Spotlight on Essential Foot Care for Diabetes

Spotlight on Essential Foot Care for Diabetes
Nov 16, 2012 - Nov 30, 2012

Proper Foot Care Critical with Diabetes

Most people are aware that diabetes is a problem of high blood sugar, but did you know that the nerve and blood vessel damage caused by diabetes makes it a disease affecting the entire body including the feet. If you have diabetes, you are at an increased risk to develop foot problems. Complications involving the feet occur in over half the people who suffer from the disease.

Diabetes diminishes your body's ability to fight infection and the damage to blood vessels caused by diabetes results in less blood and oxygen getting to your feet. Because of this decreased blood flow, small sores or breaks in the skin may become deeper wounds. The affected limb can be at risk for amputation if these skin ulcers do not receive prompt, appropriate care.

Approximately 70 percent of people with diabetes suffer from peripheral neuropathy which can result in the loss of feeling in their feet. If you have numb feet you are less able to feel an injury or pressure on the skin of your foot. You may not notice a foot injury until a sore or infection develops.

Complications due to diabetes are the number one cause of lower-leg amputations and account for more than 80,000 amputations per year.  The loss of a leg can compromise a diabetic’s health, mobility, productivity and overall quality of life. Additionally, after an amputation the chance for another amputation within three to five years is nearly 50 percent. Today’s podiatrist plays a critical role in keeping people with diabetes walking and provides diabetic foot care to prevent and treat wounds to avoid a dreaded amputation. Including a podiatrist on your diabetes care team can reduce your risk of a foot or leg amputation by up to 85%.

"I can't emphasize enough how important it is for a person with diabetes to pay rigorous attention to their feet. Foot infections are a common surgical emergency for a person with diabetes and are more severe and take longer to heal than in a person without diabetes," says California Podiatric Medical Association President-Elect Carolyn McAloon, DPM, a board certified podiatric surgeon in private practice in Castro Valley, California. Dr. McAloon offers the following tips to help those with diabetes keep their feet healthy:

Inspect Your Feet EVERY Day

Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes should look for any changes in color, sores, or dry, cracked skin,” say Dr. McAloon. She recommends that those with diabetes place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.

Don't Go Barefoot

While wearing shoes with good coverage outside to protect your feet makes sense to most people, shoes should also be worn inside your house. Walking around without shoes puts your feet at risk for small cuts, scrapes, bruises and penetration by splinters, glass shards, and the dropped and lost sewing needle or thumbtack. If you have neuropathy you might not notice injuries until they become infected. It’s best to wear shoes at all times, even in the house.

Treat Foot Problems Promptly

“Attend to bunions, calluses, corns, hammertoes, and other aggravations right away, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them,” says Dr. McAloon. See a podiatric physician instead of heading to the drug store for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot. “And under no circumstances should you shave or attempt to remove calluses or corns,” stressed Dr. McAloon. Instead, show them to your doctor and ask about specially prescribed shoes to help prevent them.

Invest in Proper Footwear and Socks

Shoe shopping for people with diabetes requires a bit more time and attention to detail than you may be used to. Dr. McAloon advises looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably ones that are padded and made from cotton or another material that controls moisture.

Keep Your Feet Dry

Make sure that drying your feet is part of your daily hygiene routine. “The space between the toes is very airtight,” says Dr. McAloon. “Skin gets moist and breaks down, leading to infection.” Help prevent this by removing wet or sweaty socks or shoes immediately and gently washing your feet in warm (not hot) water with a mild soap, then gently drying them off. You can still use moisturizer to prevent dry, cracked skin — but avoid putting it between your toes. Check with your doctor regarding using proper a moisturizer for your sensitive feet.

Consider Orthotics

Because wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. There are shoes made especially for people with diabetes – check with your doctor for advice. For qualifying patients, Medicare Part B will cover one pair of depth-inlay or custom-molded diabetic shoes a year, plus additional inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is not healing.

Choose Low-Impact Aerobics

People with diabetes benefit from exercise, but you still need to go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into low impact aerobic activities like as walking or biking, which don’t put too much jarring pressure on your feet. Just make sure you have the proper shoe and fit for whatever activity you choose.

Control Your Blood Sugar

“There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. McAloon. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term, and if you already have an infection, high blood sugar levels can make it hard for your body to fight it.

Quit Smoking Now

The dangers of smoking run from your head to your feet. The nicotine in cigarettes narrows the blood vessels in the outermost layers of your skin, impairing blood flow. And less blood flow means less oxygen and important nutrients, like Vitamin A, reaching your skin and nourishing it to stay healthy and moist. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to kick smoking,” says Dr. McAloon.

Get Regular Check-Ups From Head to Toe

November is Diabetes Awareness Month and is a great reminder to call your podiatrist to schedule your yearly comprehensive diabetic foot examination.  Your podiatrist will check the circulation and feeling in your feet as well as inspect your skin and shoes. Your podiatrist and the other doctors on your diabetes management team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. If you notice any changes in your feet like skin color changes, swelling of the foot and ankles, numbness in the feet or toes, pain in the legs, open sores on the feet that are slow to heal, ingrown and fungal toenails, bleeding corns and calluses, dry cracks in the skin, especially around the heel, see your podiatric physician right away.

To find a podiatric physician near you visit the Find a Doctor tab at www.calpma.org

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