Like car tires, feet really add up the mileage. During a lifetime, the average person walks more than 100,000 miles! But unlike tires, feet can’t be retreaded or replaced with a newer model. No wonder, then, that caring for your feet is an important part of your diabetes care.
Getting Off On The Wrong Foot
Diabetes is hard on feet for two main reasons. First, diabetes can cause nerve disease, which in turn can cause loss of feeling in the feet. You may not feel too-hot or too-cold temperatures or pain. That may sound good, but pain serves an important function. It tells you when you are doing something that is hurting you, so that you can stop doing it. And it tells you when you are injured, so that you can treat and rest the injured part. When you lose feeling in your feet, you can walk around with a sharp rock or thumbtack in your shoe and not even know it. Your feet can then sustain serious damage.
Nerve disease also can keep your feet from sweating. Again, that may sound good in theory but turns out to be bad in practice. If your feet don’t sweat, they can get dry and scaly and may even crack open.
As if that weren’t enough, nerve disease can also cause your toes to curl up or otherwise distort the shape of your foot.
A second reason diabetes is hard on the feet is that it can cause poor blood flow. Sluggish blood flow to the feet means that foot sores don’t get the oxygen they need to heal well. So foot wounds hang around a long time.
Choosing Shoes And Socks
For some people, shoes and socks are a fashion statement. For others, they’re a necessity to be dispensed with as cheaply as possible. But for people with diabetes, shoes and socks are medical devices. Taking care when choosing shoes and socks will pay off in healthier, happier feet.
When buying shoes:
- Wear the socks you plan to wear with the new shoes so that you can be sure that the shoes fit over them.
- Choose dress shoes made of leather with a thick sole and a broad, low heel. There should be room for you to wiggle your toes.
- Make sure the shoe fits and is comfortable when you buy it. Don’t buy a shoe expecting it to stretch into the correct shape and size.
- Choose lace-up shoes over slip-ons. They adjust to the shape of your foot better and can be loosened when your feet are swollen.
- For casual wear, walking shoes are a good choice.
- Go to a shoe store with trained fitters. Doing so is extra important for people with nerve disease, who may have trouble telling whether shoes fit well. A well-fitting shoe can feel too loose to a numb foot.
- Before going to a store without fitters, stand barefoot on a piece of paper and trace the outlines of your feet. At the store, set shoes on the outline. If any edges of the outline are visible, then the shoes are not going to fit you right.
- Talk to your diabetes doctor or foot doctor about whether a prescription shoe would be good for you. For example, if your foot shape has changed because of neuropathy, a shoe with extra depth may fit better than a regular shoe. Also ask whether an insole (orthotic) is worthwhile. An insole is a shoe liner that spreads your weight evenly over your shoe so that no one spot bears too much pressure.
- Feel inside the shoes you are considering. There should be no lumps or rough spots.
- After buying the new shoes, break them in by wearing them only for an hour or two at first. After each wearing, check to make sure they have not injured your feet.
When buying socks:
- Choose socks without ridges or lumps.
- Padded sports socks are good for casual wear. They cushion the feet and may reduce callus development. But because they are so thick, they may not fit well in some of your shoes.
When getting dressed each day:
- Check your socks for holes. Throw away socks with holes.
- Don’t pull your socks on roughly. You could catch and pull off a toenail.
- Look and feel inside your shoes. Make sure there are no rocks, paper clips, pennies, or other objects hiding inside. Also check that the inside surface of your shoe is still smooth.
Other Tips For Healthy Feet
A few other steps can help you keep your feet in tip-top shape.
- Examine your feet, top and bottom and between toes, every day. If there are spots you can’t see, put a mirror on the floor to aid you. Use both your eyes and fingers to check your feet. You want to find not only cuts and blisters but also cold and hot spots, rough areas, and places that hurt or have lost feeling.
- Take off your shoes and socks when you go to the doctor as a reminder that your feet need to be checked. If your doctor still doesn’t look at your feet, speak up. Foot checks are something your doctor should do at every visit.
- Wash your feet every day.
- Soothe dry skin by putting skin cream on feet after bathing. But don’t put cream between toes.
- Don’t go barefoot. Keep slippers next to your bed, and wear shoes and socks during the day.
- Test bath water before putting your feet in to make sure it’s not too hot.
- If you get corns or calluses, gently rub them with a pumice stone. But never, ever use over-the-counter corn and callus medicines on them, and never try to trim them yourself. If you think a corn or callus is getting too big, see your foot doctor.
- Consider calluses a warning sign that your shoes might not be fitting right.
- Don’t use heating pads or hot water bottles on your feet, and don’t soak feet in hot water. It’s too easy to misjudge the temperature and burn yourself. If your feet are cold, put on some soft, warm socks. If your feet are hard, try putting lotion on them.
- Don’t smoke. Smoking cuts blood flow to your feet – exactly what you don’t want.
- Exerciseto improve your blood flow.
- If you have a cut, scrape, burn, blister, ingrown nail, or other footproblem, don’t try to care for it yourself. Call your diabetes doctor or foot doctor right away. A tiny wound can blossom overnight into a large, infected one.
If You Do Get A Foot Ulcer
Sometimes, despite your best efforts, you may get a foot wound (ulcer). Some people try to continue on with normal life, but this is a terrible idea. Foot ulcers are serious business. Rearranging your life temporarily around your foot ulcer is inconvenient but necessary if you want your ulcer to heal rather than to get worse.
First, you should see your doctor that very day if you develop an ulcer. This applies even if the ulcer does not hurt. Your doctor will likely do several things:
- X-ray your foot to make sure infection has not reached the bone.
- Take a sample from the ulcer to culture to see what organisms are infecting your ulcer.
- Cut out the tissue that is dead or infected.
The doctor may send you to the hospital if the ulcer is bad enough. Or you may get an antibiotic to help kill the infection. Your doctor may put a cast on your foot so that you’ll be able to walk.
One new treatment your doctor may prescribe is becaplermin (Regranex). This drug is a gel that is put on the foot for 12 hours each day. It contains platelet-derived growth factor. This is a hormone-like protein that your body also makes naturally that aids healing.
If your doctor instructs you not to walk on your foot, it’s extremely important to do exactly that. People sometimes think that walking just to the bathroom or kitchen won’t hurt anything. But any walking at all can make an ulcer larger and spread any infection further into your foot. Spending some time in bed now may save you from an amputation later.
Another part of treating your foot ulcer is good diabetes control. Bacteria can feed on glucose, and high glucose levels encourage bacteria to grow.
After your ulcer heals, you still need to protect the fragile new tissue there. Your doctor may suggest that you start wearing special shoes.
Certain people are more at risk of ulcers than others. Although everyone with diabetes needs to pamper their feet, you need to take extra care if any of the following applies to you:
- You are at least 60 years old.
- You’ve already had at least one foot ulcer.
- You’ve had laser treatments on your eyes.
- You have kidney disease or neuropathy.
- You have vascular (blood vessel) disease.
Foot Ulcer Gel
Regranex (becaplermin) Gel 0.01%, is the only gel approved by the FDA for treating foot ulcers. It contains genetically engineered platelet-derived growth factor, one of the proteins the body produces to encourage new tissue growth.
The gel, which is made by Ortho McNeil Pharmaceutical, Inc., should only be used with good wound care practices, which include debridement to remove dead tissue, systematic treatment of wound infections, and staying off the effected foot. Side effects may include irritation and rash at the ulcer site. For more information visit www.regranex.com.