Healthy feet: preventive care is essential

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Background

Foot ulcers and amputations are major causes of disability among people with diabetes. Perhaps 15 percent of people with diabetes have a foot ulcer at some point in their lives. Most amputations are preceded by foot ulcers that won’t heal.

Research has uncovered the factors that predispose people to these serious complications. As a result, there are simple, inexpensive steps doctors and people with diabetes can take to head off problems. These steps include foot exams at the doctor’s office, as described below, and at home.

Recommendations

Doctors should be aware of risk factors for ulcers and amputations. People at higher risk include:

  • Men
  • People who have had diabetes for 10 years or more
  • People with poor blood sugar control
  • People with diabetic eye or kidney complications
  • People with heart or blood vessel disease
  • People who’ve already had foot ulcers or an amputation
  • People with severely abnormal toenails
  • People who have blood vessel disease in the feet
  • People with nerve disease in the feet that decreases sensation or causes weight to be borne improperly

Doctors should examine your feet at least once a year–more often if you have a high-risk condition. People with neuropathy should have foot exams at every visit. In the exam, the doctor should:

* Do a monofilament test (in which the doctor touches your foot with a stiff nylon fiber). This reveals whether your ability to sense light touch is normal or lessened because of nerve damage. When your sense of touch, pain, or temperature is damaged, it is easy to hurt your feet and not even notice.

* Ask about pain in the calves that comes with exercise and gets better with rest. Such pain can be a sign of decreased blood flow to the legs and feet.

* Feel the pulses in your feet. An absent pulse can be a sign of reduced blood circulation in your feet.

* Check skin to make sure it is intact, including between the toes. In people with diabetes, even a tiny foot injury can turn into a major problem.

* Check your skin for areas of redness, warmth, or calluses. All can be signs of tissue damage. Calluses can also increase pressure on some areas of the foot.

* Check for bone deformities (such as bunions and hammer toes), limited mobility in your joints, and problems with gait and balance. All can throw off how your foot hits the ground, which call lead to foot injuries.

Shoes can deal with many of these problems. A good shoe evens out pressure, reduces the number of new calluses and ulcers, and protects the foot from the outside world. Sometimes, such as when a person has nerve disease, well-fitting walking shoes may be enough. Other times, such as when a person has altered foot pressure or hammertoes, special shoes may be needed.

Doctors should treat dry foot skin, athlete’s foot, and causes of previous ulcers.

Doctors should work with their patients with diabetes to help them get their blood sugar levels as close to normal as possible. Doing so will delay nerve disease in the feet, which greatly raises the risk of ulcers. People with diabetes should be encouraged to stop smoking, too, so that they will be less likely to develop blood vessel problems.

People with diabetes need to understand the importance of good foot care and how to examine their feet each day. They also should know how to choose good shoes and how to care for the skin on their feet as well as their toenails.

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