Our knowledge of orthopaedics. Your best health.

• Never walk barefoot, even at home. The nerve damage decreases sensation, so you may not notice that little pebbles or objects have gotten stuck in your foot, or that small cuts have developed. This can lead to a massive infection. Always wearing shoes or slippers reduces this risk (just make sure that the soles of the shoes or slippers are non-skid to avoid falls).
• Never use a heating pad, hot water bottle, or electric blanket near your feet. Also, do not place your feet near heaters or a fireplace, as you can easily burn your feet without noticing.
• Wash your feet every day with mild soap and warm water. Test the water temperature with your hand first. Do not soak your feet. When drying them, pat each foot with a towel rather than rubbing vigorously. Be careful drying between your toes.
• Use recommended moisturizers to keep the skin of your feet soft and moist. This prevents dry skin cracks and decreases the risk of infection. Do not put lotion between the toes.  Be cautious with over-the-counter medications from the drug store. Do not use medicated patches on corns or warts.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, see your doctor. Good nail care is important in preventing infections.
• Keep your feet warm and dry. Do not let your feet get wet in snow or rain. Always wear warm socks and waterproof shoes in the winter.
• DO NOT smoke. Smoking damages blood vessels and decreases the ability of the body to deliver oxygen. In combination with diabetes, it significantly increases your risk of amputation.  Learn more: Smoking and Musculoskeletal Health
• Do not remove your own corns and calluses. See a foot and ankle specialist for appropriate treatment.
• Get periodic foot exams from a foot and ankle specialist to prevent complications.

• Inspect your feet every day in a well-lit room.
• Look for puncture wounds, bruises, calluses, redness, warmth, blisters, ulcers, scratches, cuts, changes in how the toenails look and feel, and redness around the toenails.
• Look at and feel each foot for swelling or increased temperature. Swelling and increased warmth in one foot not the other is an early sign that you may be experiencing Charcot (pronounced "sharko") foot. This condition, which causes weakening of the bones and joints in the foot, can occur in people who have peripheral neuropathy. Custom orthotics or a boot may be necessary to prevent further collapse of the arch.
• Examine the bottom of your feet and toes. Also evaluate the tips of the toes, spaces between toes, corners of the toenails, and back of the heel.  Look for increased pressure at sites of deformity, such as bunions or hammertoes. Also look at the toes for discoloration (change in color), changes of temperature, and swelling. If you develop pressure areas or pre-ulcerative calluses related to a deformity and/or peripheral neuropathy, see a foot and ankle specialists to get fitted for custom diabetic shoewear.

If you are unable to see the bottom or your feet, get someone to help you, or use a mirror. Inspecting for skin breakdown (damage, such as a sore or ulcer), changes in the color of skin, and development of new calluses/blisters is crucial. See a foot and ankle specialist promptly if you have any concerns.

Choose and wear your shoes carefully. A poor fitting shoe can cause an ulcer and lead to an infection.

• Buy new shoes late in the day when your feet are larger. Choose shoes that are comfortable without a "breaking in" period.
• Check how your shoe fits in width, length, back, bottom of heel, and sole. Have your feet measured every time you buy new shoes. Your foot will change shape due to the deformity getting worse or feet getting flatter over time.
• Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes.
• Wear new shoes for only 2 hours or less at a time. Do not wear the same pair every day.
• Inspect the inside of each shoe before putting it on. Do not lace your shoes too tightly or loosely.
• Avoid long walks without taking a break, removing your shoes and socks and checking for signs of pressure (redness) or ulcers.
• You may need to be casted/fitted for  custom diabetic shoes that have room for a diabetic orthotic, which can reduce pressure as well as provide stability for an at-risk foot.

The goals of orthotics in diabetic foot management are to:

• Prevent ulcers
• Protect the anatomic structure
• Regulate (control) the pressure of the foot

Orthotics also play an important role in treating diabetic feet that have previously developed foot ulcers and Charcot.

Insurance companies will often cover the cost of orthotics for people with diabetes who have related complications, such as peripheral neuropathy and/or peripheral artery disease They understand how important it is to minimize the risk of a pressure sore or developing unstable joints in these patients. Discuss this with your primary doctor or  foot and ankle specialist.  

An accommodative orthotic made from a soft material called plastizote is commonly prescribed.

• The orthotic should not be hard, as this will increase the risk of a pressure ulcer.
• The orthotic can be transferred from shoe to shoe and should be used at all times when standing or walking.
• Insurance typically covers 3 pairs of orthotics per year, and they should be replaced in your shoes every 4 months.

A functional semi-rigid orthotic may be necessary to offload areas of pressure, further support Charcot foot, and prevent worsening of a deformity that could lead to further ulceration. 

• These orthotics are typically made with a combination of more rigid and soft layers to both provide support and offload pressure.
• Your foot may need to be evaluated and casted by a trained foot and ankle specialist or pedorthist (someone specially trained to modify footwear and use supportive devices for the feet and lower limbs).
• Insurance typically covers 1 pair of orthotics per year, along with a custom diabetic/orthopedic shoe.