Why Should Diabetics Never Go Barefoot?

“Don’t go barefoot!”
“Keep your shoes on.”
“You need something on your feet.”

Most diabetics are accustomed to hearing these familiar instructions from doctors and other health professionals. From the time of diagnosis, they’re told by their doctors and other health professionals to not walk around barefoot, even in the comfort of their own homes.

Why is this? What do diabetes and feet have to do with each other anyway?
You may have heard of the risks diabetes poses to your feet and legs but pushed the thought away, turning to more immediate concerns like blood sugar and medications. After all, diabetes can be overwhelming, and you have a lot to deal with already. Luckily, taking precautions by wearing shoes and socks can help you to avoid having something else to worry about.

The truth is that serious foot problems are strongly associated with diabetes, and there are actually a variety of reasons why you need to keep your feet protected as a diabetic.

Diabetics often lose sensitivity in their feet as the disease progresses. This is because uncontrolled diabetes can cause permanent nerve damage known as diabetic neuropathy. Chronic high blood sugar causes damage to the nerve's ability to receive and then send signals and send them to the brain. (It’s important to note that even without diagnosed diabetic neuropathy, chronic high blood sugar levels alone can cause damage to nerves as it pulls water from the body to flush out excess sugar from the system.) Due to this loss of sensitivity, it’s often hard for diabetic patients to notice small injuries, and they inadvertently allow them to worsen. They could burn themselves on hot sand without feeling the heat, or develop a heel blister without ever feeling irritation there. Because there is no nerve signal, they don’t get off the sand or change shoes.

Tiny injuries like blisters and minor burns may not sound like a serious issue, but when small abrasions like this go unnoticed, they go untreated. That means open wounds left exposed to bacteria and infection. These can quickly go from tiny ailments to major health concerns.

Peripheral Arterial Disease (PAD) is another condition common among diabetics, and another reason you should be sure to keep your shoes on. In individuals with PAD, the arteries that feed into your feet and legs experience reduced blood flow, pain, swelling, or numbness, which introduces the same danger as diabetic neuropathy. In the case of PAD, reduced blood flow may cause even minor wounds to heal, which puts a patient at risk for gangrene, which is the death of tissue due to lack of blood and may require amputation. In fact, an alarming number of amputation cases in the US are the result of diabetic arterial disease. The risk here is very real and must be taken seriously.

While foot problems such as athlete's foot and blisters can happen to anyone, these issues can lead to serious complications in diabetics. Since going barefoot can increase the likelihood of foot injury and infection, diabetics should wear socks and shoes as often as possible to reduce their risk. Always wear at least shower shoes or flip flops in public restrooms, locker rooms, and showers to avoid picking up any nasty bacteria. The same goes for anywhere in a gym or fitness center.

The best way to avoid something like this is to be vigilant. Check your feet each and every day to ensure that there are no cuts, blisters, or hotspots. It’s also a good idea to shake out your shoes before you put them on to ensure there is nothing inside that could irritate your food as you go about your day.

Once the shoes are on, leave them there. Even if you are just walking around the house, you never know when there might be a small screw, pin or even pebble that could end up piercing your foot. Stories abound of folks absentmindedly moving through their homes when a sewing needle or piece of jewelry punctured their foot.

Take Jane Malone’s story, for example. “When moving into my new house, I was walking on my new carpet in stocking feet and a carpet nail went into my heel. Within a day or two, the heel was edematous, stretched tightly, white in color, and I knew it probably had staph present.The doctors in hospital confirmed this. They did an incision and drainage and debrided it, cutting off all the dead skin on my heel. The underpad was painful on that new tender pink skin. The healing continued with IV antibiotic saline, OP gauze, and a lot of difficulty moving.”

Out in public, such as at the beach, always make sure to have beach or water shoes on.Avoid walking on the hot sand without shoes or standing in the ocean barefoot. Injuries caused by crab bites or stepping on rocks or seashells can pose the same risk as a burn if you don’t notice it right away. The same goes for lakes and rivers, especially when you cannot see the bottom.

Art Lockhart can attest to this: “ I stepped on something while swimming with my grandkids. I think it was a piece of metal from the pool. And I put my foot up and my daughter recognized the fact that something had caused the swelling and infection. She rushed me to the emergency room, and they gave me some antibiotics and all, and I stayed on antibiotics for close to six months.
But it just wouldn't heal. I guess it is typical of older diabetics to have slower healing, and the reason I didn't feel it was because I had neuropathy in the feet, I had largely lost feeling. I didn't even know I had stepped on whatever it was! Well I ended up having to have it amputated. It was my big toe, so the big toe on my right foot got amputated.About three or four years ago I had part of another toe amputated on that same foot, and for the same reason -- some kind of infection they couldn't cure it with antibiotics.”

Lockhart, despite these amputations, managed to make a great recovery and still enjoys spending time playing with his grandchildren and being active, but Jane Knight’s experience of three amputations is a different story.

Knight admits to taking poor care of herself throughout her teenage years. She ate and drank whatever she wanted and did not put much thought into taking her medications. She ended up doing damage that could not be undone when she became more vigilant after having her first child. Despite paying rapt attention to her blood sugar levels and strictly regulating her diet from then on, complications ensued.

A small cut on the ball of her foot led to a toe amputation, and not long after, another tiny injury occurred.  “After the toe was removed I developed a big blister on my foot that wouldn’t heal. It was agony. I went back and forth to the hospital but there was nothing they could do; the tissue was on its way to turning gangrenous. My consultant told me I would lose my leg.”  Gangrene in her other leg two years later led to another amputation, and then, in a realization of her worst fear, she lost her writing hand due to a cat scratch that would not heal.

Unfortunately, stories like this are much more common than many are led to believe. More than 80,000 amputations are performed each year on toes, feet, and lower legs, yet many diabetics carry on believing that they are a rare phenomenon and continue to tempt the odds.  Each of the individuals above are a testament to the fact that a life-altering injury is not worth a few minutes or hours of being barefoot on the beach, and that there’s no such thing as too careful when it comes to diabetes and the feet.

While it may seem like a hassle to always be sure to have shoes and socks on, new technology has allowed these necessary items to be created that offer benefits to diabetics. So now you can not only forgo the risks of going barefoot, but also enjoy the advantages of these special socks.

In terms of shoes, it’s pretty easy to imagine what type of shoes might not be so good for someone looking to avoid blisters or other injury. Anything pointed, anything with high heels, thong-style sandals and flip flops, or shoes with tight straps are a bad idea. But so too are shoes that don’t fit correctly. Too small or too big, to narrow or too wide, all can cause rubbing, blisters, and eventually, ulcers.

Diabetic shoes offer a host of benefits. They feature protective but breathable fabric without irritating stitching, lightweight cushioning, extra depth, and stretchability. These address all of the issues that regular shoes like the ones listed above bring into the picture, promoting good air and blood circulation, support, and softness. And gone are the days where all you can find are white diabetic sneakers. Brands now offer a wide range of styles so you can find some that work with your wardrobe. You’ll stay comfortable and stylish, and your feet will be happy and healthy.

Your choice of socks, however, may be considered even more important.

Diabetic socks are socks specially designed to prevent the development of foot problems among those living with diabetes. Their features are engineered to help you keep your feet healthy.  These socks are usually made of material that wicks away moisture, like that found in exercise clothing, so that the feet stay dry. Many brands even have antimicrobial features in their fabric to help prevent bacteria and fungal growth. In colder temperatures, these socks will keep your feet warm, ensuring good circulation.

Diabetic socks are also non-elastic to avoid any slowing or prevention of circulation that regular socks may cause. No more indentations on your feet or ring around your ankle at the end of the day. For non-diabetics, this is not a problem and will likely disappear within a few minutes. But for those living with diabetes, anything that reduces circulation to the feet has the potential to cause long term damage, so it is best to avoid elastic altogether.

These socks are also seamless, so you do not have to worry about pesky rubbing producing blisters. In someone with neuropathy or chronic high blood sugar, something as small as a blister can ultimately turn into an ulcer. Special padding in sensitive areas also helps to prevent injuries like this, and many brands offer extra-padded or gel-padded socks for those who work on their feet all day or who do a lot of high-impact exercise, such as running.
In many cases, diabetic socks have white soles. This can alert the wearer if they have any sort of foot wound, because drainage of blood or other fluid will be visible from outside the sock.

There are a variety of diabetic socks available, with different features and advantages to suit each individual’s needs. Today, there acrylic socks, copper infused-socks, heavily-padded socks, a variety of socks made from soft natural materials like wool and bamboo, and even high-tech Smart Socks, which have embedded sensors that alert you of foot temperature changes that might be signs of friction that causes blisters to form.

Diabetics today have access to more resources and tools than ever, and it is vital that they take advantage of that to ensure their optimal health and longevity. But remember, even with fancy socks and shoes, nothing beats a daily foot examination Diligence is the best medicine here.  Make sure to keep up with your doctor when it comes to your feet, too. Always ask about any cuts or blisters that are slow to heal, changes in foot shape, color or temperature, and anything else that looks unusual.