Diabetes and Foot Problems -
What you should know

What is Diabetes?

Your body needs energy to perform daily activities. This energy comes from foods containing protein, fats and carbohydrates, which are broken down by the body and changed into glucose (blood sugars.)

Insulin is a hormone that is needed by the body to utilize glucose. Diabetes occurs when the body cannot make use of the glucose in the blood, either because the pancreas isn’t producing enough insulin (Type 1) or that the insulin produced is not effective, resulting in high blood sugar (Type 2.)

It is estimated that about 6 % of the US population (about 16 million people) has some form of diabetes. Half of these people (about 8 million) don’t even know they have it.

There are several types of diabetes. The most common, Type 2, accounts for approximately 90 % of all cases. It usually occurs in adults over 40 who are overweight or have a family history of diabetes.

Managing Your Diabetes

The goal of treatment for all types of diabetes is to keep the glucose within a normal range. Diabetes can often be controlled with diet and exercise alone, although some people may need oral medications or insulin injections. Research has shown that keeping glucose levels close to normal may help prevent or delay complications, like eye, kidney and nerve damage. Balancing diet, exercise and medications is the key to good control. Daily monitoring of glucose levels is essential. Use the results of your glucose monitor as a tool to gauge to how your body is doing every day. By managing your life and illness today, you will reduce the complications of diabetes tomorrow.

Diabetics are 40 times more likely to suffer amputation of a lower limb than non-diabetics. 86,000 amputations are performed every year, primarily due to infections. About half of the patients suffering a first amputation are expected back for a second within 5 years, and up to 68 % will die within 5 years. As many as 85 % of these amputations could be avoided by early and adequate prevention, evaluation, and proper management of infections. Yet foot care of the diabetic patient is all too often overlooked.

Many people with diabetes have mild to severe forms of diabetic nerve damage, which can cause a loss of feeling or sensation in the feet. As a result, cuts, scratches and openings in the skin can occur without you feeling them and can invite infection.

If you have diabetes, you may not notice rough seams in your shoes or socks that are rubbing against your skin, causing it to break down. You may also not be aware of weakening joints, which can cause you to change the way you put pressure on your feet as you walk. In turn, friction you can’t feel may cause your skin to blister or crack, opening a path for infection.

If your feet swell, your shoes have essentially become a girdle. We all have tried on or worn shoes that are too tight and know the pain and discomfort associated with it. For many diabetics, this sensation is lost and the shoe ends up causing pressure on the foot that could lead to a sore developing and the risk for infection.

Your blood nourishes tissues and carries infection-fighting cells to those tissues that need them. Because diabetes can cause circulation problems, your feet may be suffering from a reduced blood supply, putting you at greater risk for infection.

The overriding goal of foot care for diabetics is to stop infection before it starts, therefore reducing the risk of amputation. The key to successful management of diabetes is keeping your glucose (blood sugar) level under control and taking good care of your feet every day. Regular visits to a podiatrist (a doctor that specializes in foot care and foot surgery), at least annually, are important so that the health of your feet can be closely monitored. How much is your foot or leg worth to you?

The “Diabetic Foot”

You may have heard the term before without knowing exactly what it means. It is a term used by physicians who treat diabetes to indicate the complete cycle of foot irritation, skin breakdown, ulceration (a hole in the skin), necrosis (skin “death”) and bone infection that can lead to amputation and/or the spread of infection to other parts of the body. This cycle of events is not inevitable and with proper foot care, it can be prevented or minimized.

The Warning Signs of Foot Problems

If you have diabetes and experience any of these symptoms, it is important that you bring them to the attention of your physician or podiatrist.

• Changes in the color of the skin.
• Changes in skin temperature.
• Pain in the legs, either at rest or while walking.
• Swelling of the toes, foot or ankle.
• Blisters or open sores that are slow to heal.
• Ingrown or fungus infected toenails (thickened, brittle, black or yellow nails)
• Corns or calluses that bleed within the skin
• Cracks in the skin, especially around the heel.
• Tingling or burning sensations (particularly in the toes or sole areas.)
• Increased or decreased sensitivity to heat or pain.

Taking good care of your feet is a daily investment in your lifelong health and comfort. You can prevent or minimize most problems by adopting a routine of DAILY foot care and following these simple guidelines:

• Wear comfortable shoes and socks that properly fit your feet.
• Wash and dry your feet thoroughly, especially between the toes.
• Keep your toenails trimmed short and straight across.
• Apply a moisturizing lotion to your feet to keep the skin soft and smooth.
• Wear clean socks or stockings every day and avoid wearing the same shoes two days in a row.
• See your podiatrist annually for a foot check up and for any severe or persistent problems.

1. Each day, inspect your feet for any skin breaks or changes, such as:
   
   

   Inflamed areas (redness, swelling and heat indicate a possible infection) Broken skin (cracks, sores and ulcerations invite infection) Infected skin (including breaks in the skin with pus or clear drainage, bleeding and/or foul odor) Ingrown toenails (irritated skin invites infection) Red streaks in the skin (indicates possible internal infection) Pale or blue skin (indicates poor circulation) Changes in “feeling” such as pain, a tingling sensation, burning, numbness or complete lack of feeling (may indicate nerve damage) Swelling or tenderness (may indicate infection and/or poor circulation) Areas that are warm to the touch (may indicate infection) Areas that are cold to the touch (may indicate poor circulation) Corns and calluses (these often indicate spots where your feet are under pressure and if they are not taken care of, they could lead to ulcerations) Any deformity of the foot or toes that develops.

   A hand mirror can help you see the bottoms of your feet. If you can’t see your feet yourself, ask someone else to inspect them for you on a regular basis. Touch and feel your feet with your hands so you can feel if “something is not right.” Gently spread your toes and look in between them to see if there are any breaks in the skin, redness or irritation. Call your physician or podiatrist if you notice any of the above conditions.

2. Wash your feet each day with soap and warm water (never hot as this may scald the skin.) Check the water temperature with your elbow since you may not be able to feel the temperature accurately with your hand or foot. Dry your feet thoroughly including in between the toes. Apply a moisturizing lotion to your feet to keep the skin from becoming dry and possibly cracking. Use foot powder to absorb extra moisture if your feet tend to sweat.
3. Never use a heating pad or hot water bottle on your feet for any reason.
4. Do not cut corns or calluses with a razor blade. Do not use over-the-counter liquid corn removal preparations as they contain acid that destroys tissue.
5. Before putting on your shoes, always check inside them for pebbles, rough seams or other potential sources of irritation.
6. If you have circulation problems, avoid crossing your legs when sitting, as this can compress blood vessels even more.
7. Avoid wearing tight-fitting shoes, wrinkled or tight stockings, tight sandals, straps or garters.
8. To prevent ingrown toenails, keep your toenails short and cut then straight across. Smooth them with an emery board.
9. Avoid weight gain, or lose weight if necessary, to minimize the pressure on your feet. Keep your glucose/blood sugar under control.
10. Never go barefoot, even inside your home, carpeted or not. A minor cut or scratch that goes unnoticed could lead to a serious infection.
11. Wear thick, smooth-fitting socks or stockings. Avoid mended socks or those with seams that could cause blisters.
12. Stop smoking and limit alcohol consumption. Smoking can cause a decrease in the blood flow to your feet and alcohol can contribute to neuropathy (disease of the nervous system.)
13. Stay active. Walking is the best overall exercise for the feet.
14. If your feet are exposed to the sun, apply sunscreen to the tops of your feet to avoid sunburn.
15. Keep your feet away from heat sources, such as open fires and heaters.
16. Never soak your feet.

The Importance of Proper Fitting Shoes

If you have diabetes, it is very important to take the extra time to buy the right shoes to fit your foot. Poorly fitted shoes are often responsible for the problems that lead to amputation. Your shoes should keep your foot in place when you walk and should be snug but not tight. Ideally, you should be measured and fitted by an experienced person who is knowledgeable about proper fit. Here are some tips to keep in mind when buying shoes:

• Buy shoes that fit you when you try them on; don’t expect that tight shoes will stretch out.
• The upper part of the shoe should be soft and flexible. The lining inside the shoe should be smooth and free of ridges and seams.
• Buy shoes made of leather or canvas, which offer better breathability and help keep your feet dry.
• The “toe box” should allow all toes to wiggle freely without rubbing against the front or top of the shoe. There should be about ¾“ between the big toe and the front of the shoe.
• The instep should cushion the arch comfortably without causing irritation.
• The heel should fit snugly with no slipping, pressure or pinching.
• The sole should flex easily at the ball of the foot.
• AVOID high heels and shoes with pointed toes.

NEVER ignore any foot irritation or injury. All of us are likely to have problems with our feet, but diabetics may develop serious problems more quickly and have more complications, especially when circulation or nerves are affected. At the first sign of redness, cracked skin or a change in the skin color or temperature, call your physician or podiatrist and follow the instructions you receive exactly.

The Cotton Ball method:

• Remove your shoes and socks
• Drag a cotton ball lightly across your toes
• Then drag the cotton ball lightly from your heel to your toes.

If you cannot feel the cotton, you may have nerve damage. Your physician or podiatrist needs to know this right away. Do the Cotton Ball test every month.

For More Information, contact:

American Diabetes Association

1701 N. Beauregard Street

Alexandria, VA 22311

Phone: 1-800-232-3472

www.diabetes.org