IMPORTANT: If you have diabetes, you should see your podiatric physician at the first sign of pain or other problems with your legs, ankles, feet or toes, no matter how minor you may think they are. Patients with diabetes who develop podiatric problems often require special attention.  The following precautions and steps may be recommended by your podiatric physician, but should not be undertaken without his/her supervision and consent.  In particular, this paper deals with an injury where ice, heat and compression are sometimes recommended.  ACFAOM reminds patients with diabetes never to undertake such steps without the oversight and recommendation of a podiatric physician.

As an individual who has been diagnosed with diabetes, you are aware that you should take extra precautions to insure your health. These include watching what you eat, monitoring your blood sugar level, and regulating your activity. They also include not taking your feet for granted. Why? Because feet are a source of potential problems stemming from complications of this disorder.

How does it happen?
Over time, increased blood sugar levels affect the blood vessels throughout the body. Sugar-based substances line the walls of the smaller vessels and cause them to thicken and as a result, become weaker and less efficient. Fatty deposits clog the arteries (arteriosclerosis), reducing circulation and causing hardening of the arteries as well. When circulation to the legs is decreased, the foot is at much greater risk of injury and infection.

A second threat to those who suffer from diabetes is diabetic neuropathy, or damage to the nerves that occurs as a result of the side effects of diabetes. When the nerves of the feet become damaged, they do not function as well in sending messages to the brain about heat, cold, pain, itching, and other sensations and discomforts. This increases the chance of injury, and adds the risk that an undiscovered injury can go untreated, leading to infection - not a good combination with poor circulation. About one in five hospitalizations resulting from diabetes to relates to a foot problem.

What to look for:
A patient with diabetes should make a habit of checking his or her feet on a regular basis - at least twice a day (morning and evening). It's also a good idea to check after any vigorous activity, such as aerobic exercise. Try to make a routine, so that you do not forget.

Good times to check (in addition to scheduled times):

• If you've recently bought a new pair of shoes, watch carefully for any rubbing, chafing, blisters or redness that might result. Check, too, to see whether your feet are sweaty or overly damp, as these kinds of conditions can lead to fungal infections, which, though common, are far more serious for a person with diabetes.
• When changing shoes, such as going from casual shoes to dress shoes, or from work footwear to athletic shoes, take a moment to look over your feet. Pull off your socks and check not only the surface of each foot, but between the toes.
• If you have been standing or walking for a longer period of time than you are accustomed, examine your feet.

• Any healthcare professional you see should be informed of your condition. Don't assume it's on all doctors' records. Diabetes can necessitate a difference in the treatment of many other conditions.
• Keep your toenails neat and short. If they aren't causing you any problems (meaning, if you don't have ingrown toenails, or showing any signs of discoloration or thickening), clip them on a regular basis. Cut your nails straight across. It's easiest and safest to do this after a bath when the nail is at its softest. If you are uncomfortable cutting your own nails, or if you have poor vision, see a podiatric physician for assistance.
• See a podiatric physician before deciding on a pedicure. A podiatric physician can help you to understand the risks to having your nails filed or your cuticles trimmed in a salon.
• Notice any changes in your nails? See the podiatric professional for help. Don't let a fungus infection get out of hand - nail fungus is persistent, and if your skin is broken, can invade the toes and feet as well.
• If you notice warts, ulcers, corns or hard skin on your feet, don't try to remove them or treat them yourself. Do not use home remedies, instruments, or chemical compounds. Contact your podiatric professional, who can take care of the situation safely.
• Wash your feet every day. Use tepid water and mild soap, and don't soak for overly long periods. Afterwards, rinse and dry thoroughly, paying special attention to the areas between your toes. Don't leave any damp areas that might present an opportunity for a fungal infection.
• Change socks or stockings every day, and particularly after any athletic activity, or after standing or walking for long periods of time, which can make feet sweat. It's not a bad idea to change socks whenever you change shoes.
• Speaking of socks, look for pairs that don't have a seam in the toe, as those tend to cramp or rub the toes. Avoid wool socks, which can shrink and impede circulation. Avoid cotton socks, too. Cotton socks tend to hold moisture next to the skin. Find materials that wick perspiration away from your skin.
• If the skin on your feet is dry, use a light, unscented moisturizer. A light coating of baby oil or petroleum jelly works well. Don't use anything heavy, perfumed or medicated, and make sure you don't put your shoes and socks on while feet are still moist with lotion; it creates a breeding ground for fungus.
• Avoid baths or showers that are too hot. Test the water first with your elbow or with a thermometer before getting in. Remember that diabetic neuropathy can affect your fingers, too.
• Don't sit around with wet feet. If you're getting out of a pool or spa, dry off immediately. Do the same if coming in out of the rain.
• Before getting into bed, remove hot water bottles and switch off electric blankets or heating pads that might become too warm and burn your feet.
• Avoid going barefoot, which leaves your feet vulnerable to injury and to possible infections from mold spores and other opportunistic organisms.
• Avoid walking on hot surfaces, such as sandy beaches. If you must do so, wear shoes that cover your foot and do not allow sand to enter.
• Sports injury to your ankle or foot? You'll want to avoid taping your feet or ankles, as it might compromise the circulation, or cause the skin to tear or break down. Let the podiatric physician advise you on the best care.
• When sitting, avoid crossing your legs. This compromises circulation and puts pressure on nerves and blood vessels.
• Cold feet at night in bed? Ask your podiatric professional for a recommendation on what to do that will be best for you. Based on the state of your feet, and whether or not you suffer from neuropathy, the doctor may advise light socks, an additional blanket or some other treatment. Remember that heavy socks often promote sweaty feet, or can impede circulation.
• Wear comfortable, well-fitting shoes. Your podiatric physician can help you select those that are best for your foot type, for your lifestyle and for any sports you choose.
• If you're a smoker, stop. Smoking impairs circulation, particularly in those with diabetes. It can, and does, seriously worsen foot and leg problems.
• Exercise! Your doctor can advise you on an appropriate level of activity given your condition, but in general, exercise improves circulation and contributes to overall good health.
• Forego the use of garters with socks or stockings, as they tend to impede circulation
• And of course, always follow a regimen of checking your feet. Report any blisters, soreness, redness or any other changes to your podiatric physician immediately. Don't use home remedies or wait for problems to go away on their own.