Diabetes: Foot Care

Diabetes: Foot Care

Diabetes is a disease that occurs when a person's body doesn't make enough of the hormone insulin or can't use insulin properly. There are 2 types of diabetes.Type 1 diabetes occurs when your body's pancreas doesn't produce any insulin.Type 2 diabetes occurs when the pancreas either doesn't produce enough insulin or your body's cells ignore the insulin. Between 90% and 95% of people who are diagnosed with diabetes have type 2 diabetes.

How does diabetes affect our body.

When we digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn't make enough insulin or can't use it properly, so the glucose builds up in your blood instead of moving into the cells. Over time, too much glucose in the blood can damage the blood vessels and nerves in your body.

Damage to your nerves means that you may have burning pain or lose feeling in a part of your body (this is called diabetic neuropathy). Damage to the blood vessels that some areas of your body (usually the feet) may not be getting a good supply of blood.

All of us are likely to have problems with our feet, but diabetics may develop serious problems more quickly and have more complications, especially when circulation or nerves are impaired.
The key for the diabetic is to view all foot problems as potentially dangerous and to prevent them and seek podiatric care as soon as they occur. Except for blindness, the complication most heard about diabetics is loss of a leg. This widespread concern is realistic.

--30% of all diabetics have peripheral vascular disease.
--Of all non-traumatic amputations, 50% to 70% are performed on diabetics.


Diabetes may cause
Poor circulation often happens in diabetics, which can lead to serious complications. Chronically tired or painful feet may mean circulation is poor. Symptoms such as numbness, tingling, cold or blue feet, and swelling that will not go down indicate poor circulation. Cramping may occur at night, during rest, or while walking a short distance. Smoking and stress usually increase the severity of the symptoms. Examination by a podiatrist will reveal any circulatory deficiencies.

Diabetic Neuropathy can cause insensitivity or a loss in ability to feel pain, heat or cold. If precautions are not taken, a hot bath can be a potential for a burn. Position sense is often lost in neuropathy, so the feet scrape objects in their path. Diabetic neuropathy can also affect the muscles of the feet causing deformity such as hammertoes. When insensitivity is present, serious problems, such as ulcers and gangrene, can occur without pain. The infection may go unnoticed and appropriate care may be delayed until too late. By the time the trouble is discovered, amputation may be necessary to save the person's life. Daily observation of the feet is necessary by a diabetic or a responsible family member or other party.

Ulcers can be caused by lack of blood circulating to the foot, lack of soft tissue protection, excessive callus tissue, infection, and pressure points caused by deformities. Some causes of injury and ulcers are wearing ill-fitting shoes, performing self-surgery, applying electric heating pads or hot water bottles, and using ingrown toenail and corn remedies. If the circulatory response is adequate, most diabetic ulcers can be healed if diagnosed and treated early.

Skin changes in the foot can be caused by diabetes. Dehydration is common since the diabetic has less natural lubrication than the non-diabetic. Fissures and cracks in the skin develop and often itching can become severe. Scratching can cause breaks in the skin that may become infected. Dryness can be helped by using a good skin cream daily on every part of the foot except between the toes.

Cuts, Scrapes, Blisters, and Puncture Wounds can cause serious problems. To prevent such injuries, diabetics should always wear some kind of footwear. If foreign bodies, such as splinters, become lodged in the foot, or if an infection or puncture wound occurs, the diabetic should be treated promptly by a professional.

Ingrown Toenails can cause infections, which tend to be especially severe in diabetics. To treat the problem, the podiatrist may drain the infection to relieve the pressure, prescribe an antibiotic, and recommend special home care to help the infection heal.

Athlete's Foot is a fungal infection common in diabetics. If it or other skin rashes are not promptly treated, secondary bacterial infections that require vigorous treatment with antibiotics may develop.

Structural changes in the feet of healthy adults may also occur in the feet of diabetics and these problems can be far more serious because the disease causes changes in the nervous system. These changes in turn may prevent the diabetic from experiencing or expressing pain or discomfort and will require evaluation on a continuous basis to prevent serious bone and joint changes.


Why do I have to worry more about my feet.

People who have diabetes often have trouble with their feet. The loss of feeling in your feet can make it hard for you to tell if you have a blister or sore. If little sores aren't taken care of, they can get worse and turn into ulcers (serious, deep sores). If these ulcers become infected, you may have to go to the hospital or, in very serious cases, have a foot amputated (removed).

Protect Your Feet

Keep your blood sugar level as close to normal as possible. Also, follow your doctor's advice on diet and exercise. Take your insulin or medicine exactly as prescribed. Here are some other ways to protect your feet:

• Wash your feet every day with lukewarm (not hot) water and mild soap.
• Dry your feet well, especially between the toes. Use a soft towel and pat gently; don't rub.
• Keep the skin of your feet smooth by applying a cream or lanolin lotion, especially on the heels. If the skin is cracked, talk to your doctor about how to treat it.
• Keep your feet dry by dusting them with no medicated powder before putting on shoes, socks or stockings.
• Check your feet every day. You may need a mirror to look at the bottoms of your feet. Call your doctor if you have redness, swelling, pain that doesn't go away, numbness or tingling in any part of your foot.
• Don't treat calluses, corns or bunions without talking to your doctor first.
• Cut toenails straight across to avoid ingrown toenails. It might help to soak your toenails in warm water to soften them before you cut them. File the edges of your toenails carefully.
• Don't let your feet get too hot or too cold.

How often will my doctor check my feet.

Your doctor or nurse should check your feet periodically when you go in for a visit. If you are having any problems, such as numbness, sores or ingrown toenails, tell your doctor right away.

Diabetic Foot Care.

1. Do not ever walk barefoot.
2. Do not wear any shoes with open toes, soles or heels. Be sure to wear shoes or slippers with firm soles, especially outside of the house, in your yard or at the beach or pool.
3. Wear shoes that fit snugly but not tight. There should be ½ inch between the big toe and the shoe. The toe-box should be round and high to allow space for toe deformities. The upper portion of the shoe should be soft and flexible. The lining should be smooth and free of ridges, wrinkles and seams.
4. Rotate your shoes every day and keep your shoes in good condition.
5. Break in new shoes gradually and wear for only a few hours at first to prevent blisters and sore spots. Check your foot for red areas indicating too much pressure.
6. Check inside your shoes daily for sharp edges and foreign objects.
7. Do not soak your feet. This causes too much moisture between the toes and Athlete's foot.
8. Carefully and gently pat your feet dry (DO NOT RUB). Use a soft towel and remember to get in between all your toes.
9. Use moisturizing cream in small amounts and massage into feet well twice a day. Do not apply between toes.
10. Do not pull off loose pieces of skin.
11. Wear clean socks, change them daily and discard when worn out.
12. Inspect the socks daily for signs of drainage from an open sore that you may not realize you have because you cannot feel it.
13. Keep your toenails trimmed. Since you are diabetic, it is recommended that you visit a podiatrist regularly for cutting of your nails.
14. Do not attempt to trim you own corns or calluses.
15. Do not use commercial corn or wart remedies. These contain harmful acids that are very dangerous to diabetics.
16. Avoid extremes, such as cold or heat, and if your feet are cold, wear warm boots. Never use hot water bottles or heating pads.

What should I look for when choosing shoes and socks.

· Don't wear shoes without socks.

· Don't wear sandals or other open-toed shoes.

· Avoid high-heeled shoes and shoes with pointed toes.

· Wear well-padded socks or stockings that are 1/2 inch longer than your longest toe. Don't wear stretch socks, nylon socks, socks with an elastic band or garter at the top, or socks with inside seams.

· Don't wear uncomfortable or tight shoes that rub or cut into your feet. If you've had problems before because of shoes that didn't fit, you may want to be fitted for a custom-molded shoe.

· Talk to your doctor before you buy special shoes or inserts.

· Shop for new shoes at the end of the day when your feet are a little swollen. If shoes are comfortable when your feet are swollen, they'll probably be comfortable all day.

· Break in new shoes slowly by wearing them for no more than an hour a day for several days.

· Change socks and shoes every day. Have at least 2 pairs of shoes so you can switch pairs every other day.

· Look inside your shoes every day for things like gravel or torn linings. These things could rub against your feet and cause blisters or sores.

· Change socks and shoes every day. Have at least 2 pairs of shoes so you can change.