It's estimated today that diabetes mellitus affects 15% of all people over the age of 65 years old in developed countries worldwide. Over 15 million people in the United State are diabetics, with 790,000 new cases being diagnosed every year. This figure represents approximately 5.9% of the population of the U.S.. Trends in society have had a significant impact on the development of the disease. Obesity and decreased physical activity are major contributing factors to diabetes. As we move from an agrarian society to a technology-based society, our opportunity for physical labor and recreational exercise decreases. Native Americans, Hispanics, and African Americans show a particular propensity for diabetes. (1)
Diabetes affects your body in a number of ways. In lower extremity health, we are most concerned with issues related to diabetic peripheral neuropathy (DPN). Neuropathy refers not only to the loss of sensation in the foot but also to the increased sensation often described as burning or electrical shock pain. Poorly controlled diabetes results in loss of protective sensation (LOPS). Protective sensation is what prevents simple injuries like blisters or shoe irritation from turning into a major wound. Although the physiological cause DPN is still disputed, clinicians agree that the key to avoiding DPN is tight management of blood sugar and hemoglobin A1c levels. (2) Preventative measures used to treat DPN include the following-
1. To manage potential LOPS, use your hands and your eyes to visually check your feet each day to look for cracks in the skin, blisters or areas of irritation from shoes.
2. Maintain you hemoglobin A1c at or below 6.5% to prevent the onset of DPN.
Your diabetes and your feet
Lower extremity healthcare in diabetic patients includes treatment of skin, bones and joints, nerves and blood vessels. In addition to tight control of blood sugar levels and a focus on hemoglobin A1c levels, here’s some tips used in diabetic wound care centers across the nation to keep feet healthy.
1. Weight loss – although not all cases of diabetes are tied to obesity, the correlation between
obesity and diabetes is clear. (3) Weight loss can significantly reduce your medications used to
2. Diet – a diet high in protein will help sustain healthy skin and be beneficial in a case where wound healing is necessary.
3. Smoking – each cigarette smoked reduces the blood flow to the foot by 30% for 1 hour. Long
term smoking results in lower extremity arterial occlusion. Stop smoking today.
Diabetic Foot Care
In addition to daily visual and hands-on foot checks to assess possible diabetic peripheral neuropathy, follow these simple steps to maintain healthy feet-
1. Shoes – when possible, have your shoes professionally fitted. If you’re covered by Medicare,
take advantage of the Medicare Diabetic Shoe Program. Ask your doctor for more information
about this program.
2. Rotate shoes – rotating shoes halfway through the day will prevent areas of pressure on the
3. Skin – Diabetic patients often develop a condition called diabetic dyshidrosis (loss of the ability
to sweat.) Dyshidrosis results in dry skin. It is imperative for diabetic patients to use a topical
skin softener on a daily basis to manage dry skin.
4. Check between toes at least weekly to assess skin and prevent infections.
5. Build your team – work with your primary care doctor to build your health care team. Team members should include:
- Primary care for management of blood sugar and A1c
- Diabetes educators
- Dieticians to learn more about diet
- Podiatry for wound care
- Get active – take time to take care of yourself by exercising for 30 minutes a day.
2. Schreiber A, Nones C, Reis R, Chichorro J, Cunha J. Diabetic Peripheral Neuropathy:
Pathophysiology and treatment. World J Diabetes 2015 Apr; 6(3): 432-444.
3. Kashyap S, Gatmaitan P, Brethauer S, Schauer P. Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients. Cleve Clin J Med. 2010 Jul; 77(7): 468-476.
This article was written by Jeffrey Oster, DPM. Dr. Oster is a board certified podiatrist and medical advisor to Myfootshop.com. This article was most recently updated on 1/20/2021.