Diabetes and your Feet

Diabetes affects the circulation and immune system, which in turn impairs the body’s ability to heal itself. Over time, diabetes can damage sensory nerves (this is known as “neuropathy"), especially in the hands and feet. As a result, people with diabetes are less likely to feel a foot injury, such as a blister or cut. Unnoticed and untreated, even small foot injuries can quickly become infected, potentially leading to serious complications.

Daily foot care

As always, prevention is the best medicine. A good daily foot care regimen will help keep your feet healthy.

Start by assembling a foot care kit containing nail clippers, nail file, lotion, a pumice stone and a non-breakable hand mirror. Having everything you need in one place makes it easier to follow this foot care routine every day:

1. Wash your feet in warm (not hot) water, using a mild soap. Don’t soak your feet, as this can dry your skin.
2. While your feet are still wet, use a pumice stone to keep calluses under control.
3. Dry your feet carefully, especially between your toes.
4. Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.
5. Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin.
6. Trim your toenails straight across and file any sharp edges. Don’t cut the nails too short.
7. Apply an unperfumed lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don’t put lotion between your toes, as the excessive moisture can promote infection.
8. Wear fresh clean socks and well-fitting shoes every day. Whenever possible, wear white socks – if you have a cut or sore, the drainage will be easy to see.

Best advice

Do wear well-fitting shoes. They should be supportive, have low heels (less than 5 cm high) and should not rub or pinch. Shop at a reputable store with knowledgeable staff who can professional fit your shoes.
Do wear socks at night if your feet get cold.
Do elevate your feet when you are sitting.
Do wiggle your toes and move your ankles around for a few minutes several times a day to improve blood flow in your feet and legs.
Do exercise regularly to improve circulation.
Do inspect your feet daily and in particular, feel for skin temperature differences between your feet.

Don’t wear high heels, pointed-toe shoes, sandals (open toe or open heel) or worn-out shoes.
Don’t wear anything tight around your legs, such as tight socks or knee-highs.
Don’t ever go barefoot, even indoors. Consider buying a pair of well-fitting shoes that are just for indoors.
Don’t put hot water bottles or heating pads on your feet.
Don’t cross your legs for long periods of time.
Don’t smoke. Smoking decreases circulation and healing, and significantly increases the risks of amputation.
Don’t have pedicures by non-healthcare professionals.

When to see your doctor

If you have any swelling, warmth, redness or pain in your legs or feet, see your doctor right away.

If you have any corns (thick or hard skin on toes), calluses (thick skin on bottom of feet), in-grown toenails, warts or slivers, have them treated by your doctor or a foot care specialist (such as a podiatrist, chiropodist or experienced foot care nurse). Do not try to treat them yourself.

Have your bare feet checked by your doctor at least once a year. In addition, ask your doctor to screen you for neuropathy and loss of circulation at least once a year.

Take your socks off at every diabetes-related visit to your doctor and ask him or her to inspect your feet.

A diabetic ulcer

is a breakdown of the skin tissue on an area of the foot. An ulcer can develop quickly and may be painful and difficult to heal. Infection is a common complication. It may be necessary is important to have an X-ray to determine whether there is any bone involvement when an ulcer is present.

Causes of diabetic ulcers:

• Uncontrolled diabetes mellitus
• Vascular insufficiency
• Lack of sensation
• Chronic irritation from ill-fitting shoes
• Trauma

What can you do?

• Consult a podiatrist immediately.
• Alert the doctor's office that you are a diabetic with a foot sore.
• Self-treatment is not recommended for this serious condition.

What can a podiatrist do for you?

• Perform a physical examination.
• Request an X-ray, bone scan, CT, MRI or other imaging studies.
• Perform debribement and wound care.
• Conduct laboratory tests.
• Initiate total medical team approach, which may include your family practice doctor, endocrinologist, internist, vascular surgeon, and infectious disease specialist.

Source: American Podiatric Medical Association and Canadian Diabetes Association

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