Diabetic Foot care

Footcare in Diabetes

People with diabetes are prone to nerve damage and blood vessel damage. The damage usually begins in the feet and can lead to minor foot injuries developing into foot ulcers that can take months to heal.

 

The first symptoms of nerve damage in the feet are abnormal sensations such as burning, prickling pain, tingling, electric shock-like feelings, aching, tightness, hypersensitivity to touch and feelings of things crawling on the skin. As the damage to the nerve supplying the feet increases, the feet become numb and all sensation is lost. Symptoms can move up the leg and can also occur in the fingers and hands. The nerves supplying the muscles, the sweat glands and the small blood vessels are also affected. Damage to these nerves result in less secretion from the sweat glands and the skin becoming dry and cracked, and more fluid leaking from the blood vessels and the feet and ankles becoming swollen (known as oedema).

If you have abnormal sensation in your feet:

  • Symptoms are worse when blood glucose levels are high, so aim for blood glucose levels before meals of less than 6mmol/L or less.

  • Some prescription medications can help alleviate the abnormal sensations.

  • Podiatrists can apply special dressings or recommend socks to reduce discomfort

 

If you have little or NO sensation in your feet:
 

  • Damage to your feet causes little or no pain, so wear shoes that protect your feet and give your toes plenty of room to move.

  • Check your feet daily; you may need to use a mirror to see the soles.

  • Before you put on your shoes, check there isn’t anything in them that might damage your feet or limit their movement.

  • If you notice any red or thick skin, thick nails or breaks in the skin, contact your doctor, nurse or podiatrist immediately.

  • If you have normal nails and you can reach them easily and see clearly, cut the nails carefully yourself; otherwise a carer or podiatrist should cut them for you.

If you have dry skin:

  • Wash your feet using warm (not hot) water and only a small amount of soap.

  • Pat the skin dry and use lots of moisturiser.

  • Wear socks or stockings made of natural fibres such as wool or cotton, and preferably with no seams.

  • Wear shoes that have a low heel and a shock absorbing sole, and which hold the heel firmly, fasten over the foot and leave plenty of room for toes to move.

If you have swollen feet and/or ankles:

  • Wear medium strength knee-high support stockings from as soon as you get out of bed in the morning until you go to bed at night to help prevent swelling. For best effect, put them on before getting out of bed; shower in the evening rather than in the morning.

  • You may need the help of a carer or a device such as the Ezy-As compression stocking applicator when you are putting on the stockings.

  • Stockings also protect the skin of the legs against knocks that might otherwise break the skin and lead to sores.

If you have diabetes it is important to take good care of your feet because you are at increased risk of developing foot problems such as ulcers and odd-shaped feet. Daily routine care of your feet will help keep them healthy and will allow you to notice any signs of damage and take the appropriate action.

 

Routine Foot Care:

 

Following these guidelines will enable you to reduce the likelihood of a foot problem developing and to detect any problems early so they can be treated. Wash and dry your feet every day. Pay special attention to the areas between your toes, and be gentle. Your skins acts as a barrier to infections, therefore people with diabetes tend to have dry skin, so use a moisturiser on your feet each day after bathing to prevent dry skin and skin cracks. Avoid moisturizing between your toes, but apply plenty around your heels. Gentle use of a pumice stone on your feet after showering and before moisturising will help reduce callus build up.

Your toenails should be cut ‘straight across’. If you cannot see and reach you toenails, you will need help from a podiatrist. Areas of thickened skin are the result of increased pressure in the area and can become ulcers. If you find any areas of thickened skin see a podiatrist and pay attention to your choice of footwear. A callus generally refers to a wide area of thickening of the skin whereas a corn is a thicker and smaller area over a bony region. Thickened nails and areas of redness on the foot are also signs of pressure.

 

Footwear is meant to protect your feet from injury. Protective footwear is especially important if nerve damage has reduced your sense of feeling in your feet. Shoes must -fit your feet and not rub. Finding shoes that fit well is more difficult but more important if your feet are a funny shape. Check that your socks or pull-up stockings are not acting like ‘garters’ around your legs and reducing the flow of blood to your feet. Your feet need to be in good shape to walk, and you need to walk to help your diabetes, weight and blood pressure. Enjoy the fresh air! 

 

 You should have a podiatrists look after your feet if you:

  • Have  abnormal nails

  • Have  decreased circulation

Cuts or abrasions:


Simple first aid: wash and dry the area, apply mild antiseptic and cover with a sterile dressing.


See your Podiatrist for ALL of the other conditions below:

  • If wound is not  healing within 48 hours, worsens, becomes inflamed or discharges

  • Pressure areas– as indicated by:

  • Recurrent local  symptoms

  • Transient redness

  • Blisters

  • Skin and/or nail thickening Excess pressure (See podiatrist for footwear advice)

  • Crumbly brittle nails Fungal infection

  • Moist or  macerated skin between the toes Fungal infection

  • Inflammation (Redness, warmth, swelling or infection)