Diabetes

Foot care for the high-risk foot

Taking care of your feet is an important part of staying healthy when you have diabetes. Knowing your risk level for foot problems helps you know how to keep your feet healthy.

Your foot exam shows you are at high risk for serious foot problems because you have 1 or more of the following:

• blister, fissure or crack, or a sore (ulcer)
• problems with circulation (blood flow) to your legs and feet
• redness over any part of your foot such as bunions, overlapping toes, claw toes (this could be from shoes not fitting well and rubbing)

Your healthcare provider will talk with you about any extra appointments you might need for your feet.

Follow the advice below to lower your risk of losing your foot.

Stay off your foot when you have a sore

• If the bottom of your foot has a sore (ulcer) limit walking and standing as much as possible.
• You might need to use crutches or special footwear to keep your weight off the sore.

Eat a healthy diet

Eating a healthy diet can help wounds heal faster. To find information on eating well for wound healing go to Eating Well for Wound Healing.

Check your feet every day

• Look between your toes and at the tops and bottoms of your feet. Use a mirror or ask someone to help if you can’t see your feet. You can also use a selfie stick with your smart phone or a telescopic inspection mirror (available at most auto supply stores or online).

• Look for swelling, redness, new areas of skin breakdown, or changes to your sore.

• Check if there is more fluid leaking from the sore or there is a smell (odour).

• Feel for temperature differences on your feet. Check if some areas are warmer or cooler than other areas. A change in temperature could be an early sign of inflammation or infection. To help check for this you can use a personal infrared thermometer (available at most pharmacies or online).

• Use the Diabetes Foot Health Self-Screening Tool to check your feet at home. It will also help you keep track of the condition of your feet and learn how to care for your feet.

Check your feet for sensation (feeling)

• Diabetes can cause you to lose sensation in your feet. For example, you may have a stone in your shoe that you don’t feel. This can cause a sore that can become infected. You may then be at risk of amputation (having your foot cut off).

• You can do the touch the toes test at home (use the link for step-by-step instructions) to check for sensation in your feet. Do this test once a month. Have someone touch your toes and write down the results.

• The video “How to test for sensitivity in your feet” from Diabetes UK also shows how to test for sensation.

Wash your feet daily

• Wash your feet with warm water and mild soap.

• Check the water temperature with your elbow or a thermometer. It should be no warmer than 32 to 35°C (90 to 95°F). This is important to avoid burns if you’ve lost any sensation in your feet.

• Make sure to dry well between your toes.

• If you have a wound dressing that covers your sore, follow the directions from your healthcare provider to properly clean your feet.

Apply a moisturizer (lotion) to your feet every day

• Cover the tops and bottoms of your feet with moisturizer. Don’t put moisturizer between your toes or on any open sores unless your healthcare provider tells you to. Use a moisturizer with urea. Ask your healthcare provider which moisturizer is best for you.

• If it’s hard for you to reach your feet, you can use a moisturizer applicator. You can also use a plastic grocery bag: put the lotion on the outside of the bag and use the handles to move it around to get the lotion onto the bottom of your foot.

Have someone who is properly trained cut your toenails

• A foot care nurse or podiatrist is important to help you keep your feet healthy. A pedicure is not a safe option when you have diabetes.

• Use this list of foot care nurses in Alberta to find a foot care nurse near you.

• Find a list of podiatrists in Alberta at albertapodiatry.com.

Foot care nurse: _________________________

Podiatrist: ______________________________

Wear shoes that fit well

• Shoes that don’t fit well can lead to pressure areas, corns, calluses, and blisters. These can all lead to sores on your feet or toes.

• Have your shoes professionally fitted, especially if you’ve lost feeling in your feet. Some specialized shoe stores offer this service.

• Your feet swell slightly during the day, so it’s best to buy your shoes late in the day.

• Your shoes should support your feet and not rub or pinch. The heels should be lower than 5 cm (2 inches).

If you smoke, try to quit or smoke less

• Smoking can cause less blood to flow to your feet. This makes it harder for any sores (ulcers) on your feet or legs to heal. This then puts you at higher risk for amputation.

• If you want help to quit smoking or smoke less, call Alberta Quits at 1-866-710-QUIT (7848).

Get your feet checked by your healthcare provider often

Remember to take off your shoes and socks every time you visit your healthcare provider.

Practise good foot care habits

• Wear socks at night if your feet get cold.

• Put your feet up when you are sitting.

• Wiggle your toes and move your ankles around for a few minutes several times a day to help blood flow in your feet and legs.

• Always check for objects inside your shoes before you put them on.

• Get some physical activity every day to help you to have better blood flow.

• Always wear shoes, even indoors.

• Wear clothing that allows for good blood flow in your feet and legs. Tight clothing (such as tight socks or knee-high socks) can cause problems with blood flow.

• Sit with both feet on the ground, without crossing your legs as this can decrease circulation.

• Take standing or walking breaks so you aren’t sitting for long periods of time.

• Never use hot-water bottles, heat bags, or heating pads on your feet.

• Only use custom-fit orthotics or insoles. Over-the-counter insoles can cause blisters if they don’t fit well.

• See your healthcare provider to treat warts or corns. Over-the-counter medicines for these foot problems aren’t safe for people with diabetes.

Get help with these warning signs

Talk to your healthcare provider as soon as possible (within 1 week) if you have any of these changes to your feet or legs:

• pain in your calves when you walk that doesn’t go away when you rest.

• burning feeling or new pain in your feet

• red areas over any toes

• corns, calluses, or blisters, even if they’re just starting

Ask if you need to see a specialist or have more testing.

Know when to get urgent medical help

Call your healthcare provider right away and ask for an appointment today, or go to the emergency department if you have:

• cold, painful, pale, or purple feet
• red, hot, swollen feet that may or may not be painful
• a swollen area that’s red, even if it doesn’t hurt
• any open sore on your foot that’s draining or leaking fluid

Follow your self-care management plan

To help care for your feet, you’ll need to watch your blood glucose (sugar), blood pressure, and cholesterol closely. Keep track of your results to make it easier to review and plan your care. You and your healthcare provider will decide on the best levels for you.

To see this information online and learn more, visit https://myhealth.alberta.ca/health/pages/conditions.aspx?Hwid=custom.ab_diabetes_highriskfootcare_inst.

For 24/7 nurse advice and general health information call Health Link at 811.

References

Foot care checklist used with permission from Diabetes Canada 2018 Clinical Practice Guidelines.

Self-management table adapted from the New Brunswick Diabetes Foot Care Clinical Pathway.

Current as of: May 18, 2023

Author: Diabetes, Obesity & Nutrition Strategic Clinical Network, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.