Foot Care: Ten Tips For Diabetics
By Christine Dobrowolski, DPM
It is estimated that over 18 million Americans have diabetes.The majority of diabetics are between the age of 20 to 60 and are affected by type 2 diabetes. In type 2 diabetes the body produces insulin, but it does not produce enough of this hormone or the cells don't respond appropriately to it. The result is an elevated blood sugar. The blood sugar is high because the sugar is not being taken into the cells and utilized for energy properly.
The elevated blood sugar causes many problems for the body. Serious complications associated with diabetes include stroke, heart disease, blindness, kidney disease, high blood pressure, nervous system diseases and amputations. In 2002 there were 82,000 lower extremity amputations in individuals with diabetes. Six out of every 1,000 people with diabetes will have a lower extremity amputation. This is a scary thought for most diabetics.
A slow healing or non healing open sore (known as an ulceration) on the foot is the most common reason diabetics will end up with a foot or leg amputation. Over 2 million diabetics have ulcerations and one in four diabetics with an ulcer will have an amputation. Unfortunately, over 25% of diabetics have not heard of an ulcer.
Treating diabetic ulcers is difficult. Preventing diabetic ulcers is not. Preventing diabetic ulcerations is the key in decreasing the risk of amputation. Most individuals have some sort of trauma or injury that predisposes them to development of an open sore (or ulcer), a blister or an ingrown nail. The trauma may be something as simple as the shoe rubbing on the side of the foot. In individuals with poor circulation, it becomes difficult to heal even the most minor sores on the foot. When the body does not send enough blood to the feet to heal the sore, gangrene will set in. It is important to see a podiatrist for diabetic checkups every two months to help keep ingrown nails, corns and callouses from becoming a problem.
Take these steps to help prevent diabetic foot complications:
1. Check your feet everyday! If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.
2. Don’t walk around barefoot or in sandals. Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture. I once had a patient come in with a tack in the bottom of her foot. She routinely walked around the house barefoot or in socks. She had no idea there was a tack in the bottom of her foot until I pointed it out to her!
3. Check your shoes before you put your feet in them. Put your hand in first and check it before you place your foot into the shoe. Small pebbles or rocks can hide in the shoe. Items that I have found in patient’s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is “How did that get in there?” Also watch out for folds in your socks. Small folds can lead to ulceration and infections.
4. Dry off your feet after showers and dry between your toes. Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.
5. Don’t be a victim of fashion. High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. Don’t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they don’t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor.
6. Check your bath water with your hand before you put your foot in it. The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your wrist. This will be much more accurate than testing the water with your foot.
7. Do not use medicated corn pads or any medicated pads from the local drug store. These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. Don’t use any medication on the skin unless you are instructed to do so by your physician.
8. STOP SMOKING! This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.
9. Don’t cut your own toenails or callouses. This is something a podiatrist or your family doctor should be doing for you.
10. Visit a podiatrist regularly. If you have a loss of sensation or circulation in your feet or legs, you should be seen by a podiatrist every two months.
Christine Dobrowolski is a podiatrist and the author of Those Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot Problems. To learn more about Dr. Dobrowolski and her book, visit Ski Publishing