Essential Diabetic Foot Care: Foot Exams and At-Home Care

Diabetes poses a significant risk to foot health, with complications ranging from dryness and cracks to severe infections that can lead to amputation. Regular foot exams conducted by podiatrists play a crucial role in early detection and prevention of these complications. This article outlines the importance of routine diabetic foot assessments, standard examination protocols, and an at-home foot care guide for people with diabetes.

The Importance of Regular Foot Exams for People with Diabetes

Foot complications are among the most common and serious issues faced by people with diabetes. Key statistics highlight the necessity of proactive foot care:

Over 80% of diabetic patients suffer from various skin conditions, the most common being xerosis (dry skin) on their feet.
Diabetic skin has three times more lesions on the feet than non-diabetic skin, increasing the risk of infections.
Nearly two third (64%) of diabetic patients never apply moisturizer to their feet.

Regular foot exams help identify early signs of neuropathy, poor circulation, and structural abnormalities that can lead to ulcers and infections. Diabetic foot check frequency (every 3, 6, or 12 months) depends on patient risk factors and blood sugar levels (HbA1C). The American Diabetes Association recommends at least an annual Comprehensive Diabetic Foot Exam (CDFE) to mitigate risks.

The Consequences of Neglecting Foot Care

Ignoring proper foot care can lead to devastating complications. Nerve damage, known as diabetic neuropathy, impairs sensation in the feet, making injuries go unnoticed. Poor circulation, another common issue, slows healing and increases the likelihood of infections. Without timely intervention, cracks and fissures or minor wounds can evolve into severe ulcers, infections, and in extreme cases, gangrene, which may necessitate amputation.

Comprehensive Diabetic Foot Exam (CDFE)

CDFE is a detailed, annual physical examination of your feet, combined with an educational and counseling session, performed on people with diabetes. A comprehensive diabetic foot exam (CDFE) includes the following key assessments:

1. Neurological Assessment

Use monofilament testing to assess nerve sensation and response
Conduct vibration perception testing with a tuning fork to assess potential loss of sensation
Check for temperature sensation loss, which may indicate neuropathy or nerve damage.
Assess pain perception and reflex responses.

2. Vascular Assessment

Palpate pedal pulses to evaluate circulation.
Observe signs of ischemia such as cold feet, thinning skin, and lack of hair growth.
Assess capillary refill time and check for edema.

3. Skin and Nail Inspection

Look for portals of infection: cracks in heels, fissures, calluses, and dry, itchy skin.
Identify infections, ulcerations, and signs of fungal involvement.
Ensure proper toenail trimming to prevent ingrown nails.
Examine skin temperature differences between feet.

4. Musculoskeletal Examination

Identify structural deformities such as bunions, hammertoes, or Charcot arthropathy.
Assess for pressure points that may lead to ulceration.
Conduct gait analysis to detect biomechanical abnormalities.
Examine joint mobility and muscle strength.

5. Footwear Evaluation

Inspect patient’s shoes for signs of wear and improper fit.
Recommend appropriate diabetic footwear to minimize pressure points and friction.
Assess insoles and recommend modifications if necessary.

6. Daily Foot Care Education and Follow-Up

Explain why people with diabetes are at a higher risk of foot infections
Emphasize the importance of proper daily foot care, including daily moisturization given the limited use of foot moisturizer among diabetic patients
Address misconceptions (e.g. not knowing about the need to moisturize or using products not suited for dry, diabetic skin)
Recommend diabetic-specific moisturizers for best results.
Provide educational materials to reinforce best practices.
Schedule follow-up exams based on the patient’s risk level (every 3, 6, or 12 months).

At-Home Foot Care Guide for People with Diabetes

Self-care is essential in preventing complications. People with diabetes should follow these daily and routine care steps:

Daily Foot Care Routine

Inspect Feet Daily

Check for cuts, blisters, redness, and swelling.
Use a mirror or ask for help if needed.

Wash and Dry Feet Properly

Wash feet daily with lukewarm water and mild soap.
Dry thoroughly, especially between the toes.

Moisturize to Prevent Cracks

Apply a diabetic-safe moisturizer, avoiding the spaces between toes to prevent fungal infections.
Moisturize daily - especially heels & dry areas
Best time: Before bed (keep your moisturizer on your nightstand!)

Foot Protection Measures

Avoid Walking Barefoot

Always wear socks and shoes, even indoors, to prevent injuries.
Use cushioned footwear to reduce impact and pressure.

Choose Proper Footwear

Wear moisture-wicking socks and well-fitted shoes.
Check shoes for foreign objects before wearing them.
Rotate shoes to prevent wear in pressure-prone areas.

Trim Toenails Correctly

Cut toenails straight across and smooth edges with a file.
Seek podiatric care for nail disorders.

Long-Term Preventative Care

Regular Podiatry Visits

Schedule check-ups every 3, 6, or 12 months depending on risk factors.
Request advanced screening for circulation and nerve function.

Manage Blood Sugar Levels

Keep glucose levels within target range to prevent nerve and vascular damage.
Monitor for symptoms of diabetic neuropathy, such as tingling or numbness.

Quit Smoking

Smoking impairs circulation and increases the risk of foot ulcers and amputations.
Seek professional support for smoking cessation.

Engage in Regular Physical Activity

Walking and other exercises improve circulation.
Avoid high-impact activities that may cause foot injuries.

A Rapid Healing Cream Optimized for Dry, Diabetic Skin

SkinIntegra’s Rapid Crack Repair Cream is a clinically proven healing cream that was specifically formulated to provide faster and safer relief for diabetic patients with dry, cracked skin. Its patented formula features 25% urea, a recommended urea strength for moisturization and exfoliation, and lactic acid, an alpha-hydroxy acid that is also used as a peeling agent, but with added hydration benefits that can help soften callused areas. It does not contain salicylic acid, an exfoliant contraindicated for diabetic patients and found in many urea-40 creams.

In a clinical study, 100% diabetic subjects with dry, cracked skin showed improvement after just one day. A time kill study conducted by a third party independent laboratory also showed that Rapid Crack Repair Cream eliminated 99.99% of several common bacteria and fungi in less than one 1 minute.

Rapid Crack Repair Cream is free of common skin irritants which can cause a reaction and slow the natural healing process in diabetic skin such as fragrances, dyes, parabens and other harsh preservatives, petroleum-based ingredients, and phthalates.

Dr. Priya Parthasarathy, a board certified podiatrist who practices in Silver Spring, Maryland added: "SkinIntegra has become a part of our Diabetic patient protocol and the result has been transformative for my patients skin. Their compliance increases because they are so impressed with the results after trying and failing so many other skin creams. The incidence of skin fissures and infections goes down and both the patient and I are happy.“

Conclusion

Diabetic foot complications are largely preventable with proper care. Podiatrists play a key role in early detection through comprehensive exams, while patient education and self-care routines further reduce risks. Implementing daily foot checks, moisturizing daily, using appropriate footwear, and managing blood sugar effectively are critical strategies. By incorporating routine foot checks and preventive measures, both podiatrists and patients can work together to maintain foot health and prevent severe complications.