Many things work together to cause foot problems in people who have diabetes, especially poor circulation and nerve disease (neuropathy). Neuropathy significantly dulls awareness of your feet, making you more susceptible to extensive injury-related damage. Also, diabetes can impair your ability to heal by both damaging your immune system and decreasing the blood flow in your legs.
If your vision has been affected by diabetic retinopathy or other eye problems, you may not see an injury or infection in your feet early. If you get a foot infection or injury, you may not notice it until your condition is so serious that you require surgery, possibly amputation.
Who’s at risk?
Things that increase your risk for diabetic foot problems include:
- Poor blood glucose control. If your blood sugar levels are persistently above the target range, you are more likely to have foot problems.
- The risk increases with age.
- Males are at higher risk.
- African Americans, Hispanics, and Native Americans are at higher risk.
- Duration of diabetes. The longer you have the disease, the greater your risk.
- Other complications due to diabetes (small blood vessel disease, atherosclerosis of large vessels). If you already have other diabetic complications, you are more likely to have foot problems.
- Smoking contributes to circulatory problems in your extremities, increasing your likelihood of developing foot problems.
- Peripheral neuropathy (damage to the nerves that control sensation and touch). Peripheral neuropathy results in poor sensation in your extremities, increasing your likelihood of having foot problems.
- Alcohol dependence. Long-term heavy drinking can cause numbness and tingling in your hands and feet.
How do problems start?
Because foot disease in diabetes usually begins with neuropathy, your first step in preventing foot problems should be addressing problems with your nerves. Neuropathy causes problems in your feet by disrupting your nerves, both reducing your sensation of pain and causing problems with the way you walk. Such problems can damage your feet in the following ways:
- Reduced sensation prevents you from sensing pain and realising that your foot has been injured. Poor eyesight can also reduce your ability to detect foot injuries and infections. For example, you may have a blister and not realise it because you don’t feel any pain from it or see the blister. Without treatment, this injury may progress to infection.
- Your feet are at risk for problems that arise from poor muscular control. If your nerves are no longer able to carry signals that mean the appropriate motion of your feet and lower legs while you walk, your body may compensate by forcing your feet to adopt unnatural positions while you move. Changing the way you walk increases your risk of getting foot ulcers and deformities. Your feet may become deformed and misshapen if you walk abnormally for an extended period of time. In fact, about half of all people with diabetes have a hammer toe or claw toe deformityor a Charcot foot deformity, caused by an abnormal walk.
What you can do
When you have diabetes, your feet need extra care and attention. Diabetes can damage the nerve endings and blood vessels in your feet, making you less likely to notice when your feet are injured. Diabetes can also interfere with your body’s ability to fight infection. If you develop a minor foot injury, it could become an ulcer or develop into a serious infection. Ulcers can be found on the bottom of your feet, or on the top or bottom of your toes. With good foot care, you can prevent most of these problems.Caring for your feet is easy. Most of the care can be done when you are bathing and getting ready for bed.
Preventing injury to your feet is merely a matter of wearing properly fitted shoes and socks at all times.
Here are a few things you can do to take better care of your feet and make foot problems less likely:
- Have your feet examined annually. This will usually be at your GP surgery as part of your yearly diabetes check. Everyone with diabetes should have an annual foot check, so make sure you get yours however do not wait for this to raise any concerns you may have about your feet. In most cases serious foot problems can be prevented.
- Keep your blood sugar in your target range . Keeping your blood sugar levels within the target range recommended by your GP can lower your chances of getting neuropathy. This will lower your risk of having foot problems.
- Check your feet for changes in skin colour, cuts, blisters, and other problems. A foot assessment should be part of your daily routine. Look at all areas of your feet, including your toes. Use a handheld mirror or a magnifying mirror attached to the bathroom wall near the skirting board to inspect your feet. If you can’t see well, have someone else examine your feet for you.
- Wash your feet daily. Post the steps for foot-washing ( as below) and nail care in your bathroom. Refer to the steps when you wash your feet so that they become a habit. Make sure you dry your feet and toes well before putting on shoes and socks.
- Check your shoes for any loose objects or rough edges before you put them on.
- Wear shoes and socks that fit well. Soft shoes that have good support and that fit well (such as tennis shoes) are best for your feet. Break in new shoes slowly by wearing them for a few hours each day and increasing the number of hours you wear them each week. Wear socks that do not have seams.
- Look at foot care as part of your daily routine. Soon it will become as automatic as brushing your teeth.
- Don’t use home remedies to treat foot problems. Home remedies can hurt your feet. Over-the-counter medicine designed to remove calluses could contain chemicals that could burn your skin. Also, trying to cut corns or calluses yourself could lead to infections.
- Get early treatment for foot problems. Call your GP even for minor foot problems, unless you have already learned from your doctor how to handle these problems. You may be referred to a podiatrist or orthopaedic specialist if special treatment is needed. A serious problem can develop from what seems like a minor irritation. If a foot problem develops, you need to seek care early.
Steps for safe foot washing
Wash and dry your feet
- Use warm (not hot) water. Check the water temperature with your wrists, not your feet.
- Wash all areas of your feet, especially the underside of your toes and between them. Use a mild soap.
- Pat your feet dry. Don’t rub the skin on your feet.
- Dry carefully between your toes. If the skin on your feet stays moist, bacteria or a fungus can grow, which can lead to infection.
- Do not use strong antiseptic soaps, chemicals (such as Epsom salt; iodine; or corn, callus, or wart removers), or perfumed skin lotions on your feet.
- Apply an emollient moisturising cream to keep the skin on your feet soft and to prevent calluses and cracks. Do not put the cream or talcum powder between your toes.
- Clean underneath your toenails carefully. Do not use a sharp object to clean underneath your toenails. If you can’t see well, have someone do this for you or have your foot specialist do it regularly.
- Trim and file your toenails straight across. Trimming them straight across instead of rounding them will help prevent ingrown toenails. Use a nail clipper, not scissors. Use an emery board to smooth the edges. Do not use a sharp-pointed file or stick to clean around the nail. If you can’t see well or if your nails are thick, split, or yellowed, have them trimmed a podiatrist.
- Use a pumice stone to prevent calluses only if you have been shown how to use it properly.
- Put on clean socks daily.
- Do not cut or pick at the skin (cuticles) around your toenails.
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