Why are you at such a higher risk to develop foot problems? Nerve damage (neuropathy) causing loss of touch sensation, thermal sensitivity, and loss of pain sensitivity or tingling or burning in the feet; narrowing or blocking of the blood vessels; overweight, making it hard to reach your feet to properly inspect or treat; or eye complications that affect your ability to see that you have a foot problem are a few of the reasons. And, if your diabetes is out of control, you also have a higher risk of developing infections, and that especially includes the feet.
For people with diabetes with no foot neuropathy, activity using your feet is unlimited. People with mild or severe neuropathy need to replace high-impact activity with low-impact aerobics, bicycling, or swimming. Anyone with diabetes must learn and daily practice care of their feet.
At least once a day, wash (check the water temperature before you stick your foot in) and dry your feet at least once a day, especially after exercise. After drying your feet, inspect them in good light, paying special attention to the soles. Look for and treat any dryness with a moisture-restoring cream that is made specifically for people with diabetes. Begin at the back of the heel, moving forward towards the toes, taking care to avoid getting the cream between the toes as that could cause the skin to wear away, resulting in possible infection. Between the toes is also a haven for athlete's food fungus. If you can't see to do this properly, ask someone else to do this for you. Mild foot powder, baby powder, or talcum will help if your feet perspire.
Pay very close attention to any blisters or cuts. Ask your doctor how to treat simple wounds and notifying him/her immediately if redness around the wound, pain, or swelling develops, or if the area is not healing properly. If you're going on a hike (see "burning calories" for this month), blisters might, indeed, become a problem. Carry extra socks and liners as damp feet are prone to getting infections. You'll also need to have proper-fitting hiking boots or athletic shoes, and carry aerosol foot powder for drying the feet, making them less prone to blisters. If a blister forms in spite of your precautions, you'll need to use moleskin or re-usable donuts made of special cushioning material to keep the pressure off the blister until it heals. Also if a blister forms, curtail activities such as swimming which could spread any resulting infection.
Poor fitting shoes can cause corns and calluses. Both can cause increased pressure on the foot and can result in infection, leading to foot ulcers. After washing, rub the corn or callus area hard with a soft towel. Use extra moisturizing cream to help soften them. Don't pull off any loose skin. Don't cut them off. Don't use corn- or callus-removing products. If the problem persists or becomes discolored, immediately consult a foot specialist who specializes in diabetes. He/she may decide to either thin or remove them surgically. When your feet are involved, this is not the time for self-diagnosis or "bathroom surgery."
Make sure you always wear proper-fitting shoes which leave the toes in their natural resting position. If you're female, you might want to refer to our article on stiletto heels (November, 1997, in this same section). Break new shoes in gradually, never wearing them for more than an hour or so as you're doing so. If you wear slippers at home, make sure they are sturdy enough to prevent stubbing your toes. If you have foot neuropathy, change your shoes and socks every 3 to 4 hours.
Cotton and wool socks are best for people with diabetes. If you wear hosiery such as nylons, panty hose, thigh highs, etc., make sure they are absolutely clean and carefully inspect your feet after removing them. Socks should always be dry (some people have to change their socks several times a day if they perspire a lot) and checked for any drainage, your first sign of a possible foot ulcer or blister.
File your toenails with an emery board instead of using scissors or nail clipper as you're less likely to cut yourself, leading to infection. Shape the toenails to the contours of your toe and the toes next to it, taking care not to make them too short. If your vision is poor, ask a friend or loved one to help, or go periodically to your podiatrist or manicurist. If an ingrown toenail or fungal nail infection develops, seek immediately medical attention. These are problems that need expert care.
Avoid going bare-footed, especially at the beach. A simple cut or scrape could develop into something life- or limb-threatening. Again, always be prepared to treat any foot wound. If redness, pain, or swelling develops, get to a doctor.
Exercise your feet; walking helps the circulation. Don't let your feet get too hot, sunburned, or too cold. Both can harm foot tissue so be sure to include your feet when putting on sun-screen and protect them from possible frostbite. Did you know that you can get a burn on your feet from exposed radiators, a steam room, or sauna? If you didn't have diabetes, this would not be a necessarily serious problem; but for people with diabetes, it needs proper medical attention.
People with diabetes must also pay special attention to avoid possible sprains or bone breakage in the foot, ankle, or leg. If one should occur, the standard treatment for a sprain (ice, compression, elevation and reduced physical activity) may not be sufficient, particularly if you have neuropathy. Make sure the attending physician is aware of your diabetes so that he/she can decide whether it is prudent to immediately cast the sprain. If you have an actual bone break, healing may take what seems like forever, with you needing to wear a cast for several months.
Lastly, never assume that your feet are normal if you have diabetes. They are not! Your feet take more pressure and abuse that any other part of your body as you stand, walk, or run. Treat your feet with the respect they deserve. You're only born with one matched pair!
FTG
