If you’re living with diabetes, then you need to know how your condition can affect your foot health. Sometimes, a patient with diabetes also suffers from poor circulation (known as “neuropathy”). When this is the case, extra attention should be paid to foot case because the neuropathy can contribute to reduced sensations in the feet, which in turn can result in minor cuts or other injures going unnoticed long enough to become infected. There are many ways a diabetic can maintain the health of their feet at home, including:
Inspecting One's Feet Daily
Daily foot inspections are vitally important for diabetics. When a diabetic cannot feel sensation properly in their feet, they will not be aware of injuries or problems in the feet that a non-diabetic would easily feel. For example, a diabetic may not feel the puncture of a sharp object like a needle, instead feeling as if something flat or soft was stepped on. Another common problem is the development of wounds in a diabetic. Normally skin wounds are easily felt as they are painful to walk on in a non-diabetic. A diabetic with poor sensation (neuropathy) will not necessarily feel a wound on the bottom of their foot, and the wound can fester for weeks before it is noticed. At that point, many of these wounds need powerful antibiotics, possible hospitalization, possible surgery, or even possible amputation. Wounds can develop from something as simple as poorly fitting shoes rubbing on the skin, or even silently under corns and calluses that become thicker and thicker from pressure between the foot, the ground, and one's own shoe. Corns and calluses are the skin's way of protecting itself from excessive pressure, but if they become too thick the normal skin underneath will die, forming an ulcer or cavity. The corn or callus will remain on top looking like normal, if not thickened, skin, but a deepening wound continues to worsen underneath. Although this is a painful process, diabetics with poor sensation will not feel it, and eventually the area may become infected.
Simply put, a daily inspection will catch any visible foot problems before they have a chance to worsen and cause serious problems. It should be done at night before going to bed, to catch any problems that occurred that day. One needs to look at the bottom and top of the foot, the sides, the heel, and in between the toes. If seeing the bottom of the foot is difficult due to arthritis or an inability to bend the back or legs, one may use a hand mirror on the ground and wave the foot over it to see the sole of the foot. The inspection should look for redness, bruises, blisters, wounds, cuts, scrapes, new swelling, excessive skin warmth, or new derangement of joints or of the toes. If any of these things are seen, one should call a foot specialist first thing in the morning. If the foot has a wound that is draining, red, and hot, or if the foot looks newly deformed or is warm to the touch with redness and without a wound, one should proceed to the nearest emergency room or urgent care center immediately, as a serious infection or injury could be occurring.
Very few serious diabetic complications develop in the feet instantly. Most of the time these problems can be easily treated or prevented if caught early enough. The foot inspection is a vital part of this, and getting into the habit of inspecting ones feet, even if neuropathy is not present, will likely one day be the difference between quick treatment and an amputation.
Wearing Shoes At All Times
Although most people don't realize it, the ground is full of dangers to the diabetic foot. Most all diabetics have some form of poor foot sensation (neuropathy). Although normally painful, diabetics may not feel anything when they step on a sharp object, or they may feel a sensation that is too dull to notice. This becomes a problem as diabetics generally heal poorly from puncture wounds to the feet, and are much more likely to develop an infection from the bacteria living on the object puncturing the skin. This object can occasionally penetrate deep into the foot. Unfortunately, most puncture wounds that go deep are not visible on the skin, as the objects causing this tend to be small (for example, a sewing needle). These deep infections are not noticed until they are severe enough to cause redness, swelling, and sometimes drainage if fluid is able to work its way to the surface. Most of the time these deep infections require surgery to drain the infection, and if ignored long enough, sometimes removal of bone or amputation of part of the foot is necessary.
These problems can be easily prevented by wearing shoes at all times. Shoes in general will protect the foot from most puncture wounds. It is vitally important that shoes be worn at home as well, since the majority of puncture wounds seen in our offices occurred in the home. A dedicated clean 'house shoe' is recommended, but even a slipper with a thick sole will do. Finally, it is important to quickly inspect the inside of one's shoes or slippers, as occasionally objects fall into them. Inspecting for and removing any object in the shoes is another important step to protecting the foot, and is one most people don't think about.
Wearing Properly Fitting Shoes
A diabetic cannot afford to wear an improperly fitting shoe. Improperly fitting shoes will cause pressure and rubbing on the skin, which will eventually lead to blisters and wounds. This obviously applies to tight shoes, but it also applies to shoes sized too big. When a shoe is too big, the foot will slide backwards and forwards like a piston within the shoe itself, causing friction blisters to form and jamming of the toes at the end of the shoe, which can also lead to wounds. It is important that diabetics get properly measured at the shoe store every time shoes are bought to ensure the best fit. Although sizes are supposed to be universal, different manufacturers create slightly different shoe size variations, and a 10 medium in one brand may be a 10 wide or even a 10 1/2 in another brand. Diabetics should purchase shoes from a store which is staffed with employees trained to help with shoe fitting, and preferably who are knowledgeable about the brands they carry. Fitting is best done in the late afternoon, when foot/leg swelling (edema) is at its greatest. There is no sense in fitting for a shoe if one has edema when the edema is down, as the shoe won't fit when the edema returns. Additionally, if one has a foot that is bigger than the other, the bigger shoe size determines which size to get, as one does not want to wear a smaller size shoe on the bigger foot. Most people with different sized feet have only a half size difference. If the size is more than that, such as 1-2 sizes different or more, then one must consider buying different sized shoes for each feet.
Checking Hot Water Temperature
Part of diabetic neuropathy could include poor sensation of temperature. Diabetics can easily misjudge the true temperature of water and scald their feet in a bathtub. The foot is more likely to lose this temperature sensation than the hands, which can still lose temperature sensation in advanced neuropathy cases. The arms, however, will generally maintain temperature sensation. Simply put, it is much safer to check bath or hot tub water temperature with the forearms than it is with the feet or hands, avoiding the risk of scalding the feet. Burns in diabetics are common, and heal at a slower rate. Burns are also susceptible to infections more than other wounds, and diabetics are more likely to develop infections from those burns than non-diabetics.
Moisturizing Feet Daily
Dry feet are often a problem for diabetics, as the high blood sugar will cause a decrease in the body's natural sweating mechanism. This will result in dry skin, which is worsened in the winter months. Dry skin that is simply flaky is not so much of a problem as dry skin that forms cracks and fissures. Cracks and fissures, especially in weight-bearing areas like the heel and ball of the foot, can often lead to wounds and even infections. Any skin crack in a diabetic that is open or bleeding needs to be evaluated by a foot care specialist for immediate attention and treatment before it can become a more significant problem. Unfortunately, even skin that is simply dry and flaky can eventually progress to cracks and fissures. This is why it is important for diabetics to regularly moisturize their feet and legs.
Typically most diabetics need to moisturize their feet each day for proper hydration. During the winter months this may be necessary 2-3 times per day. Some diabetics may even need prescription strength moisturizers if the dryness is not improving. It is very important not to apply moisturizers in between the toes, as this can sometimes lead to skin breakdown in between the toes and can lead to infection.
Contrary to popular belief, soaking the feet will often lead to increased dryness as the water and soap or epsom salt solution will leach the skin's moisture, causing even more of a problem after the skin dries. Unless necessary for a therapy or post-surgical treatment course, it is a good idea for diabetics not to soak their feet.
Never Performing "Bathroom Surgery"
Simply stated, diabetics should never try to cut any part of their foot skin for any reason. Not only is working on oneself difficult due to poor positioning and reach, but poor sensation in diabetes can allow for disastrous injuries inflicted to one's own foot. All skin lesions or hard spots should be treated by a professional, and preferably a podiatrist, as surgically working on feet is what we do all day. Although a corn may not seem like a big deal, the fact of the matter is that improper treatment of painful skin lesions at home often lead to wounds that take a long time to heal, infections that persist, and sometimes even amputations. A simpler solution to dealing with hard skin lesions at home is to gently file them a little bit every several days after bathing using a fine emery board or pumice stone/block. After bathing the skin is softer, and will file easier. However, one must still be cautious, as aggressive filing can cause superficial wounds to the skin as well.
Controlling Blood Sugar
Controlling one's blood sugar is perhaps the most important step in preventing foot problems. When blood sugar is normal, the potential for foot complications is significantly lessened. If kept under control, diabetes may not affect the feet and all of the conditions discussed above can be potentially avoided, ensuring a lifetime of healthy feet.