Diabetes and Foot Problems

People with diabetes 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 due to complications from diabetes are expected back for a second amputation within 5 years.  Up to 68% will die within 5 years.  85% of these amputations could be avoided by prevention, early 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 and lower leg. As a result, cuts, scratches and openings in the skin can occur without you feeling them which 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 are unable to feel may cause your skin to blister or crack, opening a path for infection.

If your feet swell, your shoes may become too restrictive for adequate circulation.  We all have tried on or worn shoes that are too tight and know the pain and discomfort associated with it. For people with diabetes, this sensation is lost and the shoe ends up causing pressure on the foot that could lead to an ulcer 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 suffer from a reduced blood supply, putting you at greater risk for infection.

The overriding goal of foot care for people with diabetes is to stop infection before it starts, therefore reducing the risk of infection and possible 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.

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.

Six Steps to Healthier Feet

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.

What to Watch for in Taking Care of Your Feet

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 not taken care of, could lead to ulcerations)
• Any deformity of the foot or toes that develops.

1. 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.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.)
12. Stay active. Walking is the best overall exercise for the feet.
13. If your feet are exposed to the sun, apply sunscreen to the tops of your feet to avoid sunburn.
14. Keep your feet away from heat sources, such as open fires and heaters.
15. 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 can 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:

When Foot Problems Arise

NEVER ignore any foot irritation or injury. All of us are likely to have problems with our feet, but people with diabetes may develop serious problems more quickly and experience more complications, especially when circulation or damaged 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.

Test Your Feet at Home to Detect Nerve Damage

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