Foot Care for Older Adults with Diabetes: Tips for Health and Prevention

Our feet are the foundation of our body, carrying us through life one step at a time. But for those with diabetes, foot health can be a challenge. Poorly managed blood sugar can lead to complications like reduced circulation and nerve damage. Risk factors like how long you have had diabetes and your age can also increase the likelihood of foot-related issues.

Fortunately, many of these foot complications are largely preventable if you manage your blood sugar and adopt proactive foot care habits. Even if you’re already managing a diabetes-related foot condition, you should know how to monitor your feet for signs that it may be time to see your doctor.

Here’s what else you should know about diabetes and foot health:  

Common diabetic foot complications 

As a podiatrist, I see firsthand how closely diabetes is connected to foot health. In my practice, routine visits often involve trimming nails, addressing corns and calluses, checking shoe fit to prevent blisters, and taking other preventive measures. However, for those with diabetes at greater risk, more severe complications can arise.

Diabetic neuropathy

One of the main ways diabetes can affect foot health is by causing a condition called diabetic neuropathy, which is nerve damage caused by high blood sugar.

There are a few different types of diabetic neuropathy. The most common is called peripheral neuropathy, which can affect nerves in the feet. You may feel tingling, burning, numbness, or discomfort in your feet. In severe cases, you may lose sensation entirely.

If your blood sugar stays elevated for long periods of time, the signals traveling from your foot to your brain can become disrupted or fail to transmit altogether. This means you might not feel sensations in your feet, including injuries, increasing the likelihood that an injury could go unnoticed and unaddressed for longer. 

Peripheral artery disease

Beyond affecting your nerves, prolonged high blood sugar levels can cause the buildup of fatty deposits within blood vessels. These deposits can eventually cause your blood vessels to harden and narrow, decreasing blood flow — a condition called peripheral artery disease. This reduced circulation can significantly impact your hands, legs, and feet, leaving them more vulnerable to complications.

When peripheral artery disease reduces blood flow to the feet, even minor wounds like cuts or scrapes may heal more slowly than expected, increasing the risk of infection and further complications. 

Diabetic ulcers and wounds 

Another potential foot complication of diabetes is a diabetic ulcer, which is an open wound that doesn’t heal the way it should. Diabetic foot ulcers affect approximately one in three people with diabetes during their lifetime and tend to recur. That makes ongoing care and prevention crucial.

Often, ulcers begin as scrapes or cuts, but they can become more serious, especially if you don’t notice them because of a loss of sensation due to diabetic neuropathy. Diabetic foot ulcers can also develop if someone with neuropathy doesn’t feel a sharp object like a nail or tack puncture their skin, causing an injury that quickly becomes more serious. If you have a wound that isn’t healing or becomes red, you should call your primary care provider or podiatrist immediately.

In extreme cases, ulcers may not heal. If your ulcer becomes infected or tissue death occurs, amputation could be necessary. However, not everyone with diabetes is at risk of amputation, and this outcome is largely preventable! You can significantly reduce the risk of complications by actively managing your blood sugar levels and prioritizing foot health.

Prevention is the key to healthy feet 

Although the diabetic foot complications mentioned above may sound alarming, you can often prevent them. Even if you’ve already developed a complication like diabetic neuropathy or peripheral artery disease, you can manage your foot health to avoid health risks like ulcers. Here are some practical tips for taking care of your feet if you have diabetes:

• Manage your blood sugar. Controlling your blood sugar is one of the best ways to prevent foot problems related to diabetes. Remember, prolonged elevated blood sugar causes both diabetic neuropathy and peripheral artery disease. Maintaining a healthy diet and regular physical activity can help you keep your blood sugar in check. However, you should work with your endocrinologist for a personalized plan to manage your diabetes.
• Schedule regular visits with your podiatrist. If you’re considered low-risk and haven’t experienced foot health problems, an annual check-up may be all you need. However, if you have several diabetic foot care needs, you may need to see a podiatrist more regularly. You can work with your doctor to find the cadence that suits your needs. 
• Inspect your feet daily. If you have diabetic neuropathy or circulation problems, you might not notice a wound, cut, callus, or ingrown toenail that could lead to complications. Regular inspection is the best way to catch a potential problem early. That includes looking at the bottom of your feet and between your toes. If you can’t reach the bottom of your feet or have vision challenges, ask a loved one or caregiver if they can help. If you don’t have anyone to help, do your best and contact your doctor — a podiatrist, primary care provider, or endocrinologist — about scheduling more regular visits to monitor your foot health. 
• Clean your feet daily. Use warm water and mild soap, avoiding hot water, which can be damaging. Be especially cautious if you have neuropathy, as you may not be able to feel the temperature of the water and could be at a higher risk of burning yourself. Also, avoid soaking your feet, as it can dry out the skin.
• Use moisturizer. Moisturizing your feet every day can help avoid dry skin and cracking. By keeping your skin healthy, you can help prevent infection. You don’t need to buy anything fancy or expensive. Affordable and effective moisturizer options include Lubriderm, CeraVe, and Eucerin. 
• Pay attention to your footwear. While no single footwear works well for everyone, properly fitting shoes are essential for preventing foot problems. Make sure your shoes aren’t too tight and aren’t rubbing against your skin, as this can lead to tissue breakdown, friction, and wounds. A proper size and fit can make a big difference. Also, consider other foot issues, such as your unique foot shape, hammer toes, or bunions. Consulting with your podiatrist for personalized footwear recommendations can help you find what works best for your needs. 

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