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Diabetic foot care - Diabetic neuropathy - Podiatry -Foot sores 

If you are diabetic., footcare can never be underestimated. It should be on the top of your list alongside diabetic glucose control.

On the subject of feet, you really need to look after them, as diabetics are extremely prone to serious foot and leg conditions.  As already described in the ‘complications’ section of amidiabetic.com,

“A long term complication of diabetes is neuropathy. Neuropathy is nerve damage that results from diabetic micro vascular disease and is increased if you have poor diabetes control. Nephropathy particularly affects the feet and legs.  You may feel numbness, pain or feelings of an altered sensation. This is why you should have your feet checked regularly by your chiropodist or Podiatrists. This type is known as 'Sensory neuropathy'. It is said that around 15% of all diabetics will develop some sort of problems with their feet and legs at some time and some of these could be of a serious nature.  If you do not care for your feet, then you have more chance of joining that 15%.”

Many diabetics are prone to infections due to small cuts, wounds or with badly fitting footware, ulcerations and in extreme cases gangrene, which could lead to the loss of a toe, foot or even a leg.  Amputations are on the increase, and these are possibly due to diabetics not inspecting and looking after their feet.

Regarding foot care in diabetes, there are three primary factors to consider, these are a diminished foot sensation known as neuropathy. Poor circulation is another, together with a decreased resistance to infection.  This together with badly fitting footwear, badly cut nails and deformities cause these infections and ulcerations of the feet.

 

Neuropathy

 

Neuropathy: Sensory neuropathy is where the sensations in your feet are diminished (Nerve damage) to the extent that you cannot feel sensations of pain in your feet from cuts or grazes and can often go unnoticed by the diabetic.  Left unnoticed, these sores can and indeed will get infected, which could lead to serious infections.  You should inspect your feet regularly to check for sores and infections.  You may also notice that you get cracks in the skin, especially between the toes and the heels, as neuropathy can also reduce perspiration in the lower limbs, causing the feet to become sore and infected.

 

There is a condition called Charcot foot or joint can cause destructive problems in your feet:

Charcot foot - a foot complication associated with diabetic neuropathy, which results in destruction of joints and soft tissue. Also called "Charcot's joint", "neuropathic arthropathy", and "neuropathic joint disease"

The signs are a redness and hotness about the foot, an aching and a possible itching.  You will also find it hard to fit into shoes.  You should seek the help of chiropodist or podiatrist as soon as possible and arrange for a home visit if at all possible, as you will need to keep the weight off of your feet.

 

 

Circulation

 

Circulation: Diabetics are at a high risk of bad or poor circulation of the legs and feet and can be prone to peripheral vascular disease, sometimes known as peripheral arterial disease (PAD). Most common symptoms are mild to severe pain while walking and mild to severe pain while resting, claudication, which is pain, weakness, numbness, or cramping in the calf, thigh and buttock muscles due to the decreased blood flow and the stiffening of the vessel walls. Other signs can be thickening of the toenails, color change in the skin to a blue or paleness, thinning of the skin, resulting in a shiny appearance which can be easily injured and cut and takes a longer time to heal and possibly have little hair growth, around the lower leg for instance.

This is due to the reduced flow of blood to the feet, that restricts oxygen and vital nutrients from repairing the tissue.  If you are a smoker, it is though that you may have a 30% increased possibility of amputation within 5 years, but this has yet to be confirmed. Diabetics are more likely to be admitted to hospital with a foot ulcer than any other diabetic complications but the quicker you get help the sooner you can be treated, thus avoiding even more problems.

 

Being diabetic, you are more susceptible to infections, especially if you diabetes is poorly controlled or if neuropathy is present. This is because you may not notice that there is an infection until it is escalating due to deficiencies in our white blood cells to defend against infections and bacteria. 

Signs of infection

White skin will be red or brigh pink. Black skin will may become darker in appearance

The infected area may throb and be very painful and itchy (though this may not be the case if neuropathy is present)

 

The infected area may be puffy and appear swollen

 

The pain and swelling may mean that it becomes difficult to move the infected area (though this may not be the case if you have neuropathy)

 

The infected area may feel warm or hot to the touch

 

The area may be weeping a yellow/green matter called pus; this consists of dead cells and micro-organisms

 

 

If there are signs of infection, the first thing to do is to make an appointment to see your doctor, physician podiatrist, chiropodist or diabetic nurse THAT day.  If you cannot get an appointment right away, you should go to your hospital for treatment. In the meantime you should:

  • Bathe your foot/feet in a bowl of warm water and add a tablespoon of ordinary kitchen salt. Do not soak too long and try to soak just the sore if possible.
  • Cover the afflicted areas with sterile dressing, which you should have in your first aid box, if not get it sorted today.
  • Keep footwear off and try and to release any undue pressure off the area
  • Wear loose fitting footwear such as a pair of backless slippers if you need to go to the hospital.
  • Be careful if having to walk, you do not want to hurt your sore foot.

 

Foot ulcers

 

Some 10-15% of all diabetics develop some sort of foot ulcer at some point in their lives. The ulcer is an open sore on the skin from excessive pressure (usually shoes) on that area. With neuropathy, the sensation of the painful ulcer can go unnoticed and the person continues to carry on with their daily duties and the sore gets infected and sometimes literally wears down through the tissue to the bone.

 

If found early, this can be treated fairly easily with dressings and an  antibiotics, but if left untreated and pressure continues, a more drastic measure may be needed, such as crutches, specialist shoes or even plaster casts until the wound heals.  If the wounds are recurrent, special shoes with extra depth and cushioned insoles may be needed.

 

As we get older we suffer from reduced mobility and our eyesight gets worse and we can find it hard to examine our own feet, this is when you need help.  A sore or cut can often go unnoticed and infection soon sets in.  If not treated, this infection is only going to get worse without treatment, so it is imperative that you get regular checkups.

 

How do I help myself?

 

  • Keep your blood glucose levels as near to your agreed target as possible.
  • Examine your feet regularly for blisters, cuts, sores, bleeding or any discoloration. Use a mirror if needed and don’t forget to check in between your toes.
  • Wash your feet daily with warm, soapy water and dry well, especially between the toes. Cotton buds are very handy to soak up the excess water here. Do not soak your feet daily.
  • Don’t forget your appointments with your doctor, nurse or podiatrist.  Get a calendar or diary.
  • Tell your doctor if you think you may have any signs of neuropathy.

·         Do not walk barefoot, as you may not feel something that you are walking on that may cut or damage your feet.

·         Avoid hot water bottles on your feet.  Although it may seem nice and warm, you may be burning the skin which will blister and can become infected, especially if you do not check your feet regularly.

Use a moisturising cream or foot balm on your feet daily to prevent dry and cracked skin. Do not apply lotions between your toes but use talcum/foot powders daily instead.

·         Avoid smoking, avoid sitting with legs crossed. Buy socks with ‘no elastic’ to avoid circulation problems and with no protruding seams.  Change socks or stockings daily to avoid infection.


Do not use any sort of skin remover that uses a blade or grater style removal for dried skin. Always cut toe nail straight across, using the top of the toe as a guideline. Never cut into the corners of the nail as these can become ingrown, are very painful and become infected very easily. Never attempt to cut your toenails if your sight is impaired, see your podiatrist or chiropodist if in doubt.

.


Visit your podiatrist or chiropodist at regular intervals.  Make sure that you keep the dates in the calendar for reviews, as you cannot always rely on automatic appointments or reminders.

 

·         Buy shoes that fit comfortably.  Make sure that there is adequate room, width and depth for your feet to fit snugly, but NEVER tight.  Avoid shoes that fit a little tight when tried on, as feet can swell, especially if you are on your feet all day. Go for shoes that look good but fit good.  Have your feet measured rather that getting some straight off the shelf.

·         Again with trainers, athletic shoes and sneaker, these should fit comfortably, not too tight but not too slack, as these may cause friction and cause blisters if engaging in strenuous exercise such as running. If you are going to use a thicker sports sock, make sure that you take this into account when getting fitted for the shoes. Always check your feet after any exercise for blisters or sores.

 

  • Remember

        Your diabetes healthcare team are there to help you, so make sure that you use them!

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