Diabetes: Taking care of your feet

According to American Diabetes Association, 1 in 5 diabetics have foot problems and seek medical care for the same. Diabetes does increase the risk of losing your toes and limbs to a great extent, however, overcoming foot problems is very much possible provided you take good care of your feet.

What causes foot problems in diabetics?

If you have been a diabetic for quite some time now, there are high chances that your sensations go for a toss because of nerve damage (diabetic neuropathy). A person with diabetes may not perceive sensations such as pain, hot and cold, and touch. They may have cuts and blisters in their leg, which may go unnoticed and ultimately
become infected.

Secondly, blood circulation is also impaired in diabetics. This means that sores and cuts would take longer to heal. If they are really bad, they may not heal at all and lead to gangrene. If the gangrene is not managed immediately, your limb/ toes have to be amputed.

Charcot’s foot

When the nerve damage is severe, there may be damage to the bones, joints and soft tissue of the foot. The bones get weaker, move out of their place, and the foot becomes deformed. Charcot’s foot initially starts as redness, warmth, and swelling. If not attended on time, this can lead to:

  • Foot deformity
  • Curling of toes
  • Twisted and unsteady ankle

Therefore, good foot care is extremely important to prevent foot problems in diabetics.

Tips for daily foot care

Make sure that the water with which you clean your foot is just warm, not hot. Before starting, always check the temperature of water with your elbow/hand. A temperature of around 42-43oC is considered safe. Use a mild soap for washing your feet.

Prolonged soaking can actually make your foot very dry and vulnerable to injuries.

While washing your feet, do a thorough foot inspection. Check your feet, in between your toes for cuts, cracks, ingrown toenails, sores etc. If you have cuts and sores, clean them well with mild soap, remove all the dirt. Use a dry dressing suitable for sensitive skin to cover these injuries.

Pat dry your skin, don’t rub your foot with the towel. Make sure the areas between the toes are dried well.

Dry skin is very prone to injuries. Thus, it is very important to keep your feet well moisturised. However, do not apply moisturiser in between your toes. Excess moisture in the skin between the toes can increase the risk of skin infection and breakdown in that area.

Your daily foot inspection

You should always check your foot before and after wearing your shoes and, after taking bath. Try to inspect your feet at regular intervals multiple times a day.

Tips on inspection:

  • In addition to your foot, do not forget to inspect in between your toes as
    these areas are more prone to skin damage.
  • Use a hand mirror to check the bottom of the foot.
  • If you have difficulty in bending down to check your feet, ask somebody to
    help you with foot inspection.

Areas of colour change in the skin: Changes in skin colour is most likely due to infections.

Cuts, scratches, blisters: They are likely to be infected if not tended properly.

Corns and calluses: These areas are more prone to get injured.

Swelling: This may indicate injury to structures beneath the skin.

Care for your toenails:

Nails that are long, thick or sharp can cause foot injury. Thus, trimming your toenails is very important. Here are some tips on toenail trimming:

  • Toenails should be trimmed straight across.
  • The corners of the toenail should not be cut separately, as this can cause ingrown toenail.
  • The edges of the nail must be sharpened using a good quality nail file.
  • Always use a good quality nail trimmer. Razors, knives and scissors should never be used to cut nails.
  • Never cut the cuticles.

Do’s & Dont’s to prevent foot damage

Some important do’s and dont’s for you to prevent foot damage

Do’s:

  • Did you know that your feet slightly swell up in the evenings? So, prefer buying your footwear at late evenings.
  • During winters, wear your socks even when you are at home at night.
  • Keep your feet elevated if you are sitting.
  • Do ankle toe movements frequently to promote blood circulation in your foot.

Dont’s

  • Avoid using over-the-counter medications to treat corns and warts.
  • Avoid wearing tight socks and stockings.
  • Avoid sitting cross legged for long period of time. Sitting crossed legs slows blood flow to the limb.
  • Quit smoking as it impairs circulation.
  • Do not try to remove corns and calluses by yourself. Get it removed from a skilled practitioner (preferably a podiatrist).

Your ideal footwear

A diabetic should always wear a well-fitting pair of socks and footwear to prevent foot injuries. If you are a diabetic, it is recommended that you consult a footcare specialist (podiatrist) to help you with your right footwear.

Some tips for selecting your shoes:

  • Just because a particular shoe is called diabetic shoe, don’t buy it. Every foot is different. Ask your podiatrist to recommend you some good shoes that fit your foot requirements.
  • Wear a shoe that is made of stretchable material such as leather, so that it can accommodate your foot well.
  • The shoes sizes vary for different brands. Always try out your shoe before you buy them.
  • Do not buy shoes that are high heeled or are open at the toes or heel areas.

Your ideal shoe:

  • Shape of footwear : The shape of the foot and the shape of the shoe should match.Trace the shoe insert on a piece of paper. Now, put your foot over the tracing and then trace your foot with a pen as well. Your foot shape should match the shape of the insert, and that the foot tracing falls within the insert tracing.
  • Length of the footwear : There should be at least 1-inch gap between the longest toe and the tip of the shoe.
  • Width of the footwear : You should be able to pinch some material of the footwear on either side.

Using your shoes:

  • Always check the insides of the shoes before wearing them. See if there are any small pebbles or small sharp objects that may injure the skin of the foot. Also check for rough areas inside the shoe.
  • Always keep your shoes clean.
  • It is recommended that the shoes should be replaced atleast once every year.

Your right pair of socks:

Your socks form a barrier between your skin and your shoes and serve as an additional defence to prevent foot injuries. Here are some tips for good socks for diabetics:

  • Seamless socks : Heavy seams put extra pressure on the toes and sides of the foot and make these areas vulnerable to injury.
  • Rightly elastic : The socks shouldn’t be too tight nor too loose.
  • Light coloured socks : Prefer wearing white or light-coloured socks over dark ones. Any kind of skin discharge or bleeding is more evident in light clothing.

Signs of diabetic foot problem

Consult your doctor if you notice the following changes in your foot:

You have pain, tingling or numbness in your feet

Your have wounds and sores in the feet that won’t heal

You seem to have hair loss in your legs

The skin over your foot seem extremely smooth and shiny

Foul smell coming from a cut or a blister

Swelling in the feet

Calf cramps when you walk

Your feet don’t seem to sweat

Any cut or small injury of the foot can ulcerate. Some of the common signs of a diabetic foot ulcer are:

  • Unusual swelling
  • Skin irritation and redness
  • Odour from both the feet

Ulcers are actually not very easy to identify, sometimes they may not show any symptoms unless they are infected.

Eschar: Eschar refers to the black colour tissue that surrounds the ulcer. Formation
of an eschar indicates that the ulcer is serious.

Diabetic foot ulcer

Foot ulcers are the most common foot problems in diabetics. Around 2-10% of diabetics have foot ulcers. If left untreated, the ulcer may spread and cause serious gangrene.

Management of diabetes with insulin therapy can be a major challenge. Opt for a device that suits you the best to deliver insulin. You must meet your doctor regularly for dose adjustments, as the insulin levels frequently fluctuate.

Treating diabetic foot ulcer:

Wound debridement is the most important procedure for a diabetic ulcer. Debridement is the process by which unhealthy, dead and infected tissue are removed and the ulcerated area is cleaned. Cleaning of the ulcer triggers the body’s natural healing mechanism.

After debridement, the wound is covered using an antiseptic dressing. This dressing would be changed regularly.

Your doctor would recommend medications such as antibiotics and anticlotting medications to prevent spreading of infections and clotting of blood respectively.

Certain medications such as silver sulphadiazine cream, iodine cream, polyhexamethylene biguanide (PHMB) gel are also helpful in promoting wound healing.

All diabetics are at great risk of having foot problems. If such problems are not attended to, the quality of life of an individual is greatly affected. The measures to prevent foot problems are simple, but need to be executed on a daily basis.