Prevent diabetes problems
 

Number 

5 

in a 

Series 

of 7 

Keep your feet and 

skin healthy 

Keep your feet and 

skin healthy

U.S. Department 

of Health and 

Human Services 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse 

Prevent diabetes problems: 

Keep your feet and 

skin healthy 

U.S. Department 

of Health and 

Human Services 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse
Contents
 

What are diabetes problems?.................................. 1
 

What should I do each day to stay 

healthy with diabetes?.............................................. 2
 

How can diabetes hurt my feet? ............................. 3
 

What can I do to take care of my feet? .................. 5
 

How can my doctor help me take care of 

my feet?..................................................................... 7
 

What are common diabetes foot problems?.......... 8
 

How can special shoes help my feet? ................... 11
 

How can diabetes hurt my skin? ........................... 12
 

What can I do to take care of my skin?................ 13
 

Pronunciation Guide...............................................14
 

For More Information ........................................... 15
 

More in the Series.................................................. 17
 

Acknowledgments .................................................. 18
 
What are diabetes problems? 

Too much glucose in the blood for a long time can 

cause diabetes problems. This high blood glucose, 

also called blood sugar, can damage many parts of 

the body, such as the heart, blood vessels, eyes, and 

kidneys. Heart and blood vessel disease can lead 

to heart attacks and strokes. You can do a lot to 

prevent or slow down diabetes problems. 

This booklet is about feet and skin problems 

caused by diabetes. You will learn the things 

you can do each day and during each year to 

stay healthy and prevent diabetes problems. 

Skin 

High blood glucose can cause feet and skin problems. 

Bone 

Nerve 

Blood 

vessel 

1 
What should I do each day to stay 

healthy with diabetes? 

Follow the healthy eating plan that 

you and your doctor or dietitian have 

worked out. 

Be active a total of 30 minutes most 

days. Ask your doctor what activities 

are best for you. 

Take your medicines as directed. 

Check your blood glucose every day. 

Each time you check your blood 

glucose, write the number in your 

record book. 

Check your feet every day for cuts, 

blisters, sores, swelling, redness, or 

sore toenails. 

Brush and floss your teeth every day. 

Control your blood pressure and 

cholesterol. 

Don’t smoke. 

2 
How can diabetes hurt my feet? 

High blood glucose from diabetes causes two 


problems that can hurt your feet:
 

●	 Nerve damage. One problem is damage to 

nerves in your legs and feet. With damaged 

nerves, you might not feel pain, heat, or cold in 

your legs and feet. A sore or cut on your foot 

may get worse because you do not know it is 

there. This lack of feeling is caused by nerve 

damage, also called diabetic neuropathy.* 

Nerve damage can lead to a sore or an infection. 

●	 Poor blood flow. The second problem happens 

when not enough blood flows to your legs and 

feet. Poor blood flow makes it hard for a sore 

or infection to heal. This problem is called 

peripheral vascular disease, also called PVD. 

Smoking when you have diabetes makes blood 

flow problems much worse. 

These two problems can work together to cause 

a foot problem. 

*See page 14 for tips on how to say the words 

in bold type. 

3 
For example, you get a blister from shoes that do 

not fit. You do not feel the pain from the blister 

because you have nerve damage in your foot. 

Next, the blister gets infected. If blood glucose is 

high, the extra glucose feeds the germs. Germs 

grow and the infection gets worse. Poor blood flow 

to your legs and feet 

can slow down healing. 

Once in a while a bad 

infection never heals. 

The infection might 

cause gangrene. If a 

person has gangrene, 

the skin and tissue 

around the sore die. 

The area becomes black 

and smelly. 

To keep gangrene from 

spreading, a doctor may 

have to do surgery to 

cut off a toe, foot, or 

part of a leg. Cutting 

off a body part is called 

an amputation. 

Make sure you wear shoes 

that fit well. 

4 
What can I do to take care of my feet? 

●	 Wash your feet in warm 


water every day. Make 


sure the water is not 


too hot by testing the 


temperature with your 


elbow. Do not soak 


your feet. Dry your feet 


well, especially between 


your toes.
 

●	 Look at your feet 

every day to check 

for cuts, sores, blisters, 

redness, calluses, 

or other problems. 

Checking every day is even more important if 

you have nerve damage or poor blood flow. 

If you cannot bend over or pull your feet up 

to check them, use a mirror. If you cannot see 

well, ask someone else to check your feet. 

●	 If your skin is dry, rub lotion on your feet after 

you wash and dry them. Do not put lotion 

between your toes. 

Look at your feet every 

day to check for problems. 

5 
●	 File corns and calluses 

gently with an emery board 

or pumice stone. Do this after 

your bath or shower. 

●	 Cut your toenails once a week or when needed. 

Cut toenails when they are soft from washing. 

Cut them to the shape of the toe and not too 

short. File the edges with an emery board. 

●	 Always wear slippers or shoes to protect your 

feet from injuries. 

●	 Always wear socks or stockings to avoid blisters. 

Do not wear socks or knee-high stockings that 

are too tight below your knee. 

●	 Wear shoes that fit well. Shop for shoes at the 

end of the day when your feet are bigger. Break 

in shoes slowly. Wear them 1 to 2 hours each 

day for the first few weeks. 

●	 Before putting your shoes 

on, feel the insides to make 

sure they have no sharp 

edges or objects that might 

injure your feet. 

Always wear slippers or 

shoes to protect your feet. 

6 
How can my doctor help me take 


care of my feet?
 

●	 Tell your doctor right away about any 


foot problems.
 

●	 Your doctor should do a complete foot 

exam every year. 

●	 Ask your doctor to look at your feet at each 

diabetes checkup. To make sure your doctor 

checks your feet, take off your shoes and socks 

before your doctor comes into the room. 

●	 Ask your doctor to check 

how well the nerves 

in your feet sense feeling. 

●	 Ask your doctor to check 

how well blood is flowing 

to your legs and feet. 

●	 Ask your doctor to show 

you the best way to trim 

your toenails. Ask what 

lotion or cream to use on 

your legs and feet. 

●	 If you cannot cut your 

toenails or you have a foot problem, ask your 

doctor to send you to a foot doctor. A doctor 

who cares for feet is called a podiatrist. 

Take off your shoes and 

socks so your doctor 

will check your feet. 

7 
What are common diabetes 


foot problems?
 

Anyone can have corns, blisters, and other foot 


problems. If you have diabetes and your blood 


glucose stays high, these foot problems can lead 


to infections. 


➔

➔

Corn and callus.
 

Corns and calluses are thick 

layers of skin caused by too much 

rubbing or pressure on the same 


spot. Corns and calluses can 


become infected.
 

➔

Blisters can form if shoes always 

rub the same spot. Wearing 

shoes that do not fit or wearing 

shoes without socks can cause 

blisters. Blisters can become 

Blister. infected. 

8 
Ingrown toenails happen 

when an edge of the nail 

grows into the skin. The skin 

can get red and infected. 

➔

Ingrown toenails can happen 

if you cut into the corners Ingrown toenail. of your toenails when you 

trim them. You can also get an ingrown toenail if 

your shoes are too tight. If toenail edges are sharp, 

smooth them with an emery board. 

➔

A bunion forms when your 

big toe slants toward the 

small toes and the place 

between the bones near the 

base of your big toe grows 

Bunion. big. This spot can get red, 

sore, and infected. Bunions 

can form on one or both feet. Pointed shoes may 

cause bunions. Bunions often run in the family. 

Surgery can remove bunions. 

➔

Plantar warts are caused 

by a virus. The warts usually 

form on the bottoms of 

the feet. 

Plantar warts. 

9 
➔

Hammertoes form when a foot 

muscle gets weak. Diabetic 

nerve damage may cause the 

weakness. The weakened 

muscle makes the tendons in Hammertoe. the foot shorter and makes the 

toes curl under the feet. You may get sores on the 

bottoms of your feet and on the tops of your toes. 

The feet can change their shape. Hammertoes can 

cause problems with walking and finding shoes that 

fit well. Hammertoes can run in the family. Wearing 

shoes that are too short can also cause hammertoes. 


 ➔

Dry and cracked skin can 

happen because the nerves 

in your legs and feet do not get 

the message to keep your skin 

soft and moist. Dry skin can 

become cracked. Cracks allow 

germs to enter and cause 

infection. If your blood glucose 

is high, it feeds the germs and 

makes the infection worse. 

Dry and 

cracked skin. 

10 
➔

Athlete’s foot is a fungus 

that causes itchiness, 

redness, and cracking 

of the skin. The cracks 

between the toes allow 

germs to get under the 

skin and cause infection. 

If your blood glucose is Athlete’s foot. high, it feeds the germs 

and makes the infection worse. The infection can 

spread to the toenails and make them thick, yellow, 

and hard to cut. 

Tell your doctor about any foot problem as soon as 

you see it. 

How can special shoes help my feet? 

Special shoes can be made to fit softly around your 

sore feet or feet that have changed shape. These 

special shoes help protect your feet. Medicare 

and other health insurance programs may pay for 

special shoes. Talk with your doctor about how 

and where to get them. 

11 
How can diabetes hurt my skin? 

Diabetes can hurt your skin in two ways: 

●	 If your blood glucose 


is high, your body loses 


fluid. With less fluid in 


your body, your skin can 


get dry. Dry skin can 


be itchy, causing you 


to scratch and make 


it sore. Also, dry skin 


can crack. Cracks allow 


germs to enter and 


cause infection. If your 


blood glucose is high, it 


feeds germs and makes 


infections worse. You 


may get dry skin on your legs, feet, elbows, 


and other places on your body.
 

●	 Nerve damage can decrease the amount you 

sweat. Sweating helps keep your skin soft and 

moist. Decreased sweating in your feet and legs 

can cause dry skin. 

Drinking fluids helps 

keep your skin moist 

and healthy. 

12
 
What can I do to take care of my skin? 

●	 After you wash with a mild soap, make sure you 

rinse and dry yourself well. Check places where 

water can hide, such as under the arms, under 

the breasts, between the legs, and between 

the toes. 

●	 Keep your skin moist by using 

a lotion or cream after you 

wash. Ask your doctor to 

suggest one. 

●	 Drink lots of fluids, such as 

water, to keep your skin moist 

and healthy. 

●	 Wear all-cotton underwear. 

Cotton allows air to move 

around your body better. 

Keep your skin

moist by washing

with a mild soap 

and using lotion

or cream after

you wash.

●	 Check your skin after you 

wash. Make sure you have 

no dry, red, or sore spots that 


might lead to an infection.
 

●	 Tell your doctor about any skin problems. 

13
 
Pronunciation Guide 

amputation (AM-pyoo-TAY-shuhn) 

gangrene (GANG-green) 

neuropathy (noo-ROP-uh-thee) 

peripheral (puh-RIF-ur-uhl) 

podiatrist (poh-DY-uh-trist) 

vascular (VASS-kyoo-lur) 

14
 
For More Information 

Diabetes Teachers (nurses, 


dietitians, pharmacists, 


and other health professionals)
 

To find a diabetes teacher 

near you, call the American 

Association of Diabetes 

Educators toll-free at 

1–800–TEAMUP4 (832–6874), or look on 

the Internet at www.diabeteseducator.org 

and click on “Find a Diabetes Educator.” 

Dietitians 

To find a dietitian near you, call the American 

Dietetic Association toll-free at 1–800–877–1600, 

or look on the Internet at www.eatright.org and 

click on “Find a Nutrition Professional.” 

Government 

The National Institute of Arthritis and 

Musculoskeletal and Skin Diseases (NIAMS) 

is part of the National Institutes of Health. To 

learn more about feet and skin problems, write 

or call the National Institute of Arthritis and 

Musculoskeletal and Skin Diseases Information 

Clearinghouse, 1 AMS Circle, Bethesda, MD 

20892–3675, 1–877–226–4267 (toll-free); or 

see www.niams.nih.gov on the Internet. 

15 
To get more information about taking care of 

diabetes, contact 

National Diabetes Information Clearinghouse 

1 Information Way
 

Bethesda, MD 20892–3560
 

Phone: 1–800–860–8747
 

Fax: 703–738–4929
 

Email: ndic@info.niddk.nih.gov
 

Internet: www.diabetes.niddk.nih.gov
 

National Diabetes Education Program 

1 Diabetes Way
 

Bethesda, MD 20892–3560
 

Phone: 1–800–438–5383
 

Fax: 703–738–4929
 

Internet: www.ndep.nih.gov
 

American Diabetes Association 

1701 North Beauregard Street
 

Alexandria, VA 22311
 

Phone: 1–800–DIABETES (342–2383)
 

Internet: www.diabetes.org
 

Juvenile Diabetes Research Foundation
 

International
 

120 Wall Street
 

New York, NY 10005–4001
 

Phone: 1–800–533–CURE (2873)
 

Internet: www.jdrf.org
 

16 
More in the Series 

The “Prevent Diabetes Problems” Series has seven 


booklets that can help you learn more about how 


to prevent diabetes problems. 

For free single copies of these booklets, write, call, 

fax, or email the 

National Diabetes Information Clearinghouse 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

These booklets are also available at 

www.diabetes.niddk.nih.gov on the Internet. 

17 
Acknowledgments 

this publication: 

The National Diabetes Information Clearinghouse 


thanks the people who helped review or field-test 


For the American Association 

of Diabetes Educators 

Lynn Grieger, R.D., 

C.D.E. 

Arlington, VT 

Celia Levesque, R.N., 

C.D.E. 

Montgomery, AL 

Teresa McMahon, 

Pharm.D., C.D.E. 

Seattle, WA 

Barbara Schreiner, R.N., 

M.N., C.D.E. 

Galveston, TX 

For the American Diabetes 

Association 

Phyllis Barrier, M.S., 

R.D., C.D.E. 

Alexandria, VA 

Linda Haas, Ph.C., R.N., 

C.D.E. 

Seattle, WA 

Kathleen Mahoney, 

M.S.N., R.N., C.D.E. 

Drexel Hill, PA 

Randi Kington, M.S., 

R.N., C.S., C.D.E. 

Hartford, CT 

For the Centers for Medicare 

& Medicaid Services 

Baltimore, MD
 

Jan Drass, R.N., C.D.E.
 

For the Diabetes Research 

and Training Centers 

Albert Einstein School 

of Medicine 

Norwalk Hospital 

Norwalk, CT 

Jill Ely, R.N., C.D.E. 

Sam Engel, M.D. 

Pam Howard, A.P.R.N., 

C.D.E. 

Indiana University 

School of Medicine 

Indianapolis, IN 

Madelyn Wheeler, M.S., 

R.D., F.A.D.A., C.D.E. 

VA/JDF Diabetes 

Research Center 

Vanderbilt School of 

Medicine 

Nashville, TN 

Ok Chon Allison, 

M.S.N., R.N.C.S., 

A.N.P., C.D.E. 

Barbara Backer, B.S. 

James W. Pichert, Ph.D. 

Alvin Powers, M.D. 

Melissa E. Schweikhart 

Michael B. Smith 

Kathleen Wolffe, R.N. 

For the Grady Health System 

Diabetes Clinic 

Atlanta, GA 

Ernestine Baker, R.N., 

F.N.P., C.D.E. 

Kris Ernst, R.N., C.D.E. 

Margaret Fowke, 

R.D., L.D. 

Kay Mann, R.N., C.D.E. 

For the Indian Health 

Service 

Albuquerque, NM
 

Ruth Bear, R.D., C.D.E.
 

Dorinda Bradley, R.N.,
 

C.D.E. 

Terry Fisher, R.N. 

Lorraine Valdez, R.N., 

C.D.E. 

Red Lake, MN 

Charmaine Branchaud, 

B.S.N., R.N., C.D.E. 

For the Medlantic Research 

Center 

Washington, DC 

Resa Levetan, M.D. 

For the Texas Diabetes 

Council 

Texas Department of 

Health 

Austin, TX 

Luby Garza-Abijaoude, 

M.S., R.D., L.D. 

18
 
National Diabetes 


Information Clearinghouse
 

1 Information Way
 

Bethesda, MD 20892–3560
 

Phone: 1–800–860–8747
 

Fax: 703–738–4929
 

Email: ndic@info.niddk.nih.gov
 

Internet: www.diabetes.niddk.nih.gov
 

The National Diabetes Information Clearinghouse (NDIC) is 

a service of the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK is part of the 

National Institutes of Health of the U.S. Department of Health 

and Human Services. Established in 1978, the Clearinghouse 

provides information about diabetes to people with diabetes and 

to their families, health care professionals, and the public. The 

NDIC answers inquiries, develops and distributes publications, 

and works closely with professional and patient organizations and 

Government agencies to coordinate resources about diabetes. 

Publications produced by the Clearinghouse are carefully 

reviewed by both NIDDK scientists and outside experts. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this booklet to duplicate and distribute 

as many copies as desired. 

This booklet is also available at www.diabetes.niddk.nih.gov. 

This publication may contain information about medications 

used to treat a health condition. When this publication was 

prepared, the NIDDK included the most current information 

available. Occasionally, new information about medication is 

released. For updates or for questions about any medications, 

please contact the U.S. Food and Drug Administration 

at 1–888–INFO–FDA (463–6332), a toll-free call, or visit 

their website at www.fda.gov. Consult your doctor for more 

information. 
U.S. DEPArTmENT OF HEALTH 

AND HUmAN SErvICES 

National Institutes of Health 

NIH Publication No. 08–4282 

May 2008