You know you need to pay special attention to your feet because you have diabetes, but what does that mean? Do you need to see a podiatrist? How often? Do you need special shoes? What kind? How about socks? Do you need special lotions, creams, soaks, foot baths, etc., etc.???
Let’s start at the beginning with an absolute basic: Every adult with diabetes should have a complete foot exam at least once a year. If you have type 2 diabetes, the first exam should be soon after you are diagnosed with diabetes.
During the exam, the doctor should:
- test whether you have a circulation problem in your feet
- test the nerve function of your feet (the doctor should touch a filament to different parts of your feet to see if you can feel it)
- evaluate any seemingly minor problems. such as bunions, corns, athlete’s foot, ingrown toenails, etc.
- discussfoot care with you
Can and will your regular doctor do a complete foot exam? If you see a general practitioner, maybe. A diabetes specialist? More likely. But if you think your feet are getting short shrift, by all means see a podiatrist – a doctor specializing in foot care.
The results of your first exam will determine how often you return for foot exams. If you have no problems, you may need to be seen only once a year. If you have neuropathy and poor circulation, you should be seen much more often, perhaps every two months. Someone with a foot ulcer (an open sore) may need to be treated weekly.
There are ads for hundreds of over-the-counter creams, lotions, soaks, liquids, and powders for use on your feet. Do you need these?
Some of these products are useful for a person with diabetes. Some are dangerous. Some may do no harm but are just a waste of money.
Many people with diabetes do need creams or lotions for their feet. If you have dry skin, you should lubricate your feet daily to avoid cracks and breaks in your skin. I recommend starting with the least expensive products available. For example, something as simple as vegetable shortening works for some people. If the inexpensive products aren’t successful, you can work up to special compounds or prescription medications.
But check with your foot doctor or other health care provider first. You might think you simply have dry skin, but you may actually have athlete’s foot, which is caused by a fungus and requires special care. Unmedicated lotions won’t help, and if the fungal infection is left untreated, the skin may become damaged and a bacterial infection could start.
How about over-the-counter medications for fungal infections of the skin and nails? In general they will do no harm, but again, use these only with the approval of your doctor. Your doctor may decide that a prescription medication will work better. In fungal infections of the nails, for example, oral prescription medications are far superior to brush-on liquids.
Over-the-counter products for painful corns and calluses should never be used by people with diabetes. They have warnings about their use right on the package – but usually in small print. Most of these products contain an acid. The acid can damage healthy tissue near or under the hard tissue. This creates, essentially, a chemical burn which, in a person with diabetes or poor circulation, may not heal. In fact, these products are generally ineffective even for people who don’t have diabetes, temporarily relieving symptoms but not addressing the cause of the problem.
Sock And Shoes
Many people with diabetes are now buying special shoes and socks to protect their feet. Bravo! Wearing these lowers the risk of foot-related complications.
Pick socks that are made of yarns that wick perspiration away from the skin. Good choices are Coolmax and acrylic. Cotton, in contrast, absorbs perspiration but holds the moisture on the foot.
Extra cushioning and warmth are bonuses of some socks. Make sure your shoes are big enough since these socks may add extra bulk. Take the socks that you will wear with you when you try on and buy new shoes. If you wear special shoe inserts, such as orthoses, take these with you as well.
Your shoes should be carefully selected and fitted. Medicare will pay for a large part of the cost of therapeutic shoes for people with diabetes who meet certain criteria such as those with poor circulation, neuropathy, or deformities of the foot. The doctor that helps you control your diabetes will have to sign a form certifying that you have diabetes and need the special shoes. Your podiatrist will help select the right shoes for you and will either supply them or give you a prescription to take to a shoe store. Your doctor may work with a certified shoe fitter (pedorthist) to ensure that your shoes will protect your feet.
Unlike the tires on your car, you can’t buy a new pair of feet if they wear out. Fortunately, feet were made to last a lifetime. Take good care of them and they will.