Massage With Diabetes, Neuropathy and Fragile Skin: Cautions

Urgent Signs First

Call your health care provider right away about a cut, blister or bruise on your foot that does not start to heal after a few days, or foot skin that becomes red, warm or painful, which can be signs of infection. [1] Massage is not the answer to these. A swollen, painful, warm leg can also be a blood clot; if you also have chest pain or breathlessness, call 911 and read massage and blood clots.

The Short Version

Massage is a comfort measure that some people with diabetes use, but three things call for care: numb or dulled feeling (neuropathy), heat, and skin that breaks easily. Evidence that massage treats diabetic nerve problems or improves blood sugar is insufficient. It should never replace your diabetes care, foot checks or medicines.

Why Feeling and Skin Matter

When nerve damage reduces feeling in the feet, you may not feel a pebble in your sock or a blister, which can lead to cuts and sores. [1] Cuts and sores can become infected. [1] Diabetes can also lower blood flow in the feet. [1] About one-third to one-half of people with diabetes have peripheral neuropathy. [2] Symptoms include numbness and tingling in the feet or hands, and burning, stabbing or shooting pain. [3]

This leads to three plain-language cautions. The sources above do not test massage directly, so these are sensible questions, not proven rules.

• You may not feel too much pressure. If you cannot feel a blister, you may not feel when touch is too firm. Ask for light, gentle pressure on numb areas and tell the therapist where feeling is reduced.
• Heat can injure numb skin. The NIDDK foot-care advice says not to put a hot water bottle or heating pad on your feet. [1] Heat is part of some sessions, such as hot stones or heated tables, so tell the therapist and see Hot Stone Massage: Heat Safety.
• Oils and creams. NIDDK advises not putting lotion or cream between the toes because moistness might cause infection. [1] Ask that none be used there.

A red, warm, swollen foot may be an infection or a clot, and it can also be an early sign of a bone problem called Charcot's foot. [1] It needs a clinician, not massage.

Insulin Injection Sites

A 1986 study of nine healthy volunteers found that massaging an insulin injection site sped up absorption, and blood sugar fell faster on the massage day. [4] A later review says massage and heat increase blood flow and the absorption of insulin given under the skin. [5] These are small, older studies in people without diabetes, so we cannot say how much it matters in daily life. Tell the therapist where you inject or wear a pump or sensor, ask them to avoid those areas, and ask your diabetes team about timing around meals and medicines. Some nerve damage can also lead to hypoglycemia unawareness, meaning you may not notice low blood sugar. [2]

What Research Found

Single small, unblinded trials cannot show that massage itself caused a change, since attention and routine also differ. For more on pressure points, see Acupressure.

Fragile Skin

Thin or fragile skin can tear, and skin tears can be painful and become chronic and infected. [11] A review of nursing care found rough handling, jewelry and long nails can increase the risk. [11] That review was about nursing care, not massage. NCCIH notes rare serious harms from massage, some in people at higher risk of injury, such as elderly people. [12] If your skin is fragile, ask for gentle, slow work, no rough dragging of drapes or skin, and removal of rings and bracelets. See Massage and Skin Conditions, Infections and Wounds and Massage for Older Adults.