Foot care in Diabetic patients

Posted on July 18, 2018 with 0 comments

Diabetic patients are more common to suffer nerve damage, circulation problems, infections and subsequently foot-related problems. Not just controlling your blood glucose (sugar) levels, but also taking good care of your feet will go a long way to treat and reduce the occurrence of complications of diabetes.

Why is foot care important in diabetic patients?

Diabetes, over a long period of time, may cause nerve damage, also known as diabetic neuropathy. This may lead to decreased sensations of touch, vibration, and temperature over the affected feet. Loss in sensations prevents the patients from identifying any cuts or bruises on the feet. Eventually, these ignored cuts and bruises may become infected and lead to foot ulcers.

Diabetes may also hamper the flow of blood in your feet. This prevents any pre-existing infection present at the site from satisfactory healing. Such conditions may present as gangrene due to the loss of blood flow into the affected site.

If not cared for and treated adequately in time, such diabetic foot ulcers and gangrene may result in amputation (cutting off) the affected part of foot or toe, to prevent the infection from spreading to the rest of the body. Thus, it becomes very important to take good care of your foot so that such serious infections and gangrene are prevented.¹

Although rare, the interaction of inflammation, nerve damage, and trauma, may change the shape of your feet, seen in Charcot’s foot. Midfoot collapse may lead to a ‘rocker bottom foot’. The treatment of this condition too warrants amputation of the foot.²

Risk identification

The risk of foot ulcers and gangrene is high in patients who have had poor glycemic (sugar) control with longstanding diabetes for ≥ 10 years, or have other heart, eye or kidney problems related to diabetes. The risk of amputation is high in certain foot-related conditions such as:

• Nerve damage with loss of touch, vibration, and temperature sensation
• Altered walking due to loss of sensations
• Increased pressure at one area of the foot leading to corn formation and further bleeding into the corn
• Any bony deformity
• Peripheral vascular disease (due to loss of blood flow into the foot blood vessels)
• Past history of ulcers
• Severe nail infection or pathology³

Daily foot care

Patients at a higher risk of developing foot problems, should include a daily self-foot care, despite the usual dietary and exercise measures to reduce blood glucose (sugar) levels.

1. Wash and check your feet everyday:

Wash your feet with soap in warm water. Apply talcum powder, especially between the toes, after drying your feet. Inspect for problems like:

• Cuts, bruises or blisters – apply a bandage over the wound
• In-grown toe-nails – keep your toe-nails trimmed; do not cut into the skin and bandage the affected toes after a doctor’s consultation in case of any infection
• Corns or warts – do not use medicated corn plasters or try to cut into the corns; consult your doctor and use a pumice stone to smoothen the corn after taking a bath.
• Warm spots – these spots usually mark the appearance of any ulcer or blister; so appropriate measures can be taken beforehand.⁴

2. Wear shoes and socks at all times:

Do not walk barefoot or in socks, even while walking indoors. Any injury may lead to the aforementioned foot complications. Walking in the sun without proper protection might burn your feet causing sunburn, without you realizing it due to decreased sensations. Also, socks must be worn in winters to prevent your feet from getting cold. Thus, wearing shoes and socks at all times can help protect your feet.

• Choose comfortable, well-fitting shoes. Avoid wearing shoes that are tight and put undue pressure over your feet.
• Avoid shoes made of plastic or other materials that prevent proper air circulation inside the shoes.
• Wear clean, dry socks that are not too tight. They provide an additional support and layer of soft protection for your feet.
• Inspect the insides of your shoes or any tear or breaks.
• Consult your doctor if there’s any problem & the problem persists. Patients with Charcot’s foot may require specialized shoes with their doctor’s consultation.⁴

3. Keep the blood flowing to your feet

• Wear loose socks so that blood flow is not compromised
• Physical activity is important to maintain proper blood circulation into the feet
• Studies have shown that smoking leads to decreased blood flow in the small blood vessels of the feet and should be avoided.⁵

Get a foot-check at your next doctor’s visit

Routine check-ups at a doctor’s clinic is must. Consult with a doctor immediately if you notice the following:

• A cut, blister or wound that does not heal in a few days
• Skin becomes red, warm, or painful – signs of infection
• Callus or corn with underlying blood
• A foot infection with signs of gangrene (black and smelly)
• Any changes in the shape of your foot
• Loss of sensation in your feet⁶

References

1. Fowler M.J. (2008). Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 26(2). pp. 77-78.
2. Rogers L.C., Frykberg R.G., Armstrong D.G., Boulton A.J.M., Edmonds M., Ha Van G. et al. (2011). The Charcot foot in diabetes. Diabetes Care. 34(9). pp. 2123-2129.
3. American Diabetes Association. (2004). Position Statement: Preventive foot care in diabetes. Diabetes Care. 27(Supplement 1). pp. S63-S64.
4. Pietrangelo A. (2016). Newsletter: Diabetes Foot Care. Available from: https://www.healthline.com/health/diabetes-foot-care. Last accessed: 11.12.2017.
5. Standards of Medical Care in Diabetes – 2015. (2015). Microvascular complications and foot care. Diabetes Care. 38(Supplement 1). pp. S58-S66.
6. American Diabetes Association. (2016). Microvascular complications and foot care. Diabetes Care. 39(Supplement 1). pp. S72-S80.