How to Promote Foot Health for People With Diabetes
5 Actions for Health Care Teams
We all have a role to play to help people with diabetes live their best life!
Podiatrists play a key role in the early detection and treatment of foot problems in people with diabetes.
Neuropathy (nerve damage), arthropathy (joint damage), vasculopathy (blood vessel damage), and other complications can be avoided or delayed with annual comprehensive foot exams and treatment if needed. Annual exams include an evaluation of pulses, sensation, foot structure and function, and nails.
- Encourage your patients to ask for a basic foot check at every health care visit.
- Tell your patients that:
- Diabetes-related complications can start in their feet and may not cause recognizable symptoms.
- A basic foot check at every health care visit, combined with annual comprehensive foot exams, can help identify problems early.
- Patients with poorly managed blood sugar or high blood pressure may benefit from having their feet checked more often, such as every 3 or 6 months.
- Share information from CDC’s Take Charge of Your Diabetes: Healthy Feet fact sheet.
Take These 5 Actions to Help Your Patients
1. Know the risks of foot disorders and amputation for people with diabetes.
People with diabetes are at higher risk of diabetes-related foot conditions. Yet, many do not get regular preventive care. In the United States:
- People with both diabetes and peripheral vascular disease have a higher risk of amputation. Risk is also higher in people who are in a lower socioeconomic position, who live in rural areas, or who are African American or American Indian.1
- In 2016, there were 4.9 lower-extremity amputations per 1,000 adults 18 years or older with diagnosed diabetes.2 About 130,000 diabetes-related hospital discharges involved a lower-extremity amputation.3
- Nearly half of people with diabetic peripheral neuropathy may not have symptoms. If this condition is not recognized and treated with preventive foot care, patients can injure the areas of their feet where they do not have feeling.4
- Over their lifetime, 12% of people with diabetes develop diabetic foot ulcers.5
- Among people with diabetes who have had a lower-extremity amputation, 19% to 53% will have an amputation of the opposite extremity within 5 years.5
- Feelings of tingling, burning, or numbness or the sensation of bugs crawling on the skin.
- Puncture wounds,ulcers, redness, or new foot pain.
- Corns, calluses, toenail deformity, or bleeding beneath the nail.
- Changes infoot shape, walking with a limp, or foot swelling.
- Shoes no longer fitting.
2. Understand how diabetes can affect foot health and encourage your patients to watch for problems.
At each health care visit, tell your patients with diabetes about the signs of foot problems. This will help them be aware of changes in their feet when they start. Make sure your patients understand the information by asking them to repeat back what they heard.
3. Ask your patients questions about their foot health at each health care visit.
- Do you ask for a foot exam with shoes and socks off at all visits with your primary care provider?
- Do you check your own feet every day? Do you know how to check your feet?
- Do you have appropriate footwear to prevent ulcers?
- Do you visit a podiatrist for a comprehensive foot exam at least once a year?
- Do you always contact a health care provider when you notice a foot problem? (Tell your patients they should not attempt to treat foot problems themselves.)
You can refer your patients to a podiatrist or ask them if they want more information about recommended foot care for people with diabetes. You can base this action on how your patients answer your questions or any other concerns they share during their visit.
4. Remind your patients to keep their blood glucose, blood pressure, and blood lipids within normal levels for optimum foot health.
Use the following discussion points to help you talk with your patients about their self-care habits and their feelings about managing diabetes:
- Promote the ABCs of diabetes (A1C, blood pressure, cholesterol, and smoking cessation) and a healthy lifestyle.
- Ensure that patients have access to health coaches, patient navigators, and community health workers when possible.
- Ask your patients what other health exams they are getting, including regular ear health checkups.
- Assess symptoms that might require referral to a specialist.
- Follow up with your patients to track how well they are managing their diabetes and connecting with their health care team.
- Assess socioeconomic factors that can affect health, such as food insecurity, housing insecurity or homelessness, financial barriers, and lack of social support. Use this information when you make treatment decisions.
- Refer patients to local community resources when available.
5. Refer your patients to diabetes self-management education and support (DSMES) services.
DSMES services help people live well with diabetes. Whether a person has just been diagnosed with diabetes or has had it for years, DSMES services will make it possible for them to:
- Work with a diabetes care and education specialist to set and track goals.
- Practice how to fit diabetes self-care behaviors, like healthy eating and problem-solving, into all parts of their life.
- Learn how to use knowledge, skills, and tools to build confidence and emotional strength to manage diabetes.
- Find ways to get support (in person or online) from family, friends, their community, and their health care team.
Learn more about DSMES and encourage your patients to find a DSMES program that is recognized by the American Diabetes Association or accredited by the Association of Diabetes Care & Education Specialists.
- Prevent Diabetes Complications
- Take Charge of Your Diabetes: Healthy Feet
- Diabetes Awareness: Keep Your Appointment. Keep Your Feet.
- Lower Extremity Amputation Prevention (LEAP)
- Barnes JA, Eid MA, Creager MA, Goodney PP. Epidemiology and risk of amputation in patients with diabetes mellitus and peripheral artery dArterioscler Thromb Vasc Biol. 2020;40(8):1808–1817. doi:10.1161/ATVBAHA.120.314595
- US Department of Health and Human Services. Reduce the Rate of Foot and Leg Amputations in Adults with Diabetes — D‑ Published August 18, 2020. Accessed September 21, 2021. https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes/reduce-rate-foot-and-leg-amputations-adults-diabetes-d-08
- Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Updated August 28, 2020. Accessed September 21, 2021. https://www.cdc.gov/diabetes/data/statistics-report/index.html
- American Diabetes Association. Microvascular complications and foot care: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(suppl 1):S135–151. doi:10.2337/dc20-S011
- Boyko EJ, Mont Monteiro-Soares M, Wheeler SGB. Peripheral arterial disease, foot ulcers, lower extremity amputations, and diabetes. In Diabetes in America. 3rd ed. National Institutes of Health; 2018:20-1–20-34. NIH publication 17-1468.