If you have healthy feet, you probably don't think twice about plopping on a pair of sandals or plodding barefoot across the beach in the summertime.

But for diabetics with neuropathy, the warm weather months can bring more dangers to their often-numb and no-longer-nimble feet. Following certain, ahem, steps can help these individuals safeguard their soles while in the sunshine.

No Stroll In The Park
Neuropathy involves a disorder of the peripheral nerves, which include the motor, sensory and autonomic nerves that connect the spinal cord to muscles, skin and internal organs. It usually affects the hands and feet, causing weakness, numbness, tingling and pain. Peripheral neuropathy can progress slowly and become severe and debilitating, but it can be controlled if diagnosed early. Diabetes causes about 30 percent of neuropathy cases.

Since numbness is one of the symptoms, those with neuropathy are often at risk for injuring themselves or developing infections. If not treated quickly, infections can spread to the bone and, in severe cases, lead to amputation.

"Because people with neuropathy [may] not feel their toes or feet, one of the biggest problems is that they might have a minor injury and not feel it," said Patricia Kluding, PhD, PT, an assistant professor in the physical therapy and rehabilitation sciences department at the University of Kansas Medical Center. "So a blister from a tight shoe or a small cut can get ignored, become inflamed or infected, and the patient still wouldn't know about it.

"High levels of blood glucose can also present a double whammy following a skin injury: healing of tissues can be impaired because of damage to the small blood vessels in the skin, and bacteria can feed on the sugar content in that environment."

Common injuries seen in individuals with neuropathy include ulceration, infection due to undetected trauma or ingrown nails, and Charcot foot deformity, said Nicholas Taweel, DPM, PT, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia.

Most diabetic ulcerations, he said, are related to neuropathy and increased plantar pressure at the area of the ulcer, which often occurs without the neuropathic patient's knowledge. The lack of protective sensation in the foot causes the ulceration to expand.

Charcot foot deformity, of which diabetic neuropathy is the most common cause, involves joint destruction, pathologic fracture and, eventually, permanent foot deformity.

"Early in the pathogenesis, the clinician will note increased swelling, redness and warmth of the foot," Taweel explained. "This is commonly misdiagnosed as cellulitis or deep vein thrombosis. While these conditions must be ruled out, it is imperative that Charcot foot be considered. Initial treatment involves strict off-loading. Delayed diagnosis and treatment will allow further destruction and deformity."

Feets Of Daring
For those with neuropathy, the summer months bring the added stressors of heat and the temptation to wear less-protective shoes.

When it comes to foot temperature, a local increase in skin heat due to inflammation and enzymatic activity of the damaged tissue can mean an impending ulceration, Taweel explained. Individuals can use special skin-surface thermometers to measure the temperature at various locations on the foot multiple times a day. A difference of 2 degrees C over 2 days suggests pre-ulceration and can signal an early warning for those without protective sensation.

At that point, patients should significantly limit activity and see a foot specialist as soon as possible. In general, individuals must avoid foot soaking, hot-water bottles and heating pads, and use a thermometer to make sure bathwater temperature does not exceed 99 degrees F.

"Increased frequency of monitoring may be advisable in the summer months when individuals tend to be more active," Taweel said. "However, there are no studies that suggest ambient temperature plays a role. The increased temperatures are local and relative to other areas of the foot. Increased local temperature and ulceration can occur in the winter, spring, summer or fall."