Diabetic Foot Care
Diabetes is a disease where the body cannot manufacture or properly use insulin. The body then is unable to convert sugars and starches into energy, leaving an elevated amount of blood sugar. Too much glucose in the bloodstream can damage the feet, heart, kidney, eyes and nerves.
Diabetes can be managed with medical care, exercise and the correct diet to avoid complications.
Neuropathy, or nerve damage, results from too much blood sugar. With neuropathy, feeling is reduced in the feet, so any damage such as a cut or scrape can worsen. Because diabetes also causes poor circulation, the healing blood cannot reach the wound, resulting in an infection and a non-healing wound.
Diabetes warning signs often appear in the feet and can include:
- Leg pain
- Skin color changes
- Slow-healing sores on the feet
- Fungal toenails
- Calluses or corns that bleed
Foot Care for Those with Diabetes
Here are good guidelines to help avoid serious foot problems:
- Check your feet daily. Look for anything unusual and inspect the bottom of your feet too. Call your foot doctor if you notice anything suspicious.
- Wash feet every day in warm, soapy water and dry thoroughly especially between the toes.
- Moisturize feet with a rich, emollient lotion or cream to keep skin supple.
- When trimming the toenails, cut them straight across to avoid an ingrown nail.
- Visit your podiatrist to treat corns or calluses – never cut them yourself.
- Change shoes and socks every day, and put on clean, dry socks when they become damp.
- Consider wearing socks made for those with diabetes. These have loose tops
- and extra cushioning, with fiber that wicks moisture away from the skin.
- If your feet are cold at night, wear socks. Avoid using a heating pad.
- Keep feet warm and dry in all types of weather.
- Avoid going barefoot to protect your feet.
- Keep your blood sugar levels in control.
A Podiatrist’s Role
A podiatrist plays an important role on a patient’s diabetes management team due to the frequency of diabetic foot-related complications. Good foot care and frequent visits to the podiatrist are keys in preventing amputations.
Early recognition of problems such as an ulcer, along with regular foot screenings by a podiatrist, can help reduce the risk of lower limb amputation by up to 85%.
Neuropathy is nerve damage. Peripheral neuropathy is damage to the peripheral nerves that travel to your legs and arms. Damaged nerves will not transmit messages to the brain and therefore patients will have abnormal or decreased sensation in their toes and fingers.
The most common cause of peripheral neuropathy is diabetes. Other causes include heredity, advanced age, arthritis, certain medications, alcoholism, injury and neurological disorders like fibromyalgia and spina bifida.
Any change to the sensation in toes or fingers may indicate peripheral neuropathy. Patients often suffer from burning, tingling, numbness or stabbing pain in the toes or fingertips.
The pain and numbness of neuropathy often can be the first sign of diabetes.
Those who suspect they have peripheral neuropathy must inspect their feet regularly. With decreased sensation, you might not notice a minor injury which can worsen into a serious sore or ulcer. Ask a family member to help check the bottom of the feet. Report anything unusual to your podiatrist.
Patients with neuropathy should wear shoes that fit properly. Protect your feet by not walking barefoot.
There is no cure for neuropathy. Treatment goals are to slow the progression of the disease while maintaining foot health. Oral medication can help relieve any pain.
Patients with neuropathy should visit their podiatrist at least once a year for a thorough examination to check for damage and infection.
TKeeping blood sugar levels under control can help prevent neuropathy. The degree of neuropathy parallels blood sugar control: The better your blood sugar control, the more sensation you will be able to keep in your toes.
Ulcers and Diabetic Wound Care
A diabetic foot ulcer is an open sore or wound that appears on the bottom of the foot and may lead to amputation if not treated quickly.
Two complications from diabetes contribute to foot ulcers:
- Neuropathy, or nerve damage, reduces the sensation in the extremities. A small cut, bruise or puncture wound may not be noticed and can worsen into a sore.
- Poor circulation caused by excess blood sugar can inhibit healing blood flow to the feet. .
Foot deformities, irritation from pressure or friction such as from wearing inappropriate shoes, and trauma can cause the formation of ulcers too.
Pain is not a common symptom because of accompanying neuropathy. But you may notice:
- An open sore
- Drainage on socks
- Unpleasant odor
It’s essential to seek out a podiatrist’s help immediately if you notice an ulcer.
Our goal is healing the ulcer as soon as possible to reduce the chance of an infection. To do this, we will take pressure off the area, remove dead skin and tissue and apply medication and dressing.
Using a brace or specialized castings, wearing special footgear or using crutches or a wheelchair can help reduce pressure and irritation.
Wound management includes keeping the area covered and moist. We will apply topical medication and dressings. We will assess blood circulation levels with non-invasive tests.
We may recommend surgery if other measures to heal the ulcer are not successful. A surgical goal would be to relieve pressure on the affected area.
Complete healing of an ulcer in a patient with diabetes may take weeks or even several months.
Preventing an ulcer from developing is its best treatment:
- Visit your podiatrist regularly for comprehensive foot exams.
- Check your feet every day, especially the soles (ask for someone’s help or use a mirror) and between the toes. Look for any changes in the skin such as a cut, bruise, blister, crack, sore or redness.
- Keep blood sugar levels under control.
- Wear appropriate shoes that are supportive, roomy and comfortable.
- Reduce risk factors such as smoking, drinking alcohol and high cholesterol.