When it comes to the type of shoes worn, individuals with neuropathy should not wear sandals, because the straps can cause pressure spots, especially if the feet get swollen, Kluding said. Plastic or rubber shoes can trap the heat. Flip-flops should also be avoided, as the pressure point between the toes can cause problems.

Instead, individuals with neuropathy should don shoes made from a breathable material with roomy toes and a supportive sole, she said. Of course, any skin on the feet exposed to the sun should be covered by sunscreen. And, as tempting as the warm sand may be, diabetics with neuropathy must refrain from kicking off their shoes.

"People with neuropathy should never go barefoot," Kluding stressed. "Walking over hot pavement or on hot sand is very dangerous and can lead to serious burns and blisters. Shoes should also be worn indoors to protect the feet from sharp objects or bumping the toes."

While some might be tempted to get pedicures to titivate their toes in the spring and summer, diabetic patients with risk factors should abstain, Taweel said. Also, foot massages should avoid deep-tissue work and techniques that involve moderate to high amounts of skin friction or use of instruments.

One Step At A Time
People tend to be more active in the summer. Individuals with neuropathy can face a conundrum in this arena, because while they're encouraged to exercise to control their diabetes, they also must avoid activities that could cause injury to their feet.

"Diabetic patients are encouraged to walk and exercise, even those with risk factors," Taweel said. "Proper footwear, frequent visual foot inspections and injury precautions will avoid the development of ulcerations and infection. Also, proper disease management is crucial. Active vacations notoriously disrupt normal routines. Diabetic patients may skip blood glucose monitoring, medication, insulin injections or meals. This will result in erratic blood glucose levels and associated problems."

Ankle pumps are the basic exercise recommended to help with circulation and the prevention of pooling of blood that can lead to problems for those with neuropathy, Kluding said. The exercise involves either holding the foot straight out or resting it on a slightly elevated surface and flexing the ankle up and down.

"The basic ankle pump can be expanded to include side-to-side motions, ankle circles and even spelling out letters with your big toe," she said. "I like to ask patients to spell out their names or go through the alphabet, to make sure that they are doing a sufficient number of repetitions."

People with neuropathy are often at risk for more foot problems when doing weight-bearing exercises, especially running or even long-distance walking, Kluding added, so they should consider other activity options. Riding a bicycle, using a recumbent stepper and swimming - with pool shoes to avoid injury - can be good substitutes, she said.

Elderly patients suffering from neuropathy can be at higher risk for falls than older adults without diabetes, according to Kluding. Therapists working with this population can start by finding out which fall risk measures are most sensitive in this population.

Individualized recommendations and precautions can help neuropathic patients of all ages manage their risk of foot injury while still maintaining an active lifestyle.

"I think it makes a world of difference to have that individualized assessment and instruction," Kluding said. "Typically, people with diabetic neuropathy are just told that they need to exercise, but that they need to be careful because they might injure their feet. This is a mixed message that is confusing to people who just don't know where to start."

Lauren Fritsky is assistant editor at ADVANCE.

Do's and Don'ts From Dr. Taweel

Do:

• Wear recommended footwear.
• Perform frequent skin inspections.
• Cut nails straight across without digging into corners.
• Apply sunscreen and moisturizer.
• Remember to pack medication, insulin, glucose monitor, proper socks and footwear, and doctors' phone numbers when vacationing.
• Take insurance information when traveling and seek local medical care if a problem occurs.
• Avoid dehydration.
• Follow proper disease management routines while on vacation.

 Don't:

• Walk barefoot over asphalt or pool decks. In the summer, the surface temperatures can exceed 160 degrees F, and just a few seconds of exposure can cause a second- or third-degree burn.
• Wear flip-flops or ill-fitting sandals.
• Use hot-water bottles, heating pads or hot foot soaks.
• Cut corns or calluses.
• Use chemical corn and callus removers.