Whether you’ve been exercising for years or are just getting started, you’ll want to do everything you can to stay injury free. This article focuses on a crucial aspect of athletic injury prevention for people with diabetes: foot care.

Most people are familiar with the benefits of regular aerobic exercise: strengthening the cardiovascular system, helping to maintain or lose weight, and reducing stress. Most forms of aerobic exercise are weight-bearing exercises that put your feet under a lot of stress.

Take your daily walk, for example. With each step your foot carries 1 1/2 times your body weight. Pick up the pace to a jog and your feet carry three times your body weight. For a 150-pound person that’s 450 pounds per step.

People with diabetes are more vulnerable to foot injury. Neuropathy (nerve damage) may decrease your ability to feel injuries or pain. Diabetes may also result in impaired circulation, which can mean slow or poor healing when injuries do occur.

Before starting or changing your exercise program, consult with your physician and diabetes educator. Your doctor may want to perform some screening tests to check for blood vessel damage, neuropathy, and retinopathy. You will also want to ask your doctor about the types of activities that your feet and legs can tolerate. Some activities place more stress on your feet than others.

In addition to talking with your physician, I would also recommend consulting with a podiatrist knowledgeable in diabetes care and sports. Discuss your plans for starting, changing, or increasing your exercise program. Your doctor and podiatrist should be able to examine your feet and suggest activities that would be safe for you.

Keep in mind that an activity or sport that is recommended for one person with diabetes may not be a good choice for another. In fact, some people with diabetes have a foot structure that requires any nonessential walking or weight bearing on their feet to be kept to a minimum. People who have little sensation in their feet, who have feet that ulcerate, or who have a significant bone deformity such as a depressed metatarsal fall into this category.

The following are some common activities, potential problems, and simple solutions and preventive measures that can help.

Walking And Running

Blisters. These are probably the most common complaint of walkers and runners. Blisters are caused by an increased area of friction. A lack of sensation – not feeling the irritation – may also contribute to the blister’s development. The friction results in a fluid-filled area forming under the skin, which may be painful.

I suggest getting professional care for your blisters unless your podiatrist has trained you to treat them yourself. You may prevent blisters by wearing shoes that fit properly, using a Spenco insole in your shoe, and making sure there are no worn spots on your socks or inside your shoes.

Black toenail. This is a condition in which blood has collected under a toenail and coagulated, giving the nail a black-blue appearance. Black toenail often stems from wearing shoes that are too small or running (or walking) downhill so that the foot slides forward and jams against the front of the shoe. If you notice a black toenail, seek professional care because the discoloration could be masking an underlying ulceration. Avoid black toenail by wearing shoes that fit correctly and keeping your toenails the proper length.

Numb toes. If you notice that your neuropathy seems more intense while exercising, your shoe lacing may be the culprit. Shoe laces or any plastic grommets (speed lacing) may put excessive pressure on some nerves on the top of your foot. Irritation of these nerves may be confused with neuropathy. The treatment is simple: Try lacing your shoes more loosely or select shoes without speed lacing.

Aerobic Dance

With the advent of home videos, many people enjoy the convenience of exercising at home. Without the supervision of an instructor, it’s easy to become sloppy about the basics of sports injury prevention. Wear shoes! It’s very easy when doing aerobic dance at home to accidentally knock your foot into the coffee table or lamp and break a toe. Shoes not only help protect your feet, they also provide cushioning as you jump or bounce. Also be aware of your exercise area. Scatter rugs and shag carpet can easily trip you up. If you plan to sign up for aerobic classes, look for a classroom with wooden floors or special aerobic flooring. These surfaces are easier on your feet than tile or concrete floors.

Swimming And In-Pool Aerobics

Of the exercises discussed in this article, swimming and water aerobics place the least stress on your feet. You’ll still want to take some precautions, however.

I do not recommend swimming if you have an open sore on your foot. To avoid catching a fungus infection (athlete’s foot), wear thongs (preferably ones that do not go between the toes) in the locker room and on the pool deck.

Biking If you plan to ride more than 10 miles at a time, it may be worthwhile to invest in a pair of bike touring shoes, not only for comfort but to prevent injury. Touring shoes are not the same as the cleated type of biking shoe, which attach to the peddle with a cleat.

Unlike sneakers, bike touring shoes have a stiff sole where the peddle contacts the shoe. This stiff surface helps spread out the pressure from the peddle more evenly and prevents any high pressure points that could lead to breakdown of the skin in someone suffering from diabetic neuropathy.

If you are already biking and using cleated shoes be aware that they are narrow shoes and could put excessive pressure on some nerves in the feet. This could cause numbness, tingling, or aching in your toes. This should be differentiated from diabetic neuropathy and treated professionally.

Downhill Skiing, Cross-Country Skiing, And Ice Skating

Discuss these sports with your physician and health-care team before you start. People who have insensitive feet because of neuropathy and impaired circulation are more prone to frostbite.

One caution: Heated ski boots are on the market. I would not recommend these for people with diabetes.

Don’t let your feet fail you when it comes to staying fit. Talk to your doctor and podiatrist for suggestions about keeping your feet in tip-top shape. Practice good foot care, keep your blood-sugars in reasonable control, visit your diabetes specialist and podiatrist regularly, follow the guidelines in this article, and you should be able to exercise safely without having your feet trip you up.