Diabetes and Your Feet

According to the American Diabetes Association, about 25.8 million people (8.3 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.

Foot problems are a big risk in people with diabetes.  They must constantly monitor their feet or face severe consequences, including amputation.

A recent large study by Thomson Reuters Healthcare has shown that including a podiatrist in a patient’s diabetes care team can dramatically improve a diabetes patient's health and well-being.  This first-of-its-kind study has demonstrated that foot care by a podiatrist reduces hospitalization by 29 percent and amputation by 24 percent in adults with diabetes.

With a diabetic foot, a wound as small as a blister from wearing a shoe that's too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it's at risk for infection.  As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day.  Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.

Here's some basic advice for taking care of your feet:

• Always keep your feet warm.
• Don't get your feet wet in snow or rain.
• Don't put your feet on radiators or in front of the fireplace.
• Don't smoke or sit cross-legged. Both decrease blood supply to your feet.
• Don't soak your feet.
• Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
• Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
• Use quality lotion to keep the skin of your feet soft and moist, but don't put any lotion between your toes.
• Wash your feet every day with mild soap and warm water.
• Wear loose socks to bed.
• Wear warm socks and shoes in winter.
• When drying your feet, pat each foot with a towel and be careful between your toes.
• Buy shoes that are comfortable without a "breaking in" period. Check how your shoe fits in width, length, back, bottom of heel, and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don't wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely.
• Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
• Never wear sandals or thongs (flip-flops) and never go barefoot, indoors or out.
• Don't file down, remove, or shave off corns or calluses yourself.

When your feet become numb, they are at risk for becoming irritated or injured without you being aware of it happening.  The skin may crack or open from unprotected pressure under or over a joint. Open sores may become infected. Another thing that can happen is a weakening and falling of your arch. This is the bone condition Charcot (pronounced "sharko") foot. This is one of the most serious foot problems you can face. It warps the shape of your foot when your bones fracture and disintegrate, and yet you continue to walk on it because it doesn''t hurt. Diabetic foot ulcers and early phases of Charcot fractures can be treated. We have special dressings and casts and also special shoes that are modeled from casts of your feet. Shoe inserts made of special soft material with dimples or accomodations for your joints are made.

The shape of your foot molds the cast. It lets your ulcer heal by distributing weight and relieving pressure. If you have Charcot foot, the insole and shoe controls your foot''s movement and supports its contours. It is very important that you don''t put any weight on it. Surgery is considered if your deformity is too severe for a brace or shoe and the foot is not able to bear your weight and develops infections and ulcerations which do not heal. This problem does not occur overnight. It always follows a period of denial, neglect and delayed treatment.

Contact our office immediately if you experience any injury to your foot. Even a minor injury is an emergency for a patient with diabetes.