Diabetes : Feet care is essential to prevent pressure sores

Why are we so concerned about the feet? 

In diabetics feet complications are common and need special attention.  Once foot problem establishes itself, its very difficult to recover. Circulation can also decrease in the feet which makes healing poor. Nerves can also be affected hence becomes less sensitive to pain, touch and temperature. As we know diabetics are prone to infection and ulcers can develop without being aware. Special care & watch of the feet is very much needed regularly for any cuts, injury or ulceration. 

What problems can occur if we don't care?

• Development of pressure sores on the soles of feet from things such as corns, calluses and stones in the shoes.
• Minor cuts and splinters can become a major problem due to poor healing. 
• Toenail problems eg. paronychia (infection around the nail) and ingrowing nails can become worse.
• It is best to prevent these problems in diabetics by regular self checking of feet.

What should we do?

• Keep blood glucose under good control 
• Do not smoke
• Check the feet daily
• If needed a mirror can be used to inspect the soles. 
• If vision is poor then someone else can be asked to check 
• Meet your doctor if any sores, infection or unusual signs develop in feet. 
• Make sure to check in between the toes.

Wash the feet daily as directed: 

– For wasing use lukewarm water (beware of scalds) 

– Clean and Dry the feet thoroughly, especially between the toes.

– Use lanoline/Vaseline/foot cream to soften the dry skin especially around the heels

Attend toenails regularly:

– Clip the nails of feet straight across with clippers.

– Do not cut nails deep into the corners or too short.

– File rough edges of nails if any.

• Wear clean cotton or wool socks daily but avoid socks with elastic tops.
• Exercise your feet daily to help the regulation of circulation.
• Check insides of the shoes every week or before wearing them.

Points to avoid injury of the feet: 

• Always wear good-fitting, comfortable leather shoes
• Shoes should be fit from the beginning. 
• The shoes should not be too tight or too loose.
• Remember- never walk barefoot, especially outdoors.
• Never try to cut your own toenails if you have difficulty reaching the feet or have poor eyesight.
• Avoid home treatments for foot problems and corn pads that may contain acid.
• Always be careful while walking in & around the garden and in the home also. 
• Sharp objects such as stakes in the garden, protruding nails and sharp corners of beds at floor level should be avoided in the home of a diabetic person.
• Never use hot-water bottles or heating pads on the feet, always use warm Water. 
• Never check the temperature of water with the feet as it can burn the feet without knowing.
• Take extra care when sitting in front of an open fire or a heater.

Treatment of cuts and injuries if present:

• Clean the wounds with a mild antiseptic such as liquid Savlon/ Dettol or diluted Betadine.
• Cover the wound carefully with clean gauze and surgical tape.
• Meet the doctor if you are concerned, specially if wounds does not heal in 2 days or has signs of infection such as redness, heat and tenderness.
• Make a visit to the expert podiatrist if any problem with foot care and especially if physical condition makes attending to toenails, corns and calluses difficult.

When should you must visit the doctor?

• If there is pain in the legs or cramping in buttocks, thighs, or calves during any physical activity.
• Tingling, burning sensation or pain in the feet.
• If any loss of sense of touch or ability to feel heat or cold very well.
• If a change in the shape of the feet over time.
• If there is loss of hair on your toes, feet, and lower legs.
• If there is any dryness, cracked skin on the feet.
• Any change in the color and temperature of the feet.
• If toenails become thickened & yellow/ black.
• Fungal infections such as athlete’s foot between toes.
• If a blister, sore, ulcer, infected corn, or ingrown toenails present.

References:

1. John M. Murtaghs Patient Education. of 6th revised ed edition. North Ryde NSW: McGraw-Hill Australia. 2012
2. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
3. https://www.cdc.gov/diabetes/library/features/healthy-feet.html
4. https://www.beauchampfootcare.com/blog/5-ways-you-can-help-prevent-a-toenail-fungal-infection/5-ways-you-can-help-prevent-a-toenail-fungal-infection-photo-2 photo credit
5. https://www.nespecialists.com/practice_areas/diabetic-foot-care.cfm Photo credit
6. https://health.clevelandclinic.org/6-reasons-you-shouldnt-assume-foot-pain-is-a-heel-spur/ Photo credit
7. https://depositphotos.com/130217976/stock-photo-manicurist-doing-trimming-of-male.html photo credit
8. http://mobsea.com/Healthy-Foot/Wear-clean-dry-socks photo credit