Diabetic Foot Care

Foot care for people with diabetes (Beyond the Basics)

Author:Deborah J Wexler, MD, MSc

From Up To Date:

Foot problems are a common complication in people with diabetes. Fortunately, most of these complications can be prevented with careful foot care. If complications do occur, daily attention will ensure that they are detected before they become serious. It may take time and effort to build good foot care habits but self-care is essential. In fact, when it comes to foot care, the patient is a vital member of the medical team.

Diabetes and foot Complications:

Diabetes can lead to many different types of foot complications including athlete's foot (fungal infection), calluses, bunion and other foot deformities, or ulcers that can range from a surface wound to a deep infection

Poor circulation:

Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream , and bacterial and fungal infections can breakdown the sin and complicate ulcers.

More serious complications include deep skin and bone infections. Gangrene (death and decay of tissue) is a very serious complication tat may include infection; widespread gangrene may require foot amputation's.

Approximately 5% of those with diabetes eventually require amputation of a toe or foot.

This tragic consequence can be prevented in most patients by managing blood sugar levels a daily foot care.

Nerve damage:

Elevated blood glucose levels over time can damage the nerves of the foot, decreasing a person's ability to notice pain and pressure. Without these sensations, it is easy to develop callused pressure spots and accidently injure the skin, soft tissue, bone and joints. Over time, bone and joint damage can dramatically alter the shape of the foot. nerve damage, also called neuropathy, can also weaken certain foot muscles, further contributing to foot deformities.

Risk Factors

Patients who have had a previous foot ulcer are more likely to have future foot complications. Nerve damage, poor circulation and chronically high blood sugar levels also increase the likelihood of foot complications. It is important to wear shoes that fit well. Shoes that are too tight can cause pressure ulcers. Going barefoot, even in the home, should be avoided as this increases the risk of injury to the foot.

Foot Examinations:

People with Type 1 diabetes for at least 5 years should have their feet examined at least once a year.

People with type 2 diabetes should have their feet examined once per year.

During a foot exam, a healthcare provider checks for poor circulation, nerve damage, skin changes, and deformities. Patients should mention any problems they have noticed in their feet. An exam may reveal decreased or absent reflexes or decreased ability to sense pressure, vibration, pin pricks and changes in temperature.

Special devices, including a monofilament or tuning fork, can help determine the extent of nerve damage. A monofilament is a very thin flexible thread that is used to determine if a patient can sense pressure in various areas of the foot. A tuning fork is used to determine if a patient can sense vibration in various areas, especially the foot and toe joints.

Preventing Foot Problems in Diabetes

  • Quit smoking- smoking can worsen heat and vascular problems and reduce circulation of the feet

  • Avoid activities that can injury the feet- some activities increase the risk of foot injury and are not recommended, including walking barefoot using a heating pad or hot water bottle on the feet, and stepping into the bathtub before testing the temperature

  • Use care when trimming the nails- if you have poor blood flow or neuropathy do NOT attempt to trim your nails on your own. Drs. Gonzales and Anthony will be able to assist in cutting the nails and any calluses.

  • Wash and check the feet daily- Use lukewarm water and mild soap to clean the feet. Gently pat your feet dry and apply a moisturizing cream or lotion

  • Check the entire surface of both feet for skin breaks, blisters, swelling or redness, including between and underneath the toes where damage may be hidden. Use a mirror if it is difficulty to see al parts of the feet or ask a family member or caregiver to help

  • Choose socks and shoes carefully- select socks that fit loosely and change the socks everyday. Select shoes that are snug but not too tight. Ask about diabetic shoes if your feet are misshapen or you have a history of ulcers. Specialized shoes can reduce the changes of developing foot ulcers in the future. Shoe inserts or orthotics may also help cushion the step and decrease pressure on the solves of the feet.

  • See your podiatrist regularly! And if you see something change, say something!

While routine medical exams are important, everyday foot care plays the biggest role in preventing foot complications before they start.