Diabetic Foot Care Guidelines

What is diabetes?
Diabetes is a condition in which your body is either unable to produce insulin (a hormone that helps the body process sugar), or your tissues don’t respond to the insulin that’s produced. This leads to too much sugar in the blood, which, in turn, can damage blood vessels, nerves, kidneys, the heart, the eyes, and (always of paramount importance) the feet.

Unfortunately, damage to your nerves means that you may not notice when, say, you step on a tiny piece of glass from the jar of jelly your daughter dropped yesterday. Or, you might not be aware that your toes are becoming really irritated with being jammed into that shoe with pointy toes. Or, if your nerve damage is quite bad, you might not notice that you fractured your foot, so you keep walking on it. For a long time. In turn, ulcers might develop from that irritated skin, or from skin that’s under significant pressure, and fractures are always a bit of a problem. But things can get even worse.

Diabetes also damages blood vessels, so the circulation to and in your foot may become quite poor. Because it takes good bloodflow to stimulate the healing of wounds, those ulcers and fractures may not heal up very nicely. In fact, they may not heal at all. Or, if you get an infection (in an ulcer or even just a small cut on your foot), your blood isn’t able to adequately deliver the power to fight it off, so it might spread to your bones, or the rest of your limb.

What you can do

Diagnosis
It’s kind of a frightening picture, isn’t it? Fortunately, there’s a lot you can do to manage the care of your feet when you have diabetes. Early identification and treatment of problems is the key to preventing serious complications with your feet. Here are a few things you can do to keep those complications at bay.

• Keep blood sugar level in target range – Your primary care physician can assist you with this, but it’s vital that you monitor your blood sugar level closely between visits. Remember that it’s problems with your blood sugar level that can cause the damage to blood vessels and nerves that can be so detrimental to your overall health (and your feet). Keeping that level in check can prevent a whole host of other problems.
• Daily foot inspections – Inspecting your foot daily may not sound like the most exciting use of your time, but it’s essential in finding problems to your foot early on, particularly if you have nerve damage. (If it helps to make it seem less boring, you can begin your inspections by donning a Sherlock Holmes type of cap, putting a pipe (an unlit one, of course) firmly between your teeth and using a wonderfully large magnifying glass.) If you can’t see your foot well, or if you have trouble reaching it, have a friend or family member assist you, or use a mirror (the magnifying ones are best) to check those hard-to-see places (like the bottom of your foot). (You can also use the mirror to tell yourself what a wonderful person you are, and compliment yourself on your excellent self-care of your feet.)
  • Pay particular attention to the soles of your foot and between your toes, since this is where problems can often crop up.
  • Check your skin for any sign of irritation or injury. Look for scrapes or cuts (however small), blisters, rashes, signs of infection like redness, swelling, drainage, or a bad smell, or possibly changes in skin color, or loss of hair on your foot or toes.
  • Check your nails for problems. Do they look yellowed or have other changes in color? Are they thickened, deformed, striped, or just not growing?
  • Look for signs that you may have fractured your foot. Check your foot overall for redness, see if it’s warm or hot to the touch, swollen, or has changed in size, shape or direction.
  • If you notice any of the above on your feet, see your podiatristas soon as possible. Don’t assume that the problem will go away on its own, and don’t try to just wait it out. Getting problems treated early is a MUST in diabetic foot care. Doing so can significantly reduce your chance of developing a severe complication.
  • Set a specific time for your foot inspection every day, just to be sure you don’t forget.
• Clean your feet – Wash your feet every day with lukewarm water and mild soap. Be sure to test the water temperature with your hand (or elbow if your hand doesn’t have great sensation either) just to make sure it isn’t too hot, or have someone test the water for you. Dry your feet thoroughly but gently using a soft towel, paying particular attention to the skin between your toes. You can use talcum powder (aka baby powder) to wick moisture away from your skin, but be sure to get rid of any residue, particularly between your toes. Don’t soak your feet unless your podiatrist advises you to do so.
• Use proper shoes – Because they may expose your feet to harm, cause significant pressure, or may position your foot unnaturally, it’s important to avoid wearing certain types of shoes, such as sandals (especially those with a thong between the toes), slippers, and shoes with high heels. Instead, wear comfortable, well-fitting shoes with soft leather uppers that can mold to the shape of your feet. (Running or walking shoes may fit the bill nicely.) Wear socks with your shoes, but avoid socks or stockings with seams in them, since this can cause irritation (and potentially an ulcer). (You can ask your podiatrist about special shoes and socks designed for diabetic patients.) Always check the insides of your shoes before wearing them and after taking them off, making sure that the lining of the shoe is smooth and that there are no foreign objects (like rocks or (shudder) spiders) inside.
• Lubricate dry skin – Apply a thin film of moisturizer (Cetaphil cream is recommended) to the soles of your feet while they’re still wet. Avoid getting the cream between your toes, since this can foster a fungal infection.
• Trim nails – Cut your nails straight across. Rounding corners down can lead to ingrown toenails, which can become infected. Keeping your nails properly trimmed can also reduce pressure within your shoe and help you avoid other complications.
• Lose weight – This one may make you groan a bit. And you may not be overweight. But the truth is that an overwhelming majority of diabetic patients are also not at a healthy weight. While improving your health in general, weight loss can also take pressure off your feet, thus preventing future problems. Weight loss plans should always be discussed with your doctor, particularly if you are diabetic.
• Exercise – Along with reducing weight, exercise can help improve circulation and condition your feet. Walking is often the best exercise for diabetics. However, you should consult with your primary care physician as well as your podiatrist before adopting an exercise regimen. (Also, be sure to ask your podiatrist about the best kind of shoes to wear while exercising. He or she is sure to have some good ideas.)
• Promote circulation to your foot – You can help blood flow more easily to your foot by putting up your feet while sitting. (Putting up your feet while standing isn’t likely to work well.) You can also try little foot exercises like wiggling your toes and moving your foot up and down at the ankle for five minutes at a time. Try doing this about two or three times a day.
• See your podiatrist – See your podiatrist at least twice a year, and be sure to tell him or her that you have diabetes. See your podiatrist immediately if you notice any blisters, punctures, pain in your feet or legs (leg pain may be a sign of a blocked artery), change in skin or nail color, loss of sensation, or if there’s an area of your foot with increased or decreased temperature.

What you should avoid Treatment
Diabetic foot care isn’t all about things you should do. There’s also a list of things that you really should avoid if you have diabetes, particularly if you have nerve damage. Please pay close attention to the list below:

• DON’T go barefoot – Whether in your house or out of it, your feet may encounter things on the ground that cause damage, like small plastic toys, bits of glass, nails, or very sharp rocks. (Although you should also keep your floors free of these potentially dangerous bits of things.) Because you may not notice when you step on something like this, (and thus damage your foot as you continue to walk on your injury), you can avoid the problem entirely by wearing shoes (WITH socks) pretty much all the time. Except in bed. Your feet are usually pretty safe there. (Although you can wear socks in bed for warmth.)
• DON’T put tight things around your legs – Foot or leg-wear like garters or knee-high stockings (or elastics to hold UP the stockings) can reduce circulation to your foot, thus exacerbating your bloodflow problems. Panty girdles, thigh highs, and even sometimes men’s socks can also be problematic if the elastic is too tight.
• DON’T expose feet to extreme heat/cold – Again, because of nerve problems, you may not be able to feel when the skin of your foot is too hot or too cold, and thus be unaware when extreme heat or cold causes damage. In order to avoid problems, don’t walk on hot pavement, never use a hot water bottle or heating pad on your feet (wear socks instead if your feet are cold), be careful of car heaters on road trips, and don’t put ice on your feet if they feel hot. Also, apply sunscreen to your feet to avoid sunburn.
• DON’T cut corns or calluses yourself – If you try to perform “bathroom surgery” on your corns or calluses, you run the risk of cutting too much off, or getting an infection. If you need them removed, your podiatrist is very skilled at taking corns and calluses off. He or she can also instruct you how to work on calluses (the ones that aren’t too thick) using pumice stones or emery boards, but only if you promise to follow their instructions carefully. NEVER use medicated callus or corn removers, since these can eat into healthy skin and cause infections.
• DON’T use commercial foot supports – Your podiatrist may wish to prescribe orthotics for your use, but avoid over-the-counter arch supports or foot pads.
• DON’T smoke – Smoking can further reduce your circulation, causing even more complications with healing. Quit smoking as soon as possible to avoid these complications.
• DON’T drink excessively – Just as smoking can further damage your circulation, so alcohol can speed up the damage to your nerves already caused by neuropathy. This increases the likelihood that you’ll be unable to detect injury or other problems with your foot. Avoid drinking in excess.
• DON’T cross your legs – Crossing your legs while sitting (or even lying down) can compromise the circulation in your legs and feet. You may look great while doing it, but remember that it’s your health that’s most important, not your appearance. (Yes. Despite what the fashion industry may tell you.)

Always remember: the key to diabetic foot care is early identification and treatment of problems. See your podiatrist immediately if you notice any danger signs, and always do a daily foot-check. Doing so can save you a lot of trouble, possible amputation, and it may even save your life (and those are a lot of things worth saving).