Diabetic Foot Care
Importance of Diabetic Foot Care
Diabetes can affect many systems in the body. When diabetes is uncontrolled it may cause nerve damage, circulation issues and skin problems, which can manifest into serious foot problems. Nerve damage or diabetic neuropathy, can rob the protective normal sensation of skin, while a decrease in circulation and high blood sugar can interfere with the body’s ability to heal wounds and infections of the feet.
The best way to prevent these problems is by taking special precautions and to maintain good foot health. It is especially important for patients with diabetes to maintain a healthy lifestyle. This includes: regular podiatric medical exams, exercising consistently and controlling blood sugar daily by maintaining a balanced diet and minimize simple sugar intake.
There are certain early signs and symptoms of diabetic foot problems of small nerves and vessels in the feet, which should be monitored by your podiatrist on a regular basis. Changes to the shape, appearance and color of your feet and loss of hair on your toes can be signs of circulation changes. Decrease in circulation over time can also cause thickening and yellowing of toenails as well as dry, cracking skin, blisters, sores and ulcers. Loss of sensation to touch, inability to distinguish temperature changes, and burning, tingling or pain in your feet can be signs of neuropathy or nerve damage. Poor circulation and neuropathy in combination put diabetic patients at a high risk for limb and life threatening infections and amputations. If you have any of these symptoms call our office directly.
These are simple things that we recommend at to perform daily. Inspecting and washing feet daily is very important for a diabetic patient. Check feet, toes and especially the less noticeable areas like between toes and the soles or bottoms. Many diabetic foot issues take place in these hard to visualize areas. If you can’t see the bottom of your feet, then use a small mirror or ask someone to look at your feet for you. If you find any redness, cuts, blisters or sores contact our office immediately.
Feet should be washed daily with mild soap and warm water, followed by very thorough yet gentle drying especially in between the toes. This moist and dark area can provide and excellent breeding ground for bacteria, fungus and warts. Harsh rubbing with a towel may irritate your skin. Many diabetics cannot accurately sense water temperature with their feet so it is best to test the water on hands or elbows. This can help ensure the water is not too hot. Which may scald or damage your skin and lead to dangerous infections.
Skin is the largest organ of the body and is the first line of defense from the outside world. It is recommended that patients with diabetes use specially formulated foot moisturizers to keep skin healthy. A podiatrist can recommend and over the counter or prescribe a medicated version. Maintaining the correct moisture balance in the skin can be a challenge because many diabetics may develop dry and rough skin as the disease progresses.
Most people can trim their own toenails but may be a difficult task for some diabetic patients, especially those that are older and have difficulty reaching or seeing their toes. Many diabetics who have circulatory, neurological or poor vision are not advised to trim their nails as this is unsafe. Performing “ bathroom surgery” can lead to infections and sometimes even loss of toes and limbs.
When cutting nails, make sure the nails are cut straight across and not on an angle or curve, which can cause and ingrown toenail. Trimming nails after bathing your feet is best because nails are soft and clean. Anyone who has difficulty reaching or seeing their feet, or if nails are discolored or thick should be evaluated by our doctors. Nails can be safely cut, or debrided in a professional setting.
Footwear is also very important for people with diabetes. Choose shoes that fit well and have plenty of room in the toe box and that have adjustable velcro or laces. Shoes made of leather, canvas or suede are often recommended and it is paramount that the insides of shoes are free of any foreign substances that can cause irritation and sores.
A podiatrist can prescribe extra depth shoes with special inserts made of an accommodative material for patient with neuropathy. These become especially helpful to alleviate pressure points on the bottom of their feet that may be caused by bunions, hammertoes or bone spurs. Diabetic shoes with these inserts can prevent or minimize the chance of developing diabetic ulcers and help accommodate deformities that cannot fit into a conventional shoe.
Many diabetic patients do not have ability to sense fully when they step on something, so walking barefoot should be avoided. Small objects, splinters and even hair or carpet fibers can penetrate the skin and lead to infections. Using slippers in your home adds another barrier to protect your skin.
Calluses or corns can should be treated to alleviate these pressure points by your podiatrist. It is not recommended that patients cut them themselves. Most of these lesions are in hard to reach places. See your foot specialist at our office instead of using blades, shavers, or chemical corn removers on your skin, which can be erosive and cause sores, ulcers and infections.
Using electric blankets and heating pads on your feet can also be very dangerous due to the insensitivity to temperature leading to blisters and burns to your feet. Using cotton socks if feet are cold is much safer. Diabetic socks are also available that can help insulate and protect cold feet.
Getting a comprehensive foot exam so that the doctor can assess circulation, neurological and skin integrity every 6 months is recommended by the American Diabetes Association. If you have high-risk foot conditions then your feet should be evaluated more frequently.
During initial exam, our doctors will assess circulation, protective sensation, foot structure and skin integrity. This helps determine risk for developing ulcerations and infections. Foot X-rays are routinely taken to further assess bone structure and determine if there are pressure points that may lead to future foot ulcers. Non invasive circulation testing may include a doppler study and if there is a suspicion of serious circulation issues, then patients would be referred for further vascular assessment.
Patients should be educated on their risk factors and understand the implications of losing protective sensation. Goals include maintaining skin integrity and daily inspections of feet and shoe gear. These are the simplest and the most important preventative measures for patients with diabetes.