Taking care of feet in diabetes
Foot problems in diabetes are often caused by nerve damage and/or damage to the blood vessels, and can have serious consequences (injury, infection, ulceration, and possibly gangrene). Corns, calluses, ulcers, cracked skin and problem nails need professional treatment. Prevention involves maintaining healthy blood glucose and blood pressure levels, taking care of feet every day, having correct footwear, and getting any foot problems checked out early.
How can diabetes cause foot problems?
Some people with diabetes develop 'complications' (negative effects) of diabetes.
Two of the common complications of diabetes are:
Both of these problems can cause damage to your feet.
Nerve damage (neuropathy)
How can damage to nerves cause foot problems?
Your nerves perform many jobs in your body, some of which are quite complicated. One of the most important things your nerves do is to give you feeling (or sensation). Being able to feel things protects us from getting injured.
We feel pain and therefore take action to protect ourselves. For example, if you put your hand onto a hot element on the stove you will instantly be able to feel the pain and pull your hand away. If you cannot feel pain (because the nerves in your hand are damaged) then you could lean on the element for a long time and have to rely on your sense of smell to tell you your hand was burning!
Numbness or insensitivity to pain
People with diabetes sometimes develop nerve damage to the feet. This can result in a range of different problems. One of the most serious is that either the whole, or part, of your feet can become numb or insensitive to pain.
If your foot is numb you can walk all day with a very bad blister, or something in your shoe that is injuring you, and never know it. You could burn your foot badly on a heater and not know to pull your foot away. And you wouldn't know if you needed help for the burn, either.
This means that if you have neuropathy in your feet you are:
- more likely to get an injury
- less likely to know to get help for the injury early on.
What are signs of foot or lower limb neuropathy?
Some common signs of foot or lower limb neuropathy:
- numbness
- tingling
- pain or burning sensation (some forms of neuropathy can cause pain).
Is there any treatment for foot or lower limb neuropathy?
Currently there aren't many treatments available. If your neuropathy is of a painful type there are a number of drugs that may help, including amytriptiline and tegretol. There is some evidence from research that improving your blood glucose levels may go some way towards reversing nerve damage.
Blood vessel damage
How can damage to blood vessels cause foot problems?
Damaged blood vessels will not transport as much blood as undamaged ones. If the blood supply is either reduced or cut off from any part of our body it can cause damage or death to that part.
How does diabetes damage blood vessels?
Diabetes can cause the lining of your blood vessels to become thickened. This means not as much blood can get through them. It's a bit like rusty pipes in your laundry. Not much water comes out of the tap when you turn it on because of the rust blocking the inside of the pipes. It is the same if your blood vessels are clogged up; less blood can get to where it is meant to be.
If the blood vessels to your feet are either clogged up or completely blocked, the skin and flesh of your feet will suffer.
This can mean that your feet are:
- less able to fight off infection
- less able to heal up if injured
- likely to develop gangrene (or areas of completely dead flesh) if the blood supply becomes completely blocked.
What are signs of damage to blood vessels to the feet?
Some signs of damage to blood vessels supplying the feet:
- pain in your calves when walking
- change in the normal colour or temperature of your feet or legs
- pain in your legs and feet at night or when resting.
If nerve damage is combined with a poor supply of blood then your feet are doubly at risk. You are more likely to get an injury (because you cannot feel pain) and if you do, that injury is more likely to lead to infection, ulceration and sometimes gangrene (because your blood supply is poor).
Is there any treatment for poor blood supply to the feet?
Surgery can sometimes help, depending on the sort of blood vessel damage you have. Some of the larger arteries to the lower limbs can be very successfully reconstructed. This type of surgery is done by vascular surgeons.
Prevention of foot problems
How can I avoid nerve or blood vessel damage in the first place?
The following actions can reduce your chance of developing damage to either your nerves or blood vessels:
- maintaining healthy blood glucose levels
- maintaining a healthy blood pressure
- stopping or reducing smoking
- staying active and getting regular exercise
- maintaining healthy blood lipid levels (cholesterol)
- maintaining a healthy body weight.
Everyday foot care - without existing damage
If you have no existing nerve or blood vessel damage you should still take sensible care of your feet. You should:
- Wash and carefully dry your feet every day. Take special care to gently dry between your toes
- Very lightly moisturise your feet every day, but not between toes
- Wear well-fitting and sensible shoes. Broad and deep sports shoes are often a good option. A podiatrist or diabetes nurse educator can give you tips on choosing shoes
- Look at your feet every day to check they look healthy and normal. Report any changes immediately to your podiatrist or doctor
- Have regular foot checks by your doctor, podiatrist or diabetes nurse educator. These checks should pick up any developing numbness or signs of poor circulation.
Everyday foot care - with existing nerve or blood vessel damage
- Make an appointment with a podiatrist. Take the shoes you commonly wear to this appointment so the podiatrist can see them
- Before buying any new shoes take them to your podiatrist for their opinion (most shoe shops are quite happy for you to do this)
- Ask your podiatrist for advice on how to manage cutting your toenails long term. Many serious foot problems develop from accidents when cutting nails
- If the feeling in your feet is reduced it is wise to get someone else who is properly trained to cut your toenails for you
- Always check inside your shoes before you put them on to make sure there are no objects inside them
- Avoid going barefoot, even in the house. Many serious problems start with injuries such as standing on a pin
- Thoroughly examine your feet every day. If you have difficulty seeing underneath your feet put a mirror on the floor in good light and examine the reflection of the soles of your feet. Make sure you check between your toes and around the nails. Look for redness, cracks, swelling, bruising or blisters. Get immediate help from your doctor or podiatrist if you notice any problems
- Gently wash and thoroughly dry your feet every day
- Wear thick socks. It is best to choose socks without seams. Seams can cause pressure on your feet that can result in blisters or ulcers forming
- Always check the temperature of baths with your elbow before getting in, to avoid accidentally burning your feet
- Have your feet checked by your doctor or nurse on every visit, even if you are visiting for a different reason
- Try to keep your body weight healthy
- Ask your podiatrist to fit shock absorption to your shoes
- If you smoke, try to quit smoking. Contact the Quit Group (details under "Further Information and support" at end) or talk to your GP. See also: Diabetes and smoking
All this will seem like a lot of care for your feet. But if you have nerve or blood vessel damage in your feet these steps can avoid serious problems developing. These problems, if not treated properly, could even end up being serious enough for you to lose a limb.
Common foot problems associated with diabetes
Even common foot problems can be dangerous for people with diabetes, as they may lead to more serious foot problems.
Corns and calluses
Corns and calluses are a thickening of the skin. They are caused by repeated pressure or rubbing on the same area of the foot. Corns are often round, raised areas on your feet at points where your feet rub against your shoes. Calluses are often larger areas of thickened, yellowish skin around your heels or underneath your feet.
If not treated, corns and calluses can act like stones in the shoe, putting pressure on the tissue underneath them. This pressure can lead to bruising, infection or an ulcer. This damage is often hard to see because it is underneath the corn or callus. If you also have nerve damage you may not feel any pain. Your best bet is to show any corns or calluses to a podiatrist to get them treated. Never try to cut or cure corns yourself.
Foot ulcers
Ulcers are an area of skin that is broken and is taking longer than normal to heal. Often the inside of an ulcer looks white. Untreated ulcers can have serious consequences, such as the development of gangrene which could lead to the amputation of your foot, so you should see your doctor promptly for assessment and treatment.
Rest and elevation of the affected foot, and relief of pressure on the foot and ulcer area, are essential for healing and preventing further damage.
Medical treatment of foot ulcers
The medical treatment may vary according to the state of your foot and whether the ulcer requires antibiotics to clear up a bacterial infection. If there is any dead tissue this may need to be removed surgically or you may need to have surgical drainage of the area. In some cases it may be recommended to have vascular surgery to improve circulation to your feet.
You will need to take extra care of your feet after ulcer healing, as scar tissue under the ulcer wound can break down easily. To prevent ulcer development it is important to inspect your feet regularly, take care of them, and prevent pressure problems by wearing the correct footwear.
Problem nails
Problem nails can be caused by injury, fungal infection, curved nails and badly fitting shoes. An in-grown nail may be painful, red and swollen, or have a fluid discharge. It can get infected very quickly. Get any problem nails seen by a podiatrist.
Cracked skin or fissuring
Neuropathy, excessive weight and poor footwear can lead to cracking of the skin. Cracks allow bacteria to enter the foot and can cause infection, which can be serious. It is important to keep the skin on your feet soft and supple. Regularly moisturising your skin will help prevent cracks or fissures.
Footwear and socks
Shoes that fit well can help prevent foot problems. Pamper your feet - go for comfort, not style. Sports shoes, especially broad-fitting, or those designed for walking, are a good choice.
Wear clean, well-fitting, cotton or woollen socks. They cushion and protect feet from pressure and also allow the feet to breathe. Avoid socks with seams, creases or tight elastic - which may reduce circulation or cause rubbing.
Original material provided by Diabetes New Zealand, 2008. Edited by everybody, June 2011.
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