When did you last look at your feet? If you have diabetes, your answer should be “Just yesterday – and I will again today!” Daily inspections of your feet can help you avoid diabetic foot ulcers – sores or breaks in the skin, often on the soles of the feet, on the toes, or on the heels – and the hospital stay that too often follows.
How Diabetes Affects Your Feet
Diabetic Neuropathy. Your nerves carry messages to and from your brain to all parts of your body. Your nerves tell your muscles to move, and let you know if you have touched something hot or sharp.
If you have diabetic neuropathy, the nerves that carry messages to and from your feet may be damaged. This can cause a loss of awareness of pain or extreme temperatures, even though you may still have light-touch sensation, You could step on a thumb-tack or piece of glass without realizing it, or burn your feet if your bath water is too hot.
If your shoes don’t fit, you may not even notice. This could rub you the wrong way – literally – and cause a patch of skin to blister, resulting in a sore or an ulcer.
An ulcer on the foot can be very painful, but if you have neuropathy, it may not hurt you. You might walk around and make it worse, What was originally a trivial injury could then become a serious ulcer.
Nerve damage can also cause the foot to change shape. The ball of your foot can become more prominent, your arch higher, and your toes may curl up. This change in foot shape also means that some parts of your foot take more pressure, and you are more likely to develop a corn or callus (hard skin) in these vulnerable areas.
Vascular Disease. Your blood vessels carry blood to all parts of your body, providing nourishment and oxygen. If you have vascular disease, the narrowing and hardening of your arteries will reduce the blood supply to your feet. Sores or ulcers will heal very slowly.
Yes, EVERY Day
Not everyone with diabetes will get a foot ulcer, but some people are particularly susceptible.
Whether you have insulin-dependent (type I) or non-insulin-dependent (type II) diabetes, you are at high risk if you fit into any of the following categories:
- You are over 60 years old.
- You have had a foot ulcer in the past.
- You have had laser treatment to your eyes.
- You have kidney disease.
- You have neuropathy.
- You have vascular disease.
Have your feet examined at your regular checkups. Your doctor, nurse, or podiatrist can do tests to determine if you are at risk of developing a foot problem.
Either way, it’s wise to make foot care part of your daily routine. It only takes a moment and could prevent a trivial injury from becoming more serious.
Why not have a look now? First, remove your shoes and socks. Always examine both feet. If you can’t reach or see your feet, ask a relative or friend to do this for you, or use a mirror.
Look at both feet, on top and underneath, and don’t forget to look at your heels and between your toes. Look for any swelling, red areas, breaks, cuts, cracks, blisters, or hard skin.
Get to know your feet. Then if you do develop a problem, you are more likely to spot it. Compare one foot with the other, and feel the temperature of your feet with your hands. If one foot is much warmer or cooler than the other, this could mean that there is something wrong. A very warm foot could be a sign of a foot infection and should be reported to your doctor, If one or both feet are very cold it could indicate that the blood supply to your feet has been affected.
If you think something is wrong with your foot, especially if the skin is broken or you have a blister, contact your doctor, nurse, or podiatrist, and rest your foot. Don’t try to treat a foot problem by yourself.
Preventing a problem is better than curing one. To prevent problems:
* Don’t walk barefoot. If you have lost some of the feeling in your feet, you could step on something and damage your foot.
* Never use a hot water bottle or heating pad. You could burn your feet and not notice.
* Get any corns or calluses professionally treated. Never use at-home corn cures as they can burn away the skin on your feet and could cause an ulcer.
* If the skin on your feet is very dry, use a moisturizing cream to keep it supple and to prevent cracking. Rub the cream on your feet and legs, but not between your toes.
* Keep your nails trimmed, following the natural line of your toes. If you cannot manage to cut them yourself, make an appointment with your podiatrist.
* Choose your shoes, and your socks, carefully.
Shoes Made For Walkin’
Ill-fitting shoes are a common cause of foot problems; if worn too long, they can cause a foot ulcer that may require a lengthy hospital stay. So always put your feet first, not fashion.
* Lace-up shoes are best, because they can adjust to the shapes of individual feet, and can be loosened if your feet are swollen.
* The shoe should have a broad, low heel so that the weight of your foot is evenly distributed.
* It should be wide enough to fit the broadest part of your foot with room for you to wiggle your toes.
* The sole of the shoe should be thick enough to cushion your foot and not allow thumbtacks or nails to penetrate to your feet.
Make sure your feet actually fit in the shoes without being squashed. Your shoes should be the correct width, length, and depth; in other words they should be shaped like your feet.
Rely on a good shoe store with a trained fitter. Or do this: Stand on a sheet of paper, draw the outlines of your feet, and cut them out. Then bring these cutouts to the shoe store. Put the shoes you’re thinking of buying on top of the cutouts. Do parts of the cutouts stick out beyond the shoes? Then the shoes are too small, or not the right shape. (As long as you have the cutouts, check the shoes you have at home, too.)
If your feet have changed shape because of neuropathy, you’ll need deeper shoes to accommodate your feet and toes and prevent them from being rubbed. Remember that you might not be able to judge the fit if you have neuropathy; people with reduced feeling often perceive that a correctly fitting shoe is too loose.
Break in your new shoes gradually. Wear them for only an hour or two at first, and always inspect your feet afterward to make sure they haven’t been damaged by the shoes.
Feel inside your shoes with your hand before you put them on and make sure there are no small stones or other objects inside which could damage your feet. We have seen patients at our clinic who were walking around with various objects in their shoes without knowing it: paper clips, safety pins, coins, buttons, and even a house key.
Check also that the lining inside the shoe is smooth, with no rough seams or ridges. You should do this each time you put your shoes on.
Some clinics recommend using insoles. Insoles help spread the weight of your foot evenly, thereby relieving pressure on vulnerable areas of your foot. If you have an insole, there should be room in your shoe to accommodate both it and your foot.
Take a look at your socks – they can cause problems, too. Make sure that your socks fit and that there are no holes in them. Your toe could protrude through a hole and be damaged. Choose socks without thick ridges. If they have ridges, turn them inside out.
Pull your socks on gently, or roll them on. If you yank them on, and you have neuropathy, you could catch a toenail and rip it off without realizing it.
Padded sports socks are used by some people with diabetes. They cushion the feet, provide protection, and can help reduce callus build-up. These socks are available from sports shops and may be thicker than your usual socks. If you buy them, make sure that your shoe is large enough to accommodate both your foot and the sock.
If you do develop a foot ulcer, blister, or if you have broken skin, cover it with a clean dressing, rest, and seek immediate medical attention. Don’t walk around: You’ll make things worse.
Remember, if you have nerve damage, the ulcer may not hurt you. Rest is essential because it will enable you to keep weight off the ulcerated part of your foot and help heal the damage.
It may be necessary for you to be admitted to the hospital. If you have been asked to rest in bed, stay there. Resist the temptation to get out of bed when no one is looking. You could make the ulcer worse. Your medical staff will decide the best way to treat your ulcer.
Antibiotics are often used to prevent or treat infection. These are usually taken by mouth, but if you are in the hospital, you may get them by intravenous drip.
Some centers use casts to treat diabetic foot ulcers. These casts are similar to those used for broken ankles and are made from plaster of paris or fiberglass. They prevent pressure from being applied under the ulcer and enable you to walk around while the ulcer is healing.
An operation may be needed to treat an ulcer or infected foot. This may involve the removal of any infected or dead bone or flesh. If gangrene is present, amputation of a toe or part of the foot or leg may be necessary. The type of operation depends on the foot problem. Ask your surgeon to check the circulation in your feet before any foot surgery. Good circulation means better healing.
Once your ulcer has healed, care must be taken to ensure that it does not recur. The first few weeks are vital as the new skin is very delicate and could easily break down.
Foot ulcers are not an inevitable consequence of diabetes and can often be prevented. It only takes a few minutes each day to give your feet the attention and care they require.
They’re your feet – keep them happy!