Diabetic Foot Care

The care of your feet is as important as diet, medication and exercise.  Many complications of diabetes can be prevented if simple steps are taken.

There are two areas in which complications may arise:

• Neuropathy – This occurs when the nerves’ ability to carry pain messages from the feet and legs to the brain is impaired. The feet may feel numb or tingly, especially at night.  Many diabetics are unaware of any change at all.  A minor irritation may not be felt until it has progressed into a more severe, more difficult-to-treat problem.
• Circulatory Changes – Vessels which carry blood to the legs and feet may become impaired and cause muscles and skin to be malnourished. Healing may be delayed and minor skin irritations may develop into major problems such as ulcers and infections.

WHAT YOU CAN DO

Inspect  The most important thing you can do for yourself is inspect your feet every day.  If you can’t see well, ask someone to check your feet for you.  Minor irritations may be discovered early and prevent them from becoming serious infections. Look for areas of redness, irritations, swelling or warmth.  Check the skin for cracking and callus.  Do not forget to look between your toes.  If you find an irritation, keep the area clean and pressure free.  This may mean getting off your feet for a day or two but it will be time well spent.  If a sore does not heal quickly, consult a doctor.

Hygiene – Wash your feet daily with a mild soap.  Use warm, never hot, water.  Do not test the water temperature with your feet.  The water may not feel as hot to your feet as it really is.  Never soak your feet unless instructed to do so by your physician to treat an infection.  Soaking may excessively dry the skin.

Lubrication – Use an emollient to keep the skin soft and prevent dryness and cracking.  Aquaphor, Lanolin, Vaseline, or Eucerin cream usually works quite well.

Nail Care – Cut nails straight across using a clipper, not scissors.  File sharp edges to prevent irritation of the adjacent toes.  If the nails are thick and you have difficulty cutting them, see a podiatrist or your family doctor.  Never use over-the-counter medicines designed to remove ingrown nails.  These contain acid and may cause a skin burn and infection.

Corn and Calluses – These are caused by pressure and are the most common source of ulceration and infection.  Since the pain they usually cause is markedly diminished by neuropathy, you have to look for them and have them treated before they cause problems. Never use over-the-counter preparations to remove corns and calluses or to treat ingrown nails.  A podiatrist can treat these by trimming the callus and reducing the pressure with pads or devices inside your shoes.  Lamb’s wool can prevent irritation between the toes.

Cuts and Abrasions – Keep the wound clean and as free from pressure as possible.  Wash the wound gently with antiseptic soap.  Examine the wound for foreign matter.  Cover the area with a light, sterile dressing.  If healing does not progress rapidly or if there is redness, swelling, or drainage, call a doctor.  If you have a fever or chills, that is an emergency.

FOOT WEAR

1)  Stockings/Socks – Choose soft, absorbent materials such as:  cotton, wool or natural/synthetic blends.  Avoid purely synthetic materials.  Also avoid constricting circulation with elastic top or garters.  Be careful with socks that have seams or holes which can cause pressure and irritation.  Change your sock daily.

2)  Shoes – To prevent foot injuries, never go barefoot, even in the house.  At night, keep a pair of slippers next to your bed.

Wear new shoes no more than two hours a day for at least two weeks to prevent irritation.  Check your feet for areas of redness.  Do not plan on “breaking them in.” To reduce pressure on any one area, change shoes frequently. When buying new shoes try on both shoes.  No two feet are alike – including yours. Shoes should extend about ½” beyond your longest toe.  The second toe is the longest in about 1/3 of the population.

Width – If you pinch the shoe across the top at its widest part, you should be able to grasp a small amount of material between your fingers.

Measurements should be taken while you are standing.  The foot is longer and wider when there is weight on it.

Heels – ½” to 1 ½” are best.  High heels drastically alter the normal mechanics of walking.  This may accelerate the development of deformities and irritate existing ones.  Rubber heels provide much better shock absorption than leather heels and are therefore preferable.

Counter – This is the part of the shoe that holds the heel.  It should be snug to provide the greatest stability.

Material – There are over 250,000 sweat glands in each foot.  If the sweat can’t evaporate, fungus and bacteria will thrive.  Leather allows the foot to “breathe.”  Plastic does not and should be avoided.

Shop for shoes in the afternoon.  Feet swell during the course of the day.  Shoes purchased in the morning may be too tight by the afternoon. Don’t depend on advice of well meaning friends.  Your feet are different from theirs.  Be happy for your friends that they have found comfort and keep on looking.

PHYSICAL ACTIVITIES

Diabetics can generally take part in any form of physical activity.  Many studies have shown that exercise lowers the need for insulin and improves circulation.  Exercise, therefore, is strongly encouraged.

Any form of physical activity should be increased gradually.  The sedentary person who suddenly plays an hour of tennis or takes a three mile walk is asking for problems.

DIABETIC FOOT PROBLEMS CAN BE PREVENTED

Many studies have demonstrated that:  1) Most diabetic foot problems start with minor calluses, ingrown nails, shoe irritation, etc. than can be prevented.  2) Problems that are treated early are much more likely to improve.