If you have diabetes, here’s a way to keep standing on your own two feet: check them every day—even if they feel fine—and see your doctor if you have a cut or blister that won’t heal.

There’s a lot to manage if you have diabetes: checking your blood sugar, making healthy food, finding time to be active, taking medicines, going to doctor’s appointments. With all that, your feet might be the last thing on your mind. But daily care is one of the best ways to prevent foot complications.

About half of all people with diabetes have some kind of nerve damage. You can have nerve damage in any part of your body, but nerves in your feet and legs are most often affected. Nerve damage can cause you to lose feeling in your feet.

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in your blood and causes high blood sugar levels.

How does diabetes cause foot problems?

Foot problems are common in people with diabetes. They can happen over time when high blood sugar damages the nerves and blood vessels in the feet. The nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in your feet.

If you can't feel pain, you may not know when you have a cut, blister, or ulcer (open sore) on your foot. A wound like that could get infected. The infection may not heal well because the damaged blood vessels can cause poor blood flow in your feet.

Having an infection and poor blood flow can lead to gangrene. That means the muscle, skin, and other tissues start to die. If you have gangrene or a foot ulcer that does not get better with treatment, you may need an amputation. This is a surgery to cut off your damaged toe, foot, or part of your leg. It may prevent a bad infection from spreading and could save your life.

But there's a lot you can do to prevent a foot wound from becoming a major health problem.

How can I protect my feet if I have diabetes?

The best way to protect your feet is by controlling your blood sugar levels every day. This will help keep nerve and blood vessel damage from getting worse. The next step is to keep the skin of your feet healthy.

Good foot care for people with diabetes includes:

• Checking your feet every day. Look for cuts, redness, and other changes in the skin and toenails, including warts or other spots that your shoes could rub. Make sure to check the bottoms of your feet too.
• Washing your feet every day. Use warm water and soap. Don't soak your feet because that can dry out your skin. After you dry your feet, you can use talcum powder or cornstarch between your toes. They soak up moisture that can cause infection. If you use lotion, don't apply it between your toes.
• Asking your doctor how to remove corns and calluses safely. Thick skin on your feet can rub and lead to sores. But removing it the wrong way could damage your skin. So you don't want to cut the skin or use medicated pads or liquid removers.
• Trimming your toenails straight across with a clipper. If it's hard for you to trim your own toenails, or if they're thick or curve into the skin, have a podiatrist (foot doctor) do it for you.
• Always wearing well-fitting shoes and socks or slippers to protect your feet when walking. You don't want to walk barefoot, even indoors. And be sure your shoes are smooth inside. A seam or pebble could rub your skin raw.
• Protecting your feet from heat and cold. Use sunscreen on exposed skin and don't walk barefoot at the beach. In cold weather, wear warm socks instead of warming your feet near a heater or fireplace.
• Keeping the blood flowing in your feet. Put your feet up when you're sitting. Wiggle your toes and circle your feet throughout the day. Don't wear tight socks. And get plenty of activity that's not too hard on the feet, such as walking.
• Getting your feet checked at your health care visits. Even if you haven't noticed a problem, it's good to have your health care provider look at your feet.

When should I see my health care provider about diabetic foot problems?

Serious foot problems can develop quickly. See your health care provider right away if you notice:

• A cut, blister, or bruise on your feet that doesn't start to heal in a few days
• Red, warm, or painful skin on your feet
• A callus with dried blood inside
• A foot infection that becomes black and smells bad that could be gangrene

Remember, controlling your blood sugar and caring for your feet every day are the best steps you can take to prevent serious diabetic foot problems.

Over time, diabetes may cause nerve damage, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. Cuts and sores can become infected.

Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal. Sometimes, a bad infection never heals. The infection might lead to gangrene.

Gangrene and foot ulcers that do not get better with treatment can lead to an amputation of your toe, foot, or part of your leg.A surgeon may perform an amputation to prevent a bad infection from spreading to the rest of your body, and to save your life. Good foot care is very important to prevent serious infections and gangrene.

Although rare, nerve damage from diabetes can lead to changes in the shape of your feet, such as Charcot’s foot. Charcot’s foot may start with redness, warmth, and swelling. Later, bones in your feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.”

Anyone with diabetes can develop nerve damage, but these factors increase your risk:

• Blood sugar levels that are hard to manage
• Having diabetes for a long time, especially if your blood sugar is often higher than your target levels
• Being overweight
• Being older than 40 years
• Having high blood pressure
• Having high cholesterol

Nerve damage, along with poor blood flow—another diabetes complication—puts you at risk for developing a foot ulcer (a sore or wound) that could get infected and not heal well. If an infection doesn’t get better with treatment, your toe, foot, or part of your leg may need to be amputated (removed by surgery) to prevent the infection from spreading and to save your life.

When you check your feet every day, you can catch problems early and get them treated right away. Early treatment greatly reduces your risk of amputation.

If you experience any of these symptoms, don’t wait for your next appointment. See your regular doctor or foot doctor right away:

• Pain in your legs or cramping in your buttocks, thighs, or calves during physical activity.
• Tingling, burning, or pain in your feet.
• Loss of sense of touch or ability to feel heat or cold very well.
• A change in the shape of your feet over time.
• Loss of hair on your toes, feet, and lower legs.
• Dry, cracked skin on your feet.
• A change in the color and temperature of your feet.
• Thickened, yellow toenails.
• Fungus infections such as athlete’s foot between your toes.
• A blister, sore, ulcer, infected corn, or ingrown toenail.

Most people with diabetes can prevent serious foot complications. Regular care at home and going to all doctor’s appointments are your best bet for preventing foot problems (and stopping small problems from becoming serious ones).

Some people with nerve damage have numbness, tingling, or pain, but others have no symptoms. Nerve damage can also lower your ability to feel pain, heat, or cold.

Living without pain sounds pretty good, but it comes at a high cost. Pain is the body’s way of telling you something’s wrong so you can take care of yourself. If you don’t feel pain in your feet, you may not notice a cut, blister, sore, or other problem. Small problems can become serious if they aren’t treated early.

Preventing Nerve Damage

What’s the most important thing you can do to prevent nerve damage or stop it from getting worse? Keep your blood sugar in your target range as much as possible. Other good diabetes management habits can help, too:

• Don’t smoke. Smoking reduces blood flow to the feet.
• Follow a healthy eating plan, including eating more fruits and vegetables and less sugar and salt.
• Get physically active —10 to 20 minutes a day is better than an hour once a week.
• Take medicines as prescribed by your doctor.

Work with your health care team to make a diabetes self-care plan, which is an action plan for how you will manage your diabetes. Your plan should include foot care. A foot doctor, also called a podiatrist, and other specialists may be part of your health care team.

Include these steps in your foot care plan:

Tips to Take Care of Your Feet

• Check your feet every day.
• Wash your feet every day.
• Smooth corns and calluses gently.
• Trim your toenails straight across.
• Wear shoes and socks at all times.
• Protect your feet from hot and cold.
• Keep the blood flowing to your feet.
• Get a foot check at every health care visit.

You may have foot problems, but feel no pain in your feet. Checking your feet each day will help you spot problems early before they get worse. A good way to remember is to check your feet each evening when you take off your shoes. Also check between your toes. If you have trouble bending over to see your feet, try using a mirror to see them, or ask someone else to look at your feet.

Look for problems such as

• cuts, sores, or red spots
• swelling or fluid-filled blisters
• ingrown toenails, in which the edge of your nail grows into your skin
• corns or calluses, which are spots of rough skin caused by too much rubbing or pressure on the same spot
• plantar warts, which are flesh-colored growths on the bottom of the feet
• athlete’s foot
• warm spots

If you have certain foot problems that make it more likely you will develop a sore on your foot, your doctor may recommend taking the temperature of the skin on different parts of your feet. A “hot spot” can be the first sign that a blister or an ulcer is starting.

Cover a blister, cut, or sore with a bandage. Smooth corns and calluses as explained below.

Wash your feet with soap in warm, not hot, water. Test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow to test the warmth of the water. Do not soak your feet because your skin will get too dry.

After washing and drying your feet, put talcum powder or cornstarch between your toes. Skin between the toes tends to stay moist. Powder will keep the skin dry to help prevent an infection.

Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, talk with your foot doctor about the best way to care for these foot problems. If you have nerve damage, these patches can become ulcers.

If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.

Do NOT

• cut corns and calluses
• use corn plasters, which are medicated pads
• use liquid corn and callus removers

Cutting and over-the counter corn removal products can damage your skin and cause an infection.

To keep your skin smooth and soft, rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because moistness might cause an infection.

Trim your toenails, when needed, after you wash and dry your feet. Using toenail clippers, trim your toenails straight across. Do not cut into the corners of your toenail. Gently smooth each nail with an emery board or nonsharp nail file. Trimming this way helps prevent cutting your skin and keeps the nails from growing into your skin.

Have a foot doctor trim your toenails if

• you cannot see, feel, or reach your feet
• your toenails are thick or yellowed
• your nails curve and grow into the skin

If you want to get a pedicure at a salon, you should bring your own nail tools to prevent getting an infection. You can ask your health care provider what other steps you can take at the salon to prevent infection.

Wear shoes and socks at all times. Do not walk barefoot or in just socks – even when you are indoors. You could step on something and hurt your feet. You may not feel any pain and may not know that you hurt yourself.

Check the inside of your shoes before putting them on, to make sure the lining is smooth and free of pebbles or other objects.

Make sure you wear socks, stockings, or nylons with your shoes to keep from getting blisters and sores. Choose clean, lightly padded socks that fit well. Socks with no seams are best.

Wear shoes that fit well and protect your feet. Here are some tips for finding the right type of shoes:

• Walking shoes and athletic shoes are good for daily wear. They support your feet and allow them to “breathe.”
• Do not wear vinyl or plastic shoes, because they do not stretch or “breathe.”
• When buying shoes, make sure they feel good and have enough room for your toes. Buy shoes at the end of the day, when your feet are the largest, so that you can find the best fit.
• If you have a bunion, or hammertoes, which are toes that curl under your feet, you may need extra-wide or deep shoes. Do not wear shoes with pointed toes or high heels, because they put too much pressure on your toes.
• If your feet have changed shape, such as from Charcot’s foot, you may need special shoes or shoe inserts, called orthotics. You also may need inserts if you have bunions, hammertoes, or other foot problems.

When breaking in new shoes, only wear them for a few hours at first and then check your feet for areas of soreness.

Medicare Part B insurance and other health insurance programs may help pay for these special shoes or inserts. Ask your insurance plan if it covers your special shoes or inserts.

If you have nerve damage from diabetes, you may burn your feet and not know you did. Take the following steps to protect your feet from heat:

• Wear shoes at the beach and on hot pavement.
• Put sunscreen on the tops of your feet to prevent sunburn.
• Keep your feet away from heaters and open fires.
• Do not put a hot water bottle or heating pad on your feet.

Wear socks in bed if your feet get cold. In the winter, wear lined, waterproof boots to keep your feet warm and dry.

Try the following tips to improve blood flow to your feet:

• Put your feet up when you are sitting.
• Wiggle your toes for a few minutes throughout the day. Move your ankles up and down and in and out to help blood flow in your feet and legs.
• Do not wear tight socks or elastic stockings. Do not try to hold up loose socks with rubber bands.
• Be more physically active. Choose activities that are easy on your feet, such as walking, dancing, yoga or stretching, swimming, or bike riding.
• Stop smoking.

Smoking can lower the amount of blood flow to your feet. If you smoke, ask for help to stop. You can get help by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to SmokeFree.gov.

Ask your health care team to check your feet at each visit. Take off your shoes and socks when you’re in the exam room so they will remember to check your feet. At least once a year, get a thorough foot exam, including a check of the feeling and pulses in your feet.

Get a thorough foot exam at each health care visit if you have

• changes in the shape of your feet
• loss of feeling in your feet
• peripheral artery disease
• had foot ulcers or an amputation in the past

Ask your health care team to show you how to care for your feet.