People living with diabetes are at a greater risk of developing foot problems if blood glucose levels are not well managed. However small actions, such as well-fitted footwear and regular foot health checks, can make a real difference. NATALIE ESCOBAR finds out more.

Each year in Australia, diabetes-related foot complications lead to more than 47,000 hospitalisations. But with the right care and taking steps to look after your feet, many of these complications can be prevented.

How does diabetes affect foot health?

High blood glucose levels over time can cause damage to blood vessels and nerves and changes to the shape of the foot.
Foot problems usually begin gradually: numbness from nerve damage makes it easy to miss a sore or blister; the sore may become infected and, because diabetes slows healing, the infection can quickly worsen.

Without early treatment, these issues can develop into serious complications. If there is severe infection or gangrene, then amputation may be necessary to prevent further health issues.

Dr Deb Schoen, a podiatrist and UWA lecturer with specialist knowledge in high-risk feet, says, “The main risk is nerve damage, or neuropathy; some people notice it, some don’t.”

What are the early signs to look out for?

While the occasional blister is normal for most of us, for people living with diabetes, these can be the first signs of foot problems.

“Subtle warnings can include blisters, corns, calluses, redness, swelling or a sore that doesn’t heal,” says Dr Schoen. “They might seem minor, but in someone with diabetes, they can quickly become a much bigger problem if they’re not treated early.”

She stresses the importance of seeing a podiatrist regularly if you’re living with diabetes.

Prevention is always easier than trying to heal a wound that’s already developed. Come and see the podiatrist before you have a problem. Come and see us regularly – once or twice a year – so you don’t have problems.”

Medicare may provide a rebate on podiatrists’ fees if you have a chronic condition and have a GP referral. Department of Veterans’ Affairs Gold Card holders are entitled to free podiatry services from private podiatrists, and many private health funds cover podiatry services.

A shoe seller’s guide on choosing the right shoes

Shopping for footwear can be challenging at the best of times. For people with diabetes, there are some extra things to keep in mind. For people with active foot complications is it recommended that they talk to a podiatrist about what to look for in a shoe.

Diabetes can lead to swollen feet and ankles due to fluid retention and poor circulation and can change the shape of the foot. The wrong footwear can aggravate these issues. Shoes that are too narrow or tight may restrict blood flow, while a poor fit can place extra pressure on high-friction areas, leading to blisters, chafing or sores.

In Australia’s heat, thongs may seem appealing, but for people with diabetes, they offer very little support and increase the risk of injury. That’s why closed, well-fitting shoes are always recommended for both indoors and outdoors.

Craig Whatmore, retail manager at Jim Kidd, with more than 30 years of experience working in footwear, says that his staff are trained to ensure shoes fit properly and provide the support needed.

“We start by asking how the shoes will be used, any foot issues like swelling, and what the customer wants in terms of comfort,” he says. “We measure your feet, check your current shoes for wear patterns and always encourage people to try on two or three different models to find the right fit.”

He says that choosing the right shoe takes time. “You can’t just pick one shoe and hope it works; you need to feel how the heel locks in, check cushioning and make sure toes aren’t cramped,” Craig says. “When you stand, your foot spreads. If it starts to roll over the edge of the sole, that’s generally too narrow and can create pressure points.”

And, he adds, comfort should be immediate. “Don’t buy a shoe hoping it will stretch or soften over time, because that doesn’t always happen.”

By the end of the visit, people leave not only with shoes that fit but with confidence that their feet are supported, comfortable and safe.

Craig’s advice on shoe shopping

• Be honest about your needs. Let staff know about any health issues or concerns and be clear about what you’re looking for.

• Look for a supportive heel. A soft heel won’t give your foot the support it needs. People with diabetes can have reduced circulation or nerve sensitivity, so even small pressure points can lead to blisters or sores.

• Try multiple models. Feel how the heel locks in, check cushioning and ensure your toes have enough space. Your ideal shoe is lightweight, cushioned and provides solid support from heel to toe.

• Try on shoes at the right time. Feet swell throughout the day, so try on shoes in the afternoon, but avoid straight after exercise when swelling is at its peak.

• Check for wear. Replace shoes if they no longer feel supportive or if your feet start to feel sore (8 to 12 months for walkers, or 700 kilometres for runners.)

• Choose the right socks. Opt for breathable, moisture-wicking socks with padding in the toe and heel areas to minimise friction. Thorlo is a good brand.

• Fit matters. Shoes should feel comfortable immediately; don’t rely on them stretching over time. Width and fit are the essential elements to keep in mind.

• Understand sizing. For extra room across the foot, choose a proper wide style, such as 2E, 4E or 6E, rather than just increasing the shoe size. Remember, sizing up doesn’t equal greater width.

Your daily foot routine

• Check your feet for cuts, blisters, redness or swelling.

• Don’t forget to check the soles as most problems start there.

• If you can’t see the bottoms of your feet, use a full-length mirror or a small extendable mirror (like the ones sold in car shops.)

• Wash your feet daily with soap or body wash and warm (not hot) water, including between toes and around toenails to reduce the risk of infection.

• Keep skin moisturised to prevent cracks but avoid moisturising between toes.

• Trim nails straight across, not too short, to avoid ingrown nails.

• Wear well-fitted shoes, suitable for the situation, and avoid going barefoot.

• Wear clean socks to prevent skin from chafing (avoid socks with seams.)

Do you want to learn more about managing your diabetes, living well and staying healthy? 

Diabetes WA runs a range of free diabetes self-management programs, including face-to-face workshops and live online programs on behalf of the NDSS. You can book online or call our free helpline on 1300 001 880 to find out more or for any questions related to diabetes.