Diabetes Care Is a Team Effort: Why Your Foot Doctor Asks About Your Eyes

A man in his sixties checks the sole of his foot with a hand mirror at dawn, a daily habit between his yearly diabetic foot exam visits.

You came in about a callus. Dr. Lipton checks your feet, trims what needs trimming, and then asks something you did not expect: “When was your last dilated eye exam?” It can feel like a question for a different office. It is not.

November is American Diabetes Month. If you live with diabetes, your podiatrist may be the specialist you see most often, which puts the foot doctor in a good spot to notice when another part of your care has slipped. Below you will find why diabetes care takes a team, what a daily foot check and a yearly diabetic foot exam look like, why a yearly eye exam belongs on your calendar, how diabetes affects your bones, and what to do first if surgery is coming up.

Reviewed by: Marc N. Lipton, DPM, a podiatrist board-certified by the American Board of Foot and Ankle Surgery, whose specialties at OACM include diabetic and vascular foot care.

Watch: Preventive Medicine Diabetic Foot Care: Complications of Diabetes and Your Feet and Prevention, with Dr. Marc Lipton

Why a diabetic foot exam is a team effort

Diabetes care involves a primary care provider, often an endocrinologist, an eye doctor, a dentist, and for many people a foot doctor. The CDC’s diabetes care schedule lists a complete foot check and a dilated eye exam every year, along with kidney tests, a cholesterol test, and a dental exam.

When one of those slides, nobody may notice for a year or two. Your podiatrist sees you on a regular schedule, which makes it a natural place to ask, “Have you had this done yet?”

Your feet: a daily check and a yearly diabetic foot exam

Over time, diabetes can cause nerve damage, called diabetic neuropathy. According to the NIDDK, it can cause tingling and pain and can make you lose feeling in your feet. When you lose feeling, you may not notice a pebble in your sock or a blister until it has turned into a sore. The American Diabetes Association adds that poor circulation can make the foot less able to fight infection and heal.

That is why the CDC recommends that you check your feet every day, ask your primary care provider to check them at every visit, and see a podiatrist once a year or more for a diabetic foot exam. The daily check is simple:

  • Look at the tops, bottoms, and between your toes. Use a mirror, or ask someone in your family to help.
  • Look for cuts, blisters, red spots, swelling, calluses, or sores.
  • Feel inside your shoes before you put them on.
  • Call your provider about anything that is new or not healing.

Do not cut your own calluses or use chemical corn removers. The ADA recommends that a professional on your diabetes care team handle calluses, since cutting them yourself can lead to ulcers and infection.

Watch: A Message From Podiatrist to Diabetic Patients on Preventive Medicine: Get It Seen, with Dr. Marc Lipton

Your eyes: a dilated eye exam every year

Diabetes affects small blood vessels, and the ones in your eyes are among the smallest. Diabetic retinopathy is an eye condition that, according to the National Eye Institute, can cause vision loss and blindness in people who have diabetes.

The hard part is that it may not have any symptoms at first. You can see fine and still have early changes in the retina. That is why the NEI recommends a comprehensive dilated eye exam at least once a year if you have diabetes. The drops widen your pupils so the eye doctor can see the back of the eye.

If your foot doctor asks when you last had one, that is the reason. Nerve damage or slow-healing sores on the feet are a sign that small blood vessels elsewhere need watching too.

Your bones: why fracture risk deserves a look

This one surprises people. A 2024 review in the Journal of the Endocrine Society found that people with type 2 diabetes are at increased risk of fracture, despite often having preserved bone density on a standard bone scan. The same review notes that the usual fracture risk calculators can underestimate that risk.

So a “normal” bone density result may not tell the whole story. Falls matter too: numb feet and blurry vision both make it easier to miss a step. If you have had a fracture, or if you are over 50 with diabetes, ask your doctor whether a bone health evaluation makes sense. OACM’s osteoporosis care and our bone health assessment are good places to start.

If surgery is on your calendar

Whether it is a knee replacement, a fracture repair, or foot and ankle surgery, diabetes changes how you prepare. The American Academy of Orthopaedic Surgeons says that uncontrolled diabetes can slow the healing of bones, muscles, tendons, and skin, and increase your risk of infection. For joint replacement specifically, a review in American Family Physician found that infection risk rises as A1C rises around the time of surgery.

A few things to do before the day of surgery:

  • Talk with the doctor who manages your diabetes about getting your blood sugar where it needs to be. Your surgeon and that doctor should be working from the same plan.
  • Tell your surgeon about insulin and every other diabetes medication you take. Surgery is stressful on the body and can raise blood sugar, so your insulin dose may need to be adjusted.
  • Plan your meals for recovery with your care team. Your body needs protein and steady nutrition to heal. Our article on nutrition for surgery recovery covers the basics, and a registered dietitian can help you fit them to your diabetes plan.
  • Keep up the daily foot check during recovery.

Listen: Fuel for the Fix: Unlocking Better Recovery Through Nutrition, with Dr. Joseph Serino, a fellowship-trained hip and knee replacement surgeon, on A Bone to Fix.

About Dr. Marc Lipton and Dr. Hayden Hoffler

Marc N. Lipton, DPM, is board-certified by the American Board of Foot and Ankle Surgery and has more than 30 years of experience treating foot and ankle pain. His profile notes that he “was appointed Section Chief of Podiatry within the Department of Surgery at Saint Agnes Hospital.” His specialties include “diabetic and vascular foot care” and “advanced wound care, including the use of biological dressings.” He sees patients in Catonsville, Columbia, and Eldersburg.

Hayden L. Hoffler, DPM, is a board-certified, fellowship-trained foot and ankle surgeon whose specialties include “Charcot reconstruction” and “diabetic limb salvage & reconstruction.” He sees patients in Catonsville, Columbia, Eldersburg, and Fulton.

Schedule a diabetic foot exam in Catonsville, Columbia, Eldersburg, or Fulton

If it has been more than a year since a podiatrist looked at your feet, or if something on your daily check is not healing, book a visit with Dr. Lipton or Dr. Hoffler. Call (410) 644-1880 or schedule online.

Frequently asked questions

How often should someone with diabetes see a podiatrist?
The CDC recommends a podiatrist exam once a year or more, plus a foot check by your primary care provider at every visit. If you have had foot problems before, you may need visits more often.
Why would a foot doctor ask about my eyes?
Diabetes affects small blood vessels and nerves throughout the body. If your feet show signs of nerve or circulation problems, your eyes are worth checking too. The NEI recommends a dilated eye exam at least once a year for anyone with diabetes.
Does diabetes weaken your bones?
It can raise fracture risk, even when a bone density scan looks normal, according to a 2024 review. Ask your doctor whether a bone health evaluation is right for you.
Can I have orthopedic surgery if I have diabetes?
Many people with diabetes have successful orthopedic surgery. The key is preparing with your care team so that your blood sugar is well managed before and after the procedure, as AAOS recommends.

Disclaimer

The information in this article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always speak with a qualified orthopedic provider about your specific symptoms and medical history. To schedule an appointment with Orthopaedic Associates of Central Maryland, call (410) 644-1880 or visit mdbonedocs.com.