How to Treat Diabetic Foot Problems

Diabetes is a challenging condition that affects your entire body. Over time, you may develop nerve damage (neuropathy) that causes pain or loss of feeling in your limbs. Since your feet are usually affected before your hands or arms, you should be able to recognize problems before they worsen. If you think you're developing a diabetic foot problem, don't attempt to treat it at home. Instead, get immediate medical attention.^{[1]XTrustworthy SourceNational Institute of Diabetes and Digestive and Kidney DiseasesHealth information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of HealthGo to source}

Part 1

Part 1 of 3:

Recognizing Specific Problems

1
Get your feet examined. If you feel any changes in your feet like numbness, tingling, pain, or weakness, see your doctor immediately. Any of these symptoms could signal a problem with your feet that could lead to infection. It's important to get quick medical treatment since infection can spread throughout your body within a few hours. The doctor or podiatrist will examine your feet and may order a series of tests including:^{[2]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Blood tests, such as an HBA1C test and blood glucose level test
- X-rays or other imaging tests
- Angiogram (an x-ray of your heart)
- Nerve and sensory testing
- Muscle strength and tone
2
Watch for signs of infection. An infection in your foot can be serious and cause a lot of damage. You may develop gangrene and lose the foot if the infection is not treated promptly. Foot infections (even fungal infections like athlete's foot and fungal toenails) must be medically treated right away.^{[3]XExpert SourceMark Co, DPM
PodiatristExpert Interview. 21 April 2020.} Signs of foot infection include:^{[4]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source}
- Redness or red streaks
- Swelling of the feet or legs
- Pain
- Fever
- Chills
- A warm area on your feet or legs
- Pus
- Foul odor
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3
Test for charcot foot. If you've noticed pain, swelling, or one foot become larger than the other, you should be examined for charcot foot. Severe nerve damage can weaken the bones in your foot which can cause them to break or fracture. Your doctor will take x-rays to diagnose charcot foot.^{[5]XResearch source}
- If you don't realize that you have a fracture and continue walking on the foot, you may develop deformities.
4
Recognize foot ulcers. If you've been putting too much pressure on your feet, you may develop open sores known as foot ulcers. You'll probably notice discharge on your socks and the bottom of your foot might have a sore that's red, swollen, or smelly.
- Although foot ulcers look painful, most people who develop them have nerve damage that keeps them from feeling the pain.
- Invest in some good shoes and socks, and make sure your shoes fit well. This will help to prevent against blisters, which can turn into a sore that never heals, especially in diabetics.
- Diabetic foot ulcers are a leading cause of disability.
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Part 2

Part 2 of 3:

Treating Specific Foot Problems

1
Treat infections. Once you've been diagnosed with an infection, your feet will be x-rayed to see if the infection has spread to the bones. The doctor will grow a culture of the infection to determine what caused it in order to create a treatment plan. You'll be given antibiotics or antifungals to treat your infection. If you have a moderate or severe infection which goes deep into the skin (possibly to the bone or blood), you'll need to be treated in the hospital and may need surgery.^{[6]XResearch source}^{[7]XResearch source}
- You'll probably be examined by a team of infectious diseases specialists, surgeons, podiatrists and orthopedists.
- Infection of the bone is called osteomyelitis and it can be detected by a bone scan. You can get a bone scan at the hospital.
- If you have osteomyelitis you will be treated with antibiotics, but surgery may also be necessary. You will receive IV antibiotics for several weeks and then switch to an oral antibiotic.^{[8]XResearch source}
2
Rest if you have charcot foot. Your doctor will recommend that you completely immobilize your foot and keep all weight off of it. You'll probably need to get a cast, wear a brace, or use a wheelchair or crutches. The bones will need a chance to totally heal so you may need to stay off of the foot for several weeks or months. When you are able to carry some weight on your foot, you'll need to wear custom braces and shoe supports.^{[9]XResearch source}
- Surgery is usually only done in severe cases if earlier treatments don't work.
3
Follow your doctor's surgery recommendations. If you have dead skin tissue in your foot as well as an infection, your doctor may want to remove that while treating you with medication. This may mean that your doctor wants to surgically remove infected bone or drain infected pus. In this case, your doctor is probably suggesting surgery to save the foot from amputation.
- Surgery can improve blood flow that's been restricted. This can help medication reach the areas that need to be treated.
- Surgical procedures can either remove dead and/or damaged tissue from the wound or drain the wound of pus and purulent material. This will allow your foot to heal better, and hopefully without complication.
4
Care for foot ulcers. Foot ulcers can develop into serious health problems, so see your doctor or podiatrist right away. The doctor will cleanse the ulcer and remove any dead skin and tissue. You'll then need to take pressure off of the ulcer and keep the wound clean until it heals.^{[10]XResearch source}
- You may need to wear a brace, cast, or special shoes to keep the pressure off of the ulcers.
- Continue to treat other glucose-related health problems while you're treating the ulcers.
- When caring for your foot ulcers, make sure that you check and wash both of your feet every day with warm water. Avoid soaking your feet too long because waterlogged sores are harder to heal.
5
Pay attention to poor circulation in your feet. Poor blood circulation in your feet can be painful. You may notice pain in your feet that increases when you walk, but gets better when you rest (a condition called intermittent claudication). To improve circulation, wear warm socks and exercise. Avoid warming your feet in hot water since you may not feel how hot the water actually is and could burn yourself.^{[11]XTrustworthy SourceAmerican Diabetes AssociationHealth-based nonprofit focused on preventing and researching diabetesGo to source}
- Poor circulation can make the skin on your legs hard and shiny. You might lose hair on your lower legs and feet too.
- Home and lifestyle remedies for increase circulation and control claudication include the following include quitting smoking, controlling your cholesterol levels, protecting your feet, resting your feet below your heart, exercising, dry brushing,^{[12]XResearch source} and avoiding certain medications such as sinus medicine that constricts the blood vessels.^{[13]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
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Part 3

Part 3 of 3:

Caring For Your Feet

1
Monitor your blood sugar. Work with your healthcare team (like your endocrinologist, physical therapist, and occupational therapist) to keep your blood sugar in your target range. Keeping your blood sugar levels steady will help to prevent any of the complications of diabetes.^{[14]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Another important thing you can do to prevent diabetic complications is quit smoking. Smoking reduces your circulation and slows your body's healing ability.
- Diabetics should shoot for the lowest possible blood sugar level and HBA1c readings possible. Potential risks of tight control of blood glucose levels include hypoglycemia (low blood sugar), which is a dangerous adverse effect. If you find yourself hypoglycemic you can drink a half cup of orange juice, consume hard candies, or take three glucose tabs.^{[15]XResearch source}
2
Check your feet every day. Take your socks off and take the time to examine your feet each day. Look for any cuts, sores, changes in skin color, or anything different. If you can't see the bottom of your feet, ask someone to check them for you. If you find something (even a minor cut), make sure you contact your physician or podiatrist right away.^{[16]XTrustworthy SourceAmerican Diabetes AssociationHealth-based nonprofit focused on preventing and researching diabetesGo to source}^{[17]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Have your feet checked at least once a year either by your physician or a foot specialist (a podiatrist).
3
Clean and protect your feet. Wash and dry your feet every day. Moisturize your feet, but avoid getting lotion in between your toes.^{[18]XExpert SourceMark Co, DPM
PodiatristExpert Interview. 21 April 2020.} Trim your nails straight across and file them with an emery board. Or, you can get your toenails professionally trimmed. You should also get any corns or calluses professionally removed as soon as you see them.^{[19]XTrustworthy SourceAmerican Diabetes AssociationHealth-based nonprofit focused on preventing and researching diabetesGo to source}^{[20]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Ask your podiatrist to recommend special shoes that may protect your feet and always wear clean dry socks that don't cut off circulation.
4
Stay active. Exercising or just moving around more can really improve your circulation. You'll want to work with your healthcare team to come up with activities you can do to get the blood flowing. It's important to be active, but you may need low-impact activities if you're trying to reduce pressure on your feet.^{[21]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- If you get a foot injury, get your foot examined by your doctor as soon as possible.
5
Try a supplement. Take an alpha lipoic acid (ALA) which has been shown to prevent peripheral neuropathy (nerve damage). You'll probably want to take 300 mg three times a day or as often as your doctor recommends. Be sure to choose a high-quality supplement and continue to monitor your blood sugar since ALA can lower blood sugar levels. It can take 3 to 5 weeks before you notice an improvement in nerve sensation.^{[22]XResearch source}
- Side effects of ALA are rare, but include: stomach upset, dizziness and rashes.
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