Diabetic Foot Care: What a Foot Surgeon Says You Must Know

By Dr. Christopher R.D. Menke, DPM, FACFAS — Double Board-Certified Foot & Ankle Surgeon, Founder of 26 Apothecary

Diabetic Foot Care: What a Foot Surgeon Says You Must Know

I have performed more than a few amputations that began with something preventable. A blister from a new shoe. An ingrown toenail that went unnoticed for two weeks. A callus that was trimmed incorrectly at home and became infected. In each case, the person with diabetes had no warning from their feet — the neuropathy had removed the pain signal that would have brought them to care sooner.

Dr. Christopher R.D. Menke, DPM, FACFAS — double board-certified in foot surgery and rearfoot and ankle reconstruction, founder of 26 Apothecary — provides the essential framework for diabetic foot care.

Why Diabetes Changes the Risk Profile of Foot Conditions

Three mechanisms converge in diabetic foot disease to transform conditions that are minor inconveniences in healthy adults into potentially limb-threatening problems. Peripheral neuropathy removes the pain signal that drives people to seek care. Peripheral arterial disease reduces blood flow to the wound site, impairing both immune response and healing capacity. Hyperglycemia directly impairs leukocyte function, making bacterial infection more likely to progress and more difficult to contain.

The Essential Daily Practices

Daily foot inspection is the single most important practice. Examine every surface of both feet including between the toes, at the nail folds, at the heel, and at any area of friction or pressure. Any new finding warrants prompt podiatric evaluation — not watchful waiting.

Proper nail trimming: straight across at a length flush with the end of the toe, with no rounding of corners. People with reduced sensation, limited visual acuity, or difficulty reaching the feet should have nail care performed by a podiatrist.

Skin moisturization of the foot dorsum and plantar surface — but not between the toes, where moisture retention promotes fungal growth. Consistent emollient application maintains skin barrier integrity.

Appropriate footwear every moment the feet are bearing weight. Barefoot walking — even inside the home — is contraindicated in people with diabetes and significant neuropathy. People who qualify may benefit from diabetic shoes and custom insoles covered by Medicare and most insurance plans.

Related article:  Diabetes and Ingrown Toenails: Why This Combination Requires Specialist Attention

When Compression Is and Is Not Appropriate

For people with adequate arterial circulation and intact or near-intact sensation, mild compression socks (15-20 mmHg) can be appropriate and beneficial. For people with peripheral artery disease, compression is contraindicated and can worsen already-compromised circulation. Anyone with diabetes should confirm their vascular status with a podiatrist or primary care physician before using compression products.

When to Seek Immediate Care

• Any new open area, wound, or blister on the foot — same-day or urgent evaluation
• Redness, warmth, or swelling around a toenail or anywhere on the foot — infection signs in a diabetic foot can progress rapidly
• Any change in foot color — blue, purple, or pale color changes can indicate vascular events requiring emergency evaluation
• Fever in a person with diabetes who has a known or suspected foot problem — this is a medical emergency

Frequently Asked Questions

How often should I see a podiatrist if I have diabetes?

People with diabetes and no current foot complications should see a podiatrist at minimum annually. People with peripheral neuropathy, peripheral artery disease, a history of foot ulcers, or significant nail pathology should typically be seen every 3 to 6 months.

Can people with diabetes use over-the-counter foot products?

Appropriate: moisturizers, moisture-wicking socks, supportive footwear with wide toe box, mild compression socks in people with confirmed adequate arterial circulation. Contraindicated: chemical corn and callus removers containing salicylic acid, heating pads or hot soaks, and any product that creates pressure or friction over a bony prominence.

About the Author

Dr. Christopher R.D. Menke, DPM, FACFAS is a double board-certified foot and ankle surgeon — board-certified in both foot surgery and rearfoot and ankle reconstruction. He completed his podiatric medical training at Temple University School of Podiatric Medicine in 2005 and his residency at Northlake Medical Center and DeKalb Medical in Georgia, completing in 2008. He is the founder of 26 Foot and Ankle and 26 Apothecary, and the founder of Surgeons of Service, a Georgia-based humanitarian surgical nonprofit. Every product in the 26 Apothecary catalog was selected through the same clinical lens Dr. Menke applies in the exam room and the operating room.