From morning to night your feet work hard. Your feet will have trekked about 75,000 miles by the time you're 50. Whatever your age, if you have diabetes or are at risk for diabetes, you need to pay special attention to your feet. Even a small bump, bruise, or scratch can escalate into a serious problem for those with diabetes. This is because diabetes can cause nerve damage in your feet, making it difficult to feel pain when you injure them.

With diabetes, not only is nerve sensation compromised, but circulation is also diminished, making foot injuries difficult and slow to heal. Protect your feet by caring for them every day and taking special precautions to avoid injury.

About diabetic neuropathy

Diabetic nerve damage, called neuropathy, affects up to 65% of those with diabetes. Diabetic neuropathy can cause a variety of symptoms, including pins and needles sensation, numbness, or a loss of pain sensation in the hands and legs, which can contribute to foot problems.

If you have nerve damage in your feet and can't feel pain, it's possible to walk around with a cut or injury and not even notice. A small untended scrape on your foot can progress to a sore, which, in turn, could lead to a foot ulcer. About 70% of the foot ulcers that occur with diabetes result from what began as minor trauma in a numb foot with diabetic nerve damage, according to Robert Tanenberg, MD, professor of medicine at the East Carolina University of Medicine.

If a foot ulcer gets infected and is not treated successfully, it may eventually lead to amputation. Although only 9% of the total adult population has diabetes, more than half of all non-traumatic lower limb amputations in the United States occur in diabetic patients. Nearly 54,000 people with diabetes have amputations each year.

The best way to prevent diabetic neuropathy is to diligently monitor and control your blood glucose level. Statistics show that you can reduce your risk of neuropathy by 69% if you maintain tight control over your blood sugar.

Preventing foot problems

Aggressive treatment of diabetes, beginning as soon as possible after diagnosis, reduces complications and prolongs health, including foot health. Feet need to be pampered and protected to keep them free from harm. Follow a routine of daily care and inspection to monitor the health of your feet.

Tips to keep feet healthy:

• Wash your feet daily, paying special attention to drying them thoroughly. Keep toenails trim and soften calluses and corns.
• Inspect your feet every day, use a mirror to look carefully at the bottoms of your feet. Check for red spots, cuts, blisters, bruises, sores, or other changes that you may not even feel. If inspecting your own feet closely is difficult, try using a mirror or asking someone to help you.
• Wear comfortable shoes with leather or canvas uppers so feet can "breathe." Choose socks that are soft, thick and free from seams that can rub against your skin.
• Avoid going barefoot and keep feet covered with shoes and socks, even when indoors.

How to improve blood flow in your feet

To enhance circulation in your feet make sure that you stay active. Try to exercise at least 20 minutes twice a week. Avoid any activity that has high impact such as running and jumping.

Walking is the best exercise for your feet. It also contributes to your general health by improving circulation, contributing to weight control and promoting all-around well-being. Help your feet absorb impact by walking on soft surfaces whenever possible, such as grass or dirt instead of pavement. Dancing, swimming, and cycling are other examples of activities that are easy on the feet.

Other ways to improve circulation:

• Keep your feet elevated whenever sitting for long periods of time.
• Wiggle your toes and rotate your ankles for 5 minutes, 2 to 3 times daily, to stimulate blood flow.
• Don't keep your legs crossed for long periods of time.
• Make sure your socks are not tight around your calves; if they are leaving a mark on your leg then they're probably too tight.
• If you smoke, ask your healthcare provider about ways to help you quit. Smoking reduces blood flow to your feet.
• Keep your cholesterol levels and blood pressure under control.

Working with your healthcare team

If you have diabetes, review your foot care routine with your doctor, nurse, or diabetes educator. Also, ask if you might benefit form a referral to a foot care specialist. People with diabetes often benefit from nail trimming or callus care from an experienced foot expert.

Your doctor will test your sense of feeling and pulses in your feet at least once a year to evaluate circulation and nerve conduction in your feet. Let your doctor know about any changes in how your feet look or feel. A persistent blister or bump, even if small, may require further care at the onset to avoid complications down the road.

Call your doctor:

• For guidance on caring for corns or calluses.
• If a cut, sore, blister, or bruise on your foot does not begin to heal after 1 day.