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Managing Diabetes

Looking After Your Feet

Why the concern over Feet?

CartoonCare of the feet is particularly important when you have diabetes in order to avoid complications which could lead to ulceration of the feet or amputation of a toe or limb. Foot care is especially important if you have

  • Loss of feeling in your feet
  • Poor circulation
  • Changes in the shape of your feet
  • Foot ulcers or sores that do not heal

Damage to the Nerves of your feet due to diabetes (Peripheral Neuropathy) can cause you to lose feeling in your feet. A small stone in your shoe or in extreme situations a nail in the sole of your foot may pass unnoticed. Patients have been known to suffer burns of their feet due to placing the feet on a hot radiator where sensation of temperature is impaired. A blister due to a poorly fitting shoe may develop into a large sore before it comes to your attention.

Keeping your blood glucose (sugar) in good control and taking care of your feet every day can help you avoid serious foot problems.

What are the main causes of foot ulcers?

Foot ulcers are more common in people with diabetes due to one or more of the following problems

  • Neuropathy
  • Poor Circulation
  • Obesity
  • Abnormal weight bearing due to joint problems (Charcot Arthropathy)
  • Prone to infections due to poor control, dry skin etc

What can I do to prevent problems?

  • Take care of your diabetes. Aim to keep your blood glucose, blood pressure, and cholesterol close to normal. Doing so may help prevent or delay diabetes-related foot problems as well as eye and kidney disease.
  • Examine your feet every day, especially if you have neuropathy or poor circulation. Look for cracks, cuts, sores, red spots, swelling, and infected toenails. Find a time (evening is best) to inspect your feet each day and make this a part of your every day routine. If you have trouble bending over to see your feet, use a mirror to help or ask a family member or care professional to help you.
  • Wash your feet every day. Use warm, not hot, water.  Before bathing or showering, test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow. Dry your feet well. Be sure to dry between your toes. Do not soak your feet, because your skin will get dry.
  • Keep the skin soft and supple by using liberal amounts of emulsifying cream especially over any areas of hard skin. Avoid using creams in between the toes as this may cause the skin to become too moist and lead to infection
  • Wear footwear at all times. Preferably shoes and socks. Ensure your shoes fit well. Remember loose fitting shoes are as likely to cause ulceration as tight ones. An insole may help protect your feet, ask your podiatrist. Choose clean, lightly padded socks that fit well. Socks that have no seams are best. Change your socks daily!
  • Check your feet often in cold weather to avoid frostbite
  • Ensure your toenails are cut 'straight across', preferably by a podiatrist.
  • Don't cause problems for your circulation! Avoid crossing your legs and do not wear tight socks.
  • Exercise helps stimulate blood flow. Choose activities which do not place undue pressure on your feet. Swimming, Cycling and walking are generally safe.
  • Gentle foot massage is good for circulation.
  • always treat athletes foot promptly. Seek professional advice.
  • Keep feet warm in winter by wearing warm clothing such as leg warmers and 'long johns'. 'Lagg the pipes' and the blood will be warmer when it enters your feet. Never warm feet quickly by sitting close to fires or using hot water bottles.

How does a podiatrist help?

A podiatrist can do a great deal to prevent ulcers and to keep your feet healthy. Some of the many ways a podiatrist can help are by

  • treating corns and calluses - paring down hard skin which causes build up of pressure
  • using padding to redistribute pressure away from danger areas
  • safely trimming your toe nails
  • advising on correct footwear
  • examining your feet. You should be tested annually for signs of neuropathy and poor circulation.
  • prescribing orthoses. These are devices used to correct foot instability

Who should see a Podiatrist?

Ideally all people with diabetes should have access to podiatry. Unfortunately resources often do not permit this and podiatrists tend to concentrate their efforts on people who at particular risk of ulcers. We suggest you see a podiatrist regularly if you have any factors which place you at risk of developing an ulcer or if you have visual impairment which makes it unsafe to trim your toenails.

Do seek treatment from state registered podiatrists and chiropodists (they use the letters S.R.Ch after their names).

To locate a podiatrist follow the link to the website of the Society of Podiatry.

Advice on footwear

Wear well fitting shoes which are comfortable. Shoes which are loose are every bit as unsafe as shoes which are too tight. Poor quality footwear may result in bunions, corns, calluses, painful heels and in-growing toe nails. Some suggestions for buying shoes

  • have your feet measured by staff
  • if your feet tend to swell up later in the day, shop for shoes at the end of the day!
  • choose 'sensible' shoes rather than those with pointed toes or extra high heels!
  • if you have any deformities of your feet such as bunions or hammertoes you may require shoes which are extra wide or have greater depth. In this situation, custom made or bespoke footwear is often the best solution.

Some don'ts!

  • Do NOT cut corns or calluses. Never use razor blades, corn plasters, or liquid corn and callus removers - they can damage your skin.
  • Do NOT soak your feet or place them on hot water bottles, radiators or near open fires
  • Do NOT walk barefoot. Many ulcers begin on holiday walking on the beach!
  • Do NOT smoke. Smoking reduces blood flow to your feet. Ask for help to stop smoking.

For more information

Take care of your Feet for a lifetime!

http://ndep.nih.gov/campaigns/Feet/Feet_overview.htm

 

Dr Nishan Wijenaike, Consultant Physician
West Suffolk Hospitals Diabetes Service
October 2002