some best practices, developed in collaboration with Cleveland Clinic Canada, when it comes to diabetic foot care:

1. Check your feet daily. Get in the habit of examining your feet each day for cuts, scrapes or any changes.¹ If you can’t see the bottom of your feet, use a mirror to help.¹And, be sure to treat any small cuts and scrapes immediately by cleaning thoroughly with mild soap and water, and applying a dry bandage, and monitoring until healed.¹
2. Wash your feet with warm water. Once you have looked them over, wash the entire surface of your feet in warm, never hot, water with a mild soap.¹ Make sure to rinse and dry them thoroughly, especially between the toes.¹ 
3. Apply lotion. After you’ve dried your feet, you can apply a moisturizing lotion approved by your doctor.¹ Avoid putting lotion between the toes as bacteria thrives in a warm, moist environment which can increase susceptibility to infection.¹
4. Wear supportive and proper fitting footwear. Ensure your shoes are comfortable and not too tight.¹ If you need help, getting expert advice from your doctor or chiropodist is best. Ensure your shoes have enough room in the toe box, are cushioned and free from rips or tears. Always wear socks when wearing shoes.¹ More on this below.¹
5. Never go barefoot. Wearing shoes or slippers, even indoors, will reduce the risk of a foot injury.¹
6. Call your doctor if you develop any swelling, warmth, redness, or if a cut or scrape isn’t healing. It’s best to check with your doctor if anything changes with your feet. This can help prevent any foot problems from getting worse.¹

Safe and focused exercise for people with diabetes

People with foot complications related to diabetes, particularly individuals with diabetes-related neuropathy,should take some precautions before beginning an exercise routine.² This is because repeated stress to the tissues of the feet can lead to ulcers, fractures, and joint problems.²

Use caution if you’re going to be performing any high-impact exercises such as running on a treadmill, jumping and hopping, or exercising in extreme heat or cold.⁵ Before getting started, it’s best to consult with your physician.³

Exercises that could be beneficial to someone with diabetic foot complications might include:

• Low-impact, daily activities such as light household chores,³ 
• Non-weight bearing activities such as walking, cycling, swimming, seated exercises, and arm and upper-body exercises.²

Shoes and socks to protect your feet

Wearing proper shoes and socks is a crucial factor in helping protect your feet and preventing injuries if you have diabetes.⁴ Choosing appropriate socks is an important step for people with diabetes, and while this might seem simple, there are some key things to consider.⁴

Here’s what to look for when selecting a good pair of socks:⁴

1. White or light-coloured so it is easier to spot bleeding or drainage.
2. Comfortable fit that is not too tight or restrictive to prevent blood flow.
3. Made from a breathable material, such as wool, to wick away moisture.
4. No seams that could cause irritation or pressure points.
5. Padded for extra cushion on the bottom of the feet.⁴

Compression socks or stockings could be recommended by your physician if you have varicose veins or leg swelling but might not be prescribed or recommended if you have poor blood circulation to your feet.⁴ A healthcare professional will be the best source of guidance on whether these types of socks will be beneficial in your situation.⁴

The shoes you wear also play an important role in helping to prevent complications and maintaining foot health.⁴

When selecting footwear, consider:⁴

• Having your foot measured to ensure a proper fit,
• Selecting shoes that aren’t too tight and leave space between the tip of your big toe and the end of the shoe, made from natural and breathable materials to prevent excess sweating or moisture,
• Choosing footwear that is supportive and cushioned,
• Using sport-specific footwear, and
• Updating walking shoes frequently to ensure the best possible support.⁴

If you’re unsure, check with your physician or chiropodist for their recommendations on socks and shoes that would best suit your needs.⁴

Yearly diabetic foot examination

While it’s important to check your own feet every day and have your healthcare provider do a basic check of your feet at each appointment, a comprehensive diabetic foot examination should be done every year by a healthcare professional.⁵

A yearly, comprehensive diabetic foot examination usually includes:⁵

• Skin examination to check for dryness, blisters, ulcers, or any abnormal issues and an examination of the toenails. The temperature of your feet might also be noted.⁵
• Nerve examination to evaluate the feeling in your feet. Your doctor might do this by testing the sensitivity of the skin of your feet and check your ankle reflexes with a small instrument.⁵
• Muscle and bone (musculoskeletal) examination to check for toe alignment or other changes to the shape and structure of your foot.⁵
• Blood vessel (vascular) examination by assessing the pulse in your foot and ankle.⁵

A yearly diabetic foot examination could help you and your doctor notice and address complications before they become more serious.⁵

Common foot problems for people with diabetes

There are several common foot problems that people with diabetes should be aware of.⁶ It’s important to note that anyone can get these foot problems, but many of these problems are more concerning in someone with diabetes, as the problems can increase the risk of infection and serious complications.⁶

Here are some common foot problems for people with diabetes:⁶

Blisters can form when your shoe continually rubs on the same spot of your foot. The fluid-filled pockets develop in the top layer of the skin and can become infected.⁶

Calluses happen when an area of skin builds up and hardens into a lump, which can lead to open sores over time. It’s best to let a professional examine your calluses instead of attempting to trim them yourself.⁶

Fungal infections of the nail are more than just a cosmetic issue. Fungus can infect the nail causing them to become yellow, thick, brittle, and can damage the skin.⁶ In some cases a damaged nail might need to be removed.⁶ Nail infections can also also increase the risk of Athlete’s foot infection.⁷

Athlete’s foot is an itchy, scaly, red rash caused by a fungus that can lead to cracks and infection in the skin.⁶

Dry skin can become an issue because it can crack and increase the chance of infection. Speak to your doctor to find a proper moisturizer for your feet.⁶

Bunions and hammer toes: Bunions are the result of changes to the joint of the big toe, creating a bump on the side of foot where the big toe meets the foot, which can be prone to blisters or ulcers.⁶ Hammer toes are the result of changes to the small joints of any toes, creating a prominence on the top of the middle of the toes, which may be prone to blisters and corns.⁶

Ulcers are deep sores or breaks in the skin caused by scrapes, cuts, or repeated rubbing, which can become infected.⁶ Ulcers are one of the most common complications in people with diabetes who have persistently high blood sugar levels. ⁸

Foot health and your Manulife Group Benefits Plan

Manulife offers coverage options for Group Benefits Plans that could help people with diabetes manage foot care: 

• Chiropody to help people treat and manage foot issues, to provide a complete foot exam, perform footcare and help prevent serious complications.
• Physiotherapy to help people improve their movement, engage in a safe exercise plan, and manage stiffness and discomfort,
• And Lifestyle Health Coaching to help people keep their blood sugar in check by working with a dietician.

Questions? Reach out to your usual Manulife representative for help.

Disclaimer: This article is for educational purposes only and not intended to replace the advice of a medical doctor. Please contact your health care provider or physician for advice.