The care of your feet is as important as diet, medication and exercise. Many diabetes related foot complications 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 cannot see well, ask someone to check your feet for you. Minor irritations may be discovered early and prevented 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 the sore does not heal quickly, consult a doctor. When you call, let them know that you are a diabetic and have an open sore on your foot that needs to be seen soon.
Hygiene – Wash your feet daily with a mild soap. Use warm, never hot water. Do not test the water temperature with your feet. In the presence of a diabetic neuropathy, 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, urea creams (e.g. Carmol), lanolin or solid vegetable shortening such as Crisco usually work very well.
Nail care – Cut nails straight across using a clipper not scissors. File the edges to prevent irritation of the adjacent toes. If the nails are thickened 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.
Corns and calluses – These are caused by pressure and are the most common source of diabetic foot ulcers and infections. Since the pain they usually cause is markedly diminished by neuropathy, you have to look for them and have them treated before they cause pain and problems.
Never use over-the-counter preparations to remove corns and calluses or treat ingrown nails. A podiatrist can treat these by trimming the nails and reducing the pressure with pads or devices inside your shoes. Lambs wool can prevent irritation between the toes.
Cuts and abrasions – Keep the wound cleaned and as free from pressure as possible. Watch 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 a medical emergency.
Stockings/Socks – Use soft, absorbent materials such as cotton, wool or natural/synthetic blends. Avoid purely synthetic materials. Also avoid constricting your circulation with elastic top or garters. Be careful with stocks that have seams which can cause pressure and irritation. Change your socks daily.
Shoes – To prevent injuries, never go barefoot, even in the house. At night, keep a pair of slippers next to your bed.
New shoes – Where new shoes for no more than two hours a day for the first two weeks to prevent irritation. This provides your skin an opportunity to build up strength against sources of irritation. Check your feet for areas of redness. Do not try to “break them in” by wearing new shoes all day. Foot ulcers are a common result.
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.
Length – A shoe should extend about 1/2″ 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 all be taken when you are standing. The foot is longer and wider when there is weight on it.
Heels – 1/2″ to 1 1/2″ are best. High heels drastically alter the normal mechanics of walking. This may accelerate the development of deformities and irritate existing ones. If you’ve been wearing high heels for a long time, low heels may be uncomfortable at first. That is usually because the muscles in the back of the leg have accommodated and shortened.
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 breathe and should therefore 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.
Do not depend on the advice of well-meaning friends. Your feet are different from theirs. Be happy for your friends that they have found a comfortable shoe and keep on looking.
Diabetics can generally take part in any form of physical activity. Many studies have shown that exercise lowers the need for insulin and improved 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 3 mile walk is asking for potentially serious problems.
Diabetic foot problems can be prevented
Many studies have demonstrated that most diabetic foot problems start with minor calluses, ingrown nails, shoe irritations etc. that can be prevented. Problems that are treated early are much more likely to improve and resolve.