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Foot Care In
Diabetes
posted 04/05/04
Two risk factors come together to make the feet particularly vulnerable in people with diabetes. The combination of peripheral vascular disease (inadequate circulation of blood to the extremities) and peripheral neuropathy, which deadens the sensation in the feet of many people with diabetes, leads to a high incidence of foot problems for people with diabetes. Amputation is a dreaded complication of this disease. Today, with new wound-treating technology and better preventive care, amputation can be avoided in most cases.
In your regular physical exams, your doctor will test for numbness, something you can monitor yourself, although the slow progression of nerve deterioration may make it difficult to detect. Poor circulation is sometimes signaled by cold feet. A more reliable clue is a pain in the legs when walking or exercising that stops promptly with rest, called intermittent claudication. Exercise is a good treatment for poor circulation; it helps promote growth of new blood vessels.
Injury to your feet can come from many different sources: a break in the skin, a penetrating wound (such as stepping on a tack), walking barefoot on a hot surface, continued pressure in one spot (as from a tight shoe), repetitive stress or infection. If you are at risk, you need to be on guard. Several guidelines can help prevent injuries and keep them from getting worse when they do occur.
 | Bathe your feet daily. Wash carefully, with warm water and soap, and rinse and dry thoroughly. Make sure you dry completely between the toes. |
| Trim your toenails with a nail file, not scissors or clippers, which can break the skin. File straight across, with a curve at the edge to avoid bothering the next toe. |
| Don't use commercial corn or callus removers or trim calluses yourself. Try to figure out pressure points that might be causing a callus and remove the cause; see a podiatrist or foot specialist for treatment. |
| If the skin on your feet is dry, a moisturizing cream will help, but apply it sparingly, and not between the toes. |
| Inspect your feet daily. Be on the lookout for cuts, red spots, warm or hot spots, calluses, corns, ingrown toenails, discoloration or any other abnormalities. |
| Never go barefoot. |
| Finally, make sure your shoes fit right. Too-tight shoes can cause blisters and calluses; too-loose shoes can also cause ulcers or blisters as they rub against the foot. Make sure socks aren't rubbing, either. |
If your daily foot inspection shows anything you are not comfortable with (a new sore, an irritated spot that isn't getting better, a break in the skin) see your doctor or health care professional. Foot problems can be treated with a number of different interventions: medications (primarily antibiotics), bed rest and elevation, debridement (scraping away of dead tissue), casting, special shoes and vascular or orthopedic surgery. Only in the most severe cases of out-of-control infection or gangrene is amputation necessary.
Source: LifeScan: Johns Hopkins University, Updated March 2004.
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