Diabetes and Foot Problems
Foot infections are another important concern for people with diabetes. Diabetes-related nerve damage can reduce feeling in the feet, making it difficult to detect a foot injury.
Diabetes can also impair blood circulation and wound healing by narrowing the arteries that carry blood to the legs. This combination is extremely serious, because a wound on your foot or leg that doesn't heal can turn into an ulcer (deep sore) that quickly becomes infected.
Amputation is often necessary. In fact, one fifth of all hospitalizations in people with diabetes are for foot infections, resulting in over 80,000 lower-limb amputations each year.
Blood glucose control, quitting smoking, and proper foot care can greatly reduce these risks. That's why everyone with diabetes, and especially those with neuropathy or poor circulation, should follow a routine of inspecting each foot and lower leg every day and carefully treating and monitoring even the most trivial blister, cut, or abrasion. Any injured areas should be washed with warm water and soap, cleaned with a mild antiseptic (such as Bactine), and covered with a dry, sterile dressing and paper tape.
If you do develop a foot or leg ulcer, call your doctor immediately. Because people with diabetes often have poor blood circulation, ulcers can become infected rapidly. Although treatment with antibiotics is needed, it's not enough to cure these serious infections.
Incision and drainage procedures are the best treatment. Severe ulcers usually require wearing a boot to protect the foot. These woundcare treatments are so complex that most doctors now send people with infected ulcers to specialized wound care centers. Treatment can take many months because wound dressings must be applied and changed frequently, and dead tissue may have to be removed from the wound (a process called debridement). Considering that the alternative to treatment is amputation, this expensive and timeconsuming process is definitely worthwhile.
Foot care tips for people with diabetes
You can reduce your risk of foot complications by keeping your diabetes well controlled, having your feet inspected by a family doctor or podiatrist at least twice a year, and taking care of your feet.
- Inspect your feet each day. Contact your doctor or podiatrist if you notice any infected toenails, swelling, sores, cuts, bruises, blisters, or red spots that do not heal after a day. Also, notify your doctor if you experience tingling, numbness, or pain in your feet. If you cannot see your feet well, use a mirror or ask for help from a family member or friend.
- Wear shoes and socks. Always wear well-fitting footwear, even indoors. If you walk barefoot, it is easy to injure your feet without realizing it. Before putting on your shoes, check for pebbles, gravel, or anything that could potentially cause a cut or sore.
- Break in new shoes slowly and carefully. To prevent blisters, you should always have on socks or stockings when wearing shoes. Avoid tight socks, garters, or elastic bands to hold up socks because they can cut off circulation to your feet.
- Wash your feet daily. Use a gentle soap and warm water. If you have nerve damage, hot water can scald your skin without your even noticing it, so always be sure to test the temperature of the water using your elbow or a thermometer. Avoid soaking your feet, which can cause your skin to become dry and crack.
- Treat calluses and corns gently. If recommended by your doctor, gently file calluses and corns after bathing, using an emery board or pumice stone. To avoid irritating your skin, rub in one direction only. Do not use chemicals, razor blades, or other harsh methods to remove corns or calluses. If calluses or corns are particularly troublesome, you can have them removed by a healthcare professional.
- Dry your feet thoroughly after bathing. Use a nonabrasive towel to gently blot dry your skin. Avoid rubbing, which can damage the skin. Don't forget to dry the spaces in between your toes.
- Moisturize your feet. Apply a thin layer of skin cream, lanolin lotion, or petroleum jelly to the top and bottom of each foot after drying your feet. Avoid putting lotion between your toes, where excess moisture can contribute to infection. Cornstarch may help to minimize moisture in between your toes.
- Cut your toenails once a week. Toenails should be cut after washing and drying your feet, when the nails are soft. Cut the nails straight across without curving in at the edges. Cutting into the corners of the nails can lead to ingrown toenails. Also, avoid cutting your nails too short. If you have trouble trimming your toenails, ask a family member or friend for assistance or have a health care professional trim them for you.
- Carefully wash any cuts or blisters using soap and water. For cuts, use a mild antiseptic like Bactine and cover the cut with a dry, sterile dressing and paper tape. Do not pop a blister. Instead, rub an antibiotic cream on the blister a few times daily until it heals.
- Avoid heat and cold. Never place a hot-water bottle or heating pad on your feet or place your feet near a radiator or fire because you may not be able to feel any damage that occurs. Instead, wear warm socks. Also, avoid sunburns by keeping your feet out of direct sunlight or by applying sunscreen. Feet can be damaged easily by cold surfaces or frostbite during the winter. Be sure to protect your feet from the cold during winter by wearing extra-warm socks and shoes.