Foot Care in Diabetes

Foot problems are a common complication in people with diabetes. Most of these complications can be prevented with careful foot care. Diabetes can lead to many different types of foot complications, including athlete's foot (a fungal infection), calluses, bunions and other foot deformities, or ulcers that can range from a surface wound to a deep infection. Persistent high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream, and bacterial and fungal infections can break down the skin and complicate ulcers. Approximately 5 percent of men and women with diabetes eventually require amputation of a toe or foot. Elevated blood glucose levels over time can damage the nerves of the foot, which is described as neuropathy, decreasing a person's ability to notice pain and pressure. Without these sensations, it is easy to develop callused pressure spots and accidentally injure the skin, soft tissue, bones, and joints. It is important to wear shoes that fit well. Shoes that are too tight can cause pressure ulcers. Going barefoot, even in the home, should be avoided as this increases the risk of injury to the foot.

People with  diabetes should have their feet examined at least once a year. During a foot exam, a health care provider checks for poor circulation, nerve damage, skin changes, and deformities. Patients should mention any problems they have noticed in their feet. An exam may reveal decreased or absent reflexes or decreased ability to sense pressure, vibration, pin pricks, and changes in temperature. Preventing foot problems in diabetes:Controlling blood sugar levels can reduce the blood vessel and nerve damage that often lead to diabetic foot complications. If a foot wound or ulcer does occur, blood sugar control reduces the risk of requiring amputation. Smoking can worsen heart and vascular problems and reduce circulation to the feet. Avoid activities that increase the risk of foot injury, which includes walking barefoot, using a heating pad or hot water bottle on the feet, and stepping into the bathtub before testing the temperature. Appropriate trimming of the nails. It is important to trim the toe nails along the shape of the toe and file the nails to remove any sharp edges. Never cut (or allow a manicurist to cut) the cuticles. Do not open blisters, try to free ingrown toenails, or otherwise break the skin on the feet. See a health care provider or podiatrist for even minor procedures. Use lukewarm water and mild soap to clean the feet. Gently pat your feet dry and apply a moisturizing cream or lotion. Check the entire surface of both feet for skin breaks, blisters, swelling, or redness, including between and underneath the toes where damage may be hidden. Use a mirror if it is difficult to see all parts of the feet or ask a family member or caregiver to help. Select cotton socks that fit loosely, and change the socks every day. Select shoes that are snug but not tight, and break new shoes in slowly to prevent any blisters. Customized shoes should be purchased if the feet are misshapen or have ulcers. Shoe inserts may also help cushion the step and decrease pressure on the soles of the feet. Don't hesitate to ask the health care provider for a foot check at least once a year and more frequently if there are foot changes.