It’s important to understand the connection between diabetes and foot care. As a person with diabetes, you are more vulnerable to foot problems because diabetes can damage your nerves and reduce blood flow to your feet. By taking proper care of your feet, most serious health problems associated with diabetes can be prevented.
Society pays a lot to amputate a leg, but almost nothing to protect it – Bernard Shaw.
Daily foot care routine in diabetes
i. Check your feet every day. Inspect the top, sides, soles, heels, and between the toes.
ii. Wash your feet every day with lukewarm water and mild soap. Strong soaps may damage the skin.
iii. Test the temperature of the water before putting your feet in, because the normal ability to sense hot temperature is usually impaired in people with diabetes. Burns can easily occur.
iv. Gently and thoroughly dry the feet, particularly between the toes. Infections can develop in moist areas.
v. Because of skin changes linked with diabetes, the feet may become very dry and may crack, possibly causing an infection. After bathing the feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your toes.
vi. Ask your health care provider to show you how to care for your toenails. Soak your feet in lukewarm water to soften the nail before trimming. Cut the nail straight across, because curved nails are more likely to become ingrown.
vii. Exercise daily to promote good circulation. Avoid sitting with legs crossed or standing in one position for long periods of time.
viii. If you smoke, stop. It decreases blood flow to the feet.
Important tips on shoes and socks
i. Wear shoes at all times to protect your feet from injury. Otherwise, if you have poor vision and less ability to feel pain, you may not notice minor cuts or bumps.
ii. Wear comfortable, well-fitting shoes. Never buy shoes that do not fit properly, expecting the shoes to stretch with time. Nerve damage may prevent you from being able to sense pressure from improperly fitting shoes.
iii. Check the inside of your shoes for rough areas or torn pieces that can cause irritation.
iv. Change your shoes after 5 hours of wearing during the day to alternate pressure points.
v. Avoid wearing thong sandals or stockings with seams that can cause pressure points.
vi. Wear clean dry socks or non-binding panty hose every day. Socks may provide an extra layer of protection between the shoe and your foot.
vii. Wear socks to bed if your feet are cold. In cold weather, wear warm socks and limit your exposure to the cold.
More helpful tips
i. Avoid using antiseptic solutions on your feet since these can burn and injure skin.
ii. Avoid applying a heating pad or hot water bottle to the feet. Avoid hot pavement or hot sandy beaches.
iii. Report sores, changes, or signs of infection to your doctor immediately. Report all blisters, bruises, cuts, sores, or areas of redness.
iv. Remove shoes and socks during visits to your health care provider. This is a reminder that you need a foot exam.
v. Make an appointment with a podiatrist to treat foot problems or to have corns or calluses removed. Never attempt to treat these yourself using over-the-counter remedies.
vi. If obesity prevents you from being physically able to inspect your feet, ask a family member, neighbor, or visiting nurse to perform this important check.
Here are some diabetes foot care tips to follow:
i. Wash and Dry Your Feet Daily
ii. Use mild soaps.
iii. Use warm water.
iv. Pat your skin dry; do not rub. Thoroughly dry your feet.
v. After washing, use lotion on your feet to prevent cracking. Do not put lotion between your toes.
Examine your feet each day
i. Check the tops and bottoms of your feet. Have someone else look at your feet if you cannot see them.
ii. Check for dry, cracked skin.
iii. Look for blisters, cuts, scratches, or other sores.
iv. Check for redness, increased warmth, or tenderness when touching any area of your feet.
v. Check for ingrown toenails, corns, and calluses.
vi. If you get a blister or sore from your shoes, do not “pop” it. Apply a bandage and wear a different pair of shoes.
Take care of your toenails
i. Cut toenails after bathing, when they are soft.
ii. Cut toenails straight across and smooth with an emery board.
iii. Avoid cutting into the corners of toes.
iv. You may want a podiatrist (foot doctor) to cut your toenails.
Be careful when exercising
i. Walk and exercise in comfortable shoes.
ii. Do not exercise when you have open sores on your feet.
Protect your feet with shoes and socks
i. Never go barefoot. Always protect your feet by wearing shoes or hard-soled slippers or footwear.
ii. Avoid shoes with high heels and pointed toes.
iii. Avoid shoes that expose your toes or heels (such as open-toed shoes or sandals). These types of shoes increase your risk for injury and potential infections.
iv. Try on new footwear with the type of socks you usually wear.
v. Do not wear new shoes for more than an hour at a time.
vi. Look and feel inside your shoes before putting them on to make sure there are no foreign objects or rough areas.
vii. Avoid tight socks.
viii. Wear natural-fiber socks (cotton, wool, or a cotton-wool blend).
ix. Wear special shoes if your health care provider recommends them.
x. Wear shoes/boots that will protect your feet from various weather conditions (cold, moisture, etc.).
xi. Make sure your shoes fit properly. If you have neuropathy (nerve damage), you may not notice that your shoes are too tight.
What to do if you get a diabetic foot ulcer?
It is estimated that about 15% of people with diabetes will develop a foot ulcer sometime during their lifetime. Fortunately, up to 86% of foot ulcers will heal when treated properly. A foot ulcer is defined as a break in the skin or deep sore; they are most often located on the ball of the foot, an area of repeated stress.
If you develop any kind of sore or wound on your feet that doesn’t heal in a day or two, it’s very important that you see your doctor or foot care specialist right away. Untreated lesions or ulcers can become infected quickly; even when treated, foot ulcers may not heal well in people with diabetes.
How are diabetic foot ulcers treated?
Your doctor may x-ray your feet to make sure the bone is not involved. If the results are not clear, you may have an MRI scan to help your doctor determine the extent of the lesion.
Treatment must address all of the factors involved in wound healing:
i. Infection – which stops or delays the normal wound repair process.
ii. Repeated trauma during the wound healing process – which continually destroys new tissue.
iii. Decreased blood flow – which reduces the amount of oxygen and nutrients getting to the tissues.
Treat the infection
The doctor will thoroughly clean the wound to remove all infected tissue; in severe cases, this may be done in the operating room. Early, aggressive wound cleaning (called “debridement”) has been shown to heal these wounds more rapidly. If there is an infection, your doctor will prescribe antibiotics. If the infection is serious, you may be hospitalized to receive intravenous antibiotics.
Dressings are used to prevent further trauma, to minimize the risk of infection, to relieve local pain, and to optimize the environment for healing. A moist wound environment is important for wound healing to occur.
You can help by keeping the area clean and moist at all times and using the medications your doctor has prescribed for you. It’s important that you only use the medications your doctor has suggested. People used to use cleansers or antiseptics such as hydrogen peroxide on these types of wounds, but it is now known that they actually delay wound healing. They also dry out the tissue, and it is now believed that a moist environment stimulates more rapid wound healing.
Depending on the location of your foot ulcer, you may need to keep pressure off the area. This is called “off-loading” and means avoiding all mechanical stress on the wound so that it can heal. If there is no infection, a total contact cast may be used to relieve pressure. Or your doctor may recommend using “non-weight-bearing” devices such as orthopedic shoes, a walker, crutches, or even a wheelchair or bed rest – these can help healing by relieving pressure on the injured part of your foot. If your doctor has suggested keeping weight off of your foot, it’s important to do so. Keep your foot elevated as much as possible.
Improve blood flow
If there is evidence of impaired blood flow to your feet, then your doctor may consider a surgical procedure called “revascularization.” This involves bypassing or implanting a graft past lesions in the arteries that are obstructing blood flow. These procedures have been as successful in restoring blood flow for people with diabetes as in others and have been shown to help achieve rapid and durable healing of diabetic foot ulcers. They have also been shown to decrease the need for amputation.
New treatments for foot ulcers in diabetes
New treatments such as recombinant growth factors and bioengineered skin patches are now available to help improve healing of foot ulcers. Growth factor gels contain a protein that helps the ulcer fill in with healthy tissue, so it heals faster and better than it would otherwise. Human skin cells are processed and grown in the laboratory to produce bioengineered skin, or skin equivalents, which are applied to the foot ulcer to enhance the process of wound healing.
Foot care experts are encouraged by the early results of these treatments, which they say “are healing diabetic foot wounds faster and preventing amputations.” Used with traditional approaches such as removing pressure, the new high-tech treatments reduce healing time, infection, hospitalization, and amputation while improving the quality of life. They’ve been called “a winning combination to reduce the needless number of lower extremity amputations in this country.”
Other treatments are sometimes used but, according to the American Diabetes Association, they have not been adequately tested in clinical trials to prove their worth. These include hyperbaric oxygen, electrical stimulation, cold laser, and heat treatment.