03 January 2007
People with diabetes can develop many different foot problems. Even ordinary problems can quickly get worse and lead to serious complications. Problems most often develop when blood flow is poor or when there is nerve damage in the legs and feet.
When people with diabetes enter the hospital, about one in five do so for foot problems. But you can protect your feet by following some basic guidelines. Inspect your feet every day, and seek care early if you do get a foot injury.
Make sure your doctor examines your feet at each regular visit and checks the circulation and nerve function. Your doctor should also give you a list and explanation of the do's and don'ts of foot care.
Diabetes can cause changes in the skin of your foot. At times, your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control sweating no longer work.
Taking care of dry, scaly feet is easy. After bathing, dry your feet and seal in the moisture that remains with a thin coat of a lubricant. You can use plain petroleum jelly, unscented hand creams, or other such products.
Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, most doctors believe you should not soak your feet, especially if your foot cannot feel whether the water is hot.
Calluses occur more often and build up faster on the feet of people with diabetes. Using a pumice stone and emery board every day will help keep calluses under control.
Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself. Home surgery can lead to ulcers and infection. Let your doctor or podiatrist (foot doctor) cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin.
Ulcers occur most often over the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes.
Remember, even though some ulcers do not hurt, every ulcer should be seen by your doctor right away. Neglecting ulcers can result in infections, which in turn can lead to gangrene and amputation. In fact, amputation occurs 15 times as often in people with diabetes than in those without diabetes.
What your doctor will do for your ulcer varies with the ulcer. Your doctor will take X rays of your foot to make sure the bone has not become infected. Also, the doctor will culture the wound to find out what type of infection you have and which antibiotic will work best. Then the doctor will cut out the dead and infected tissue. You may need to go into the hospital.
Keeping off your feet is very important. Walking on an ulcer can make it get larger and forces the infection deeper into your foot. Your doctor may put a cast on your foot to protect it, while allowing you to walk.
Good diabetes control is important. High blood glucose levels make it hard to fight infection.
If an ulcer is not healing and your circulation is poor, the doctor may need to improve the circulation by doing surgery on the blood vessels.
After the foot ulcer heals, you should still treat your foot carefully. Scar tissue under the healed wound has a tendency to break down. You may need to wear special shoes after the ulcer is healed to protect this fragile area and to prevent the ulcer from returning.
Several factors make some people more likely to get foot ulcers. You are more prone to foot ulcers if you are more than 60 years old; have had a foot ulcer before; have had laser treatment for your eyes; or have kidney disease, neuropathy, or vascular disease.
Although it can hurt, diabetic nerve damage (neuropathy) can lessen your ability to feel pain, heat, and cold. Loss of sensation often leads to foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You might not notice a foot injury until the skin ulcerates and becomes infected.
Neuropathy can also lead to deformities of the feet and toes. Your toes may curl up. People with deformed feet and toes should not force them into regular shoes. Ask your doctor or podiatrist about special therapeutic shoes.
Poor circulation can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. Some of this damage, which is caused by fatty deposits in blood vessels, is beyond your control. But you can control other risk factors.
Don't smoke. Smoking makes arteries harden faster. Also, follow your doctor's advice for keeping your blood pressure and cholesterol under control.
If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot detect heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.
Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, comfortable shoes. Don't walk when you have open sores.
Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain.
If you have these symptoms, you must stop smoking. You should also see your doctor to get started on a walking program. Some people can be helped with the medication pentoxifylline (Trental) prescribed by their doctors.
People with diabetes are far more likely to have a limb amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation.
Together these problems make it easy to get ulcers and infections that may lead to amputation.
For these reasons, you should take good care of your feet (see Caring for Feet below) and see your doctor right away about foot problems. Always follow your doctor's advice to the letter to care for ulcers or other foot problems.
One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause restricted blood flow to the feet and make wounds heal slowly. Almost all people with diabetes who need amputations are smokers.
Often, your doctor can prevent amputation by vascular reconstruction -- an operation that improves blood flow in your feet.
Your Doctor's Role
Because people with diabetes are more prone to foot problems, a podiatrist may be on your health-care team.
You should call or see your doctor or podiatrist if you have cuts or breaks in the skin or have an ingrown nail. Also, tell your doctor if the foot changes color, changes shape, or just feels differently (for example, becomes less sensitive or hurts).
Your diabetes doctor should inspect your feet carefully at every visit. Remember to take off your socks and shoes while you wait for your physical exam. Also, at least once a year, your doctor should check your feet for blood vessel, muscle, and nerve problems.
If you have corns or calluses, your doctor or podiatrist can trim them for you. Your podiatrist can also trim your toenails if you cannot do so safely.
Caring for Feet
There are many things you can do to protect your feet from injury and to keep them healthy:
Wash your feet every day.
Dry them carefully, especially between the toes.
Check your feet every day.
Be sure to look between the toes, at the toe webs, and on the bottoms (use a mirror). If you cannot see well, have a friend or relative check your feet every day.
You should look for blisters, cuts, redness, hard skin, breaks, and scratches. Also feel the temperature of your feet. If they feel hot or cold, something could be wrong.
Don't put your feet into hot water.
Test water before putting your feet in it just as you would before bathing a baby.
If your feet are cold, wear socks.
Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
Don't cut off blood flow to your feet.
Don't wear garters. Don't smoke.
Do not use chemicals on corns, calluses, or warts.
Over-the-counter products are often too strong for use by people with diabetes. They can burn your feet. Also, do not cut corns or calluses yourself.
Cut your toenails to follow the curve of your toe.
Do not rip off hangnails.
Wear flat shoes that fit your feet.
They should be comfortable when you buy them. Break in your new shoes slowly.
Consider wearing comfortable walking shoes every day.
Check your shoes before putting them on.
Make sure there are no stones, nails, or other sharp objects in them. Make sure that the shoe itself is not rough and the lining is not torn.
Choose socks carefully.
They should not have seams or other bumpy areas. Do not wear socks that have been mended. Pull your socks on gently to prevent ripping a toenail. Choose padded athletic socks to protect your feet and make walking more comfortable.
Never walk barefoot.
You could burn or cut your feet and not notice it. Keep slippers by your bed to use when you get up at night.
See your doctor at the first sign of infection or inflammation.