Diabetes and Foot Health: What CDC and NIH Say
Why diabetes can affect the feet, what CDC and NIDDK say about daily checks and yearly foot exams, warning signs, and questions for your care team.
Diabetes can affect the feet in ways that are easy to miss until a small problem becomes a serious one. Federal health agencies put a lot of weight on regular foot checks, both at home and by a clinician. This guide sums up what the Centers for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) say, and suggests questions to bring to your care team. It is general information, not medical advice. Your own clinician is the right person to say what applies to you. If you have an emergency, call 911.
Why diabetes affects the feet
The agencies point to two main causes.
- Nerve damage. CDC's page on diabetes and your feet says about half of all people with diabetes have some kind of nerve damage, and that the feet and legs are affected most often. NIDDK's page on peripheral neuropathy describes it as nerve damage that usually affects the feet and legs, with symptoms such as burning, tingling, numbness, pain or weakness. When feeling is reduced, a person may not notice a blister, cut or sore.
- Poor blood flow. NIDDK's page on diabetes and foot problems explains that diabetes can reduce blood flow to the legs and feet, which can make it hard for a sore or an infection to heal.
Foot problems the agencies describe
NIDDK lists a range of foot problems that can occur with diabetes. They include calluses and corns, cuts and sores that become infected, foot ulcers (open sores), infections that are slow to heal, fungal infections such as athlete's foot, ingrown toenails, and Charcot's foot, in which bones in the foot shift or break and the foot changes shape. In the most serious cases, NIDDK says, infection can lead to gangrene and amputation of a toe, foot or part of a leg. CDC notes that small problems can become serious if they are not treated early.
Checks at home
Both agencies describe a daily foot check as a way to catch problems early. CDC lists things to look for: cuts, redness, swelling, sores, blisters, corns, calluses and any change to the skin or nails. NIDDK adds checking between the toes, and suggests making the check part of an evening routine, such as when you take off your shoes. Both mention using a mirror, or asking a family member to help, if it is hard to see the bottom of your feet.
NIDDK's foot problems page also has tips on washing, drying, trimming nails, shoes and socks. Read it in full and ask your clinician which of these fit your situation.
Checks by a clinician
CDC says feet should be checked at every primary care visit, and that people with diabetes should see a foot doctor every year for a complete exam, or more often if they have nerve damage. NIDDK says to get a thorough foot exam at least once a year, including a check of the feeling and the pulses in your feet, and more often for people who have lost feeling, have changes in foot shape, have peripheral artery disease or have had an ulcer or amputation.
NIDDK describes how clinicians look for nerve damage in the feet. Tests can include touching the foot with a thin nylon strand (a monofilament test), checking vibration with a tuning fork, checking how you sense temperature, and watching your walk and balance. NIDDK notes that your doctor may refer you to a podiatrist for specialized foot care.
When the agencies say to call your provider
NIDDK lists signs that call for a prompt call to your health care provider. They include a cut, blister or bruise on the foot that does not start to heal after a few days; skin that becomes red, warm or painful, which can be a sign of infection; a callus with dried blood inside it, which can be the first sign of a wound under the callus; and a foot infection that turns black and smells, which can be a sign of gangrene. CDC has its own list of symptoms and says not to wait for your next appointment if you have any of them. The list includes leg pain, tingling or burning in the feet, loss of feeling, changes in foot shape or skin color, dry cracked skin, thick toenails and open sores.
What Medicare covers
If you have Medicare and diabetes, two Part B benefits are worth knowing about. Medicare covers a foot exam every six months for people with diabetic peripheral neuropathy and loss of protective sensation, as long as they have not seen a foot care professional for another reason in between. Medicare also covers therapeutic shoes and inserts for people with diabetes and severe diabetes-related foot disease, when the doctors and supplier are enrolled in Medicare. Our guide to Medicare and foot care covers the rules and costs in more detail.
Questions to ask your care team
- Have my feet been checked for loss of feeling? What were the results?
- Do I have signs of reduced blood flow to my feet?
- How often should my feet be examined, and by whom?
- Would seeing a podiatrist be helpful for me? Can you refer me?
- Which of the foot care steps NIDDK describes apply to me?
- Do I qualify for Medicare's diabetic foot exam or therapeutic shoes?
- What signs mean I should call the office right away?
Finding a podiatrist with this directory
This directory lists podiatrists and podiatry practices that registered a podiatry specialty code in the federal NPPES registry. You can search by location and compare up to three listings side by side. Where CMS data is available, listings show Medicare enrollment, whether the podiatrist accepts Medicare assignment, a telehealth indicator and group practice details.
Keep in mind what a listing does not tell you. The specialty code is chosen by the provider and is not checked by anyone. It does not mean a podiatrist has any special training in diabetic foot care, or that he or she is board certified. The site has no reviews, ratings or prices. Our guide on what a podiatrist is and how to check credentials shows how to look up a license and board certification yourself. Start your search from the home page.
General information only, current as of the date above. The information on Podiatrist Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.