American college of foot and ankle surgeons offers tips for patients living with diabetes to prevent disease complications.

As public health officials nationwide take precautions to help senior citizens endure the sizzling summer weather, another group vulnerable to heat-related health problems is people living with diabetes. The American College of Foot and Ankle Surgeons (ACFAS) urges patients living with diabetes to be aware that prolonged hot and humid weather can lead to myriad foot woes—even third-degree burns—if they don’t protect their feet carefully.

“Our concerns for patients living with diabetes include extreme heat, swelling, dryness and cracking from wearing sandals and problems associated with walking barefoot, such as puncture wounds and burns and blisters from hot pavement,” said Thanh Dinh, DPM, FACFAS, a foot and ankle surgeon working in the diabetes clinic at Boston’s Beth Israel Deaconess-Joslin Foot Center.

Dinh said just a few minutes walking barefoot on a hot driveway or sidewalk to fetch the newspaper can badly burn the soles of a patient’s feet due to impaired nerve sensation from the disease.

“Most patients living with diabetes know they shouldn’t walk barefoot, but sometimes they think there’s no harm if it’s just for a few minutes. However, one of my patients recently was hospitalized for three weeks with third-degree burns on the soles of his feet from walking barefoot. He needed multiple surgeries to fix the wounds,” she said.

According to FootHealthFacts.org, ACFAS' consumer website, any type of skin break on a diabetic foot has the potential to get infected and ulcerate if it isn’t noticed right away. Therefore, wearing sandals all the time in the summer poses problems if you have diabetes, adds Virginia-based foot and ankle surgeon Michael Donato, DPM, FACFAS.

“Feet constantly exposed in flip-flops or strap sandals can dry out from loss of moisturizing oils, causing dry, rough skin prone to cracking. So I advise patients who like to wear sandals a lot to inspect their feet very carefully everyday and to wear regular shoes a few days a week to limit exposure,” Donato said.

Some patients living with diabetes experience foot swelling in hot weather, which makes their shoes fit tighter and may exert blister-causing pressure on the toes and heels.

“Like it or not, patients living with diabetes whose feet get swollen in hot weather should wear support stockings,” said Kent DiNucci, DPM, FACFAS, a Scottsdale, Ariz. foot and ankle surgeon. “Compression is the best way to reduce swelling and avoid complications, such as poor circulation and further impaired nerve function.”

DiNucci admitted his patients aren’t happy about having to wear thick compression hosiery in the summer but realize the importance of keeping foot swelling in check to avoid more serious complications.

Dinh noted that vigilant foot care is a year-round responsibility for patients living with diabetes, but the temptations of summer can test even the most conscientious patient’s resolve.

“What’s more natural than bare feet and sandals in the summer?” asked Dinh. “Unfortunately, there’s no off-season for diabetes, so our patients always must be very careful with their feet to avoid skin breaks and subsequent infections and ulcerations that result from this disease.”