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Foot Care Treatment at Home
Foot problems are a big risk. All people with diabetes should take extra care of their feet. If you don't, the consequences can be severe; minor injuries become major emergencies before you know it. Because diabetes may decrease your blood flow, your injuries can be slow to heal, which puts you at greater risk for infection. Diabetes also affects your immune system and makes it harder to fight infections, so they may spread quickly.
If you have neuropathy you may not recognize that the problem is getting worse. One in five people with diabetes who seek hospital care do so for foot problems. Nearly 80% of all diabetes related amputations could be avoided with proper and early treatment. By taking proper care of your feet, most serious health problems associated with diabetes can be prevented.
Examine your feet daily and, especially, after any injury, no matter how minor. Feel each foot for swelling. Look for puncture wounds, bruises, redness or warmth, blisters, ulcers, scratches, cuts or nail problems. Examine between your toes, the tip of the big toe and base of the little and middle toes. Check the heel, outside edge of the foot and across the ball of the foot. Check for sensation in each foot using the pencil eraser test. If you have difficulties get someone to help you, or use a mirror.
Immediate wound care treatment is extremely important for people with diabetes because an infection can lead to serious health problems. Treat even small wounds as an emergency. Always discuss any concerns you may have with your doctor and /or podiatrist, even for the care of minor wounds and skin cracks.
Wash your feet every day with mild soap and warm water; this helps keep bacteria off of the feet.
Don’t soak your feet. Always be sure to test the water temperature with your hand, first, to avoid burning your feet if you have neuropathy.
Gently using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin.
Dry your feet by patting (don’t rub) each foot with a towel and be careful between your toes.
The nerves that control the oil and moisture in your foot may no longer work effectively. Your foot skin may become very dry and may peel or crack. Use a water-based moisturizer to keep the skin of your feet from drying and cracking -- but don't put any between your toes.
Always cut your nails with a toe nail clipper, never scissors. Cut them straight across and leave plenty of room out from the nail bed or quick. If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member how to do it safely.
Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs and help stabilize your blood sugar levels. Walk and exercise in comfortable shoes. Do not exercise when you have open sores on your feet. Plan your physical activity program with your health team.
Keep blood flowing to your feet by wiggling your toes and moving your ankles up and down for 5 minutes, two or three times a day. Don't cross your legs for long periods of time.
Protect Your Feet
People with diabetes should never go barefoot. Always protect your feet by wearing shoes or hard-soled slippers or other similar footwear. Wear shoes/boots that will protect your feet from various weather conditions (cold, moisture, etc.).
Caution: Wearing shoes with high heels, pointed toes, or shoes that expose your toes or heels (such as open-toed shoes or sandals) can increase your risk for injury and potential infections.
Look and feel inside your shoes before putting them on to make sure there are no foreign objects or rough areas (or spiders!).
Wear clean, dry socks every day. Choose natural-fiber socks (cotton, wool, or a cotton-wool blend) when possible, which allow moisture, to wick away from the foot. Avoid socks with holes or wrinkles. Avoid socks that are tight, have stiff seams or are heavily elasticized because they can create pressure points or reduce circulation. Seamless socks are available for those with neuropathy. Consider using compression stockings if your feet tend to swell.
Make sure your shoes fit properly. Wear special shoes if your health care provider recommends them.
Never use a hot water bottle, heating pad or put your feet near a heater, especially if you suffer from neuropathy. You may burn your feet and not feel it, creating further problems.
Move or remove any items you are likely to trip over or bump your feet on. Keep clutter off the floor. Light pathways used at night - indoors and outdoors.
Smoking accelerates damage to blood vessels, especially small blood vessels, leading to poor circulation, which is a major risk factor for foot infections and, ultimately, amputations.
Good Diabetes control
Eating properly, taking your medications, checking your blood sugar regularly, exercising and seeing your medical team is essential in keeping your diabetes under control. Keeping long-term blood sugar control to near normal levels can greatly lower the risk of damage to your nerves, kidneys, eyes and blood vessels, as well as being healthy for your feet.
When to Seek Medical Care
When it comes to a condition that can affect your mobility, it is much better to be safe, than sorry. At every visit your doctor should examine your feet. You should always remove your shoes and socks in the examining room so neither of you forget. Have your doctor examine your feet at least once a year using a monofilament, a device that tests sensation.
You should seek a doctor’s care within 72 hours if you have any significant injury to the feet or legs; persistent mild-to-moderate pain; areas of warmth, redness, or swelling on the feet or legs.
Corns, calluses, bunions, hammer toes, athlete’s foot, other skin problems, or ingrown toe nails should also be treated by a doctor, not at home.
New or constant numbness in the feet or legs can be a sign of diabetic neuropathy or poor blood circulation. This puts you at risk for serious problems, such as infections and amputations, and should be discussed with your doctor. Nerve damage can also lead to changes in the shape of your feet and toes. Ask your doctor about special therapeutic shoes, rather than trying to force deformed feet and toes into regular shoes.
Difficulty walking can result from diabetic arthritis (Charcot's joints). Early intervention is important to preventing more serious problems, including falls, skin breakdown and infections.
Seek immediate medical attention for the following:
Antibiotics may be prescribed if an infection is present or has a high risk of becoming infected, such as a cat bite. The doctor may also give a single dose of antibiotics as a shot or IV dose in the clinic or emergency department prior to starting pills. It is very important to take the entire round of antibiotics. You should see some improvement in the wound in two to three days and may even see improvement the first day.
For limb or life-threatening infections, the patient will be admitted to the hospital and given IV antibiotics. Your doctor may also order x-rays of your foot to make sure the bone is not infected and culture the wound to find out what type of infection you have and which antibiotic will work best. Your doctor may also clean out any dead and infected tissue or refer you to a wound care center.
Many hospitals, now have wound care centers specializing in the treatment of diabetic lower extremity wounds and ulcers. In these centers, doctors, nurses and therapists work with you and your primary care physician to develop a treatment plan. Treatment plans may include surgical debridement of the wound, improvement of circulation through surgery or therapy, special dressings, and antibiotics or a combination of treatments. Your doctor may also prescribe a special shoe, brace, or cast on your foot to protect it.
If necessary, your doctor may prescribe a home health nurse, or aide, to help with wound care and dressings, monitor blood sugar, and help you take antibiotics and other medications properly during the healing period.
After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.
If you have bone-related problems, toenail problems, corns and calluses, hammertoes, bunions, flat feet, heel spurs, arthritis, or have difficulty with finding shoes that fit, your physician may refer you to a podiatrist or orthopedist. They may create shoe inserts, prescribe shoes, remove calluses and have expertise in surgical solutions for bone problems. They can also be an excellent resource for routine foot care. Ask your doctor about Medicare coverage for special shoes.
Updated June 3, 2011
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