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KRTV - Health Specialists - Foot & Ankle Clinic

Diabetes and Foot Care

Posted: May 23, 2007 10:52 AM

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People with diabetes should be concerned about foot care. Twenty percent of all diabetic hospital admissions are related to foot problems. Severe complications in the diabetic patient lead to a significant number of amputations each year. Yet, with proper care and medical treatment, when needed, most of these complications could be avoided, saving the patient much grief and expense. As podiatrists, we feel it is our role to inform and educate people with diabetes about proper foot care. These people are more likely to develop foot problems for three reasons. Diabetes predisposes a person to peripheral vascular disease, in which here is a lack of blood flow or circulation to the feet. Because of diabetes, the body is less capable of fighting infection. And, diabetics have a greater chance of developing peripheral neuropathy. This makes it difficult to detect sensations, such as pain or discomfort that normal feet can feel, causing the patient to be particularly vulnerable to injury. Not all people with diabetes have a tendency to develop all of these problems. For example, more than 20 percent of all diabetics have good circulation. But, many such patients are predisposed to developing at least one of these problems. Let's explore each of them in greater detail. Peripheral Vascular Disease People with diabetes are more likely to develop blockage of the arteries in the legs that supply blood to the feet. High blood pressure, high blood cholesterol, smoking and diabetes are considered risk factors for developing this buildup of plaque in the vessels. This narrowing of the arteries causes signs and symptoms of poor circulation, including:
  • Dry, scaly skin
  • Atrophy, a wasting of the soft tissues
  • The absence of hair on the foot or leg
  • A tendency to develop fissures or ulcerations over bony areas
  • Diminished or absent pulses to the feet
  • Blanching of foot on elevation
The decreased blood flow limits the healing potential of the diabetic and causes the foot to be vulnerable to trauma and complications. The foot may become extremely sensitive, and any lesion or inflammation is more painful than would normally be expected. If you are diabetic, the blood flow to the feet should be checked by your doctor. Special studies called doppler studies or plethsmography can confirm the diagnosis of vascular disease. Restoration of adequate blood flow is advised, if feasible. Otherwise, careful monitoring of the foot for even minor problems needs to be done on a frequent and regular basis.

Infection

Diabetes affects the body's white blood cells, those that fight infection. Because these cells are less effective, cuts, scratches, ingrown toenails and blisters must be dealt with early to prevent bad side effects.

Neuropathy

In people with diabetes, the biochemistry of nerve tissue is altered, leading to malfunction of the nerves and disruption of the body's protective mechanism. Diabetic neuropathy commonly develops with symptoms falling into two major groups; the patient either has few symptoms or feels tingling, coldness or numbness in the toes or entire foot. As the problem progresses, a person may have sensations of "dead feet" or walking on air. Although the early stages of neuropathy get little attention, they are the most dangerous because of decreased sensitivity to pain. This leads to the inability to perceive minor foot trauma, resulting in infection and ulceration. In addition to the loss of sensation, patients may have severe pain with neuropathy. Nerve damage may lead to weakness in the small muscles of the foot and leg, creating a loss of balance, and the development of foot deformities. If you feel you may be suffering from neuropathy, contact your physician. Neuropathy can be easily diagnosed by a physician. Special studies referred to as electromyography can be used to confirm or help establish a diagnosis. Prevention is important to avoiding the potential problems of neuropathy. Injury to the feet can be prevented by properly checking water temperature before bathing and looking at shoes for tacks or nails that have worn through the soles. Simply being aware can reduce the risk of foot problems. The following information should serve as a daily guide to healthy feet.

Daily Foot Care

Washing. Wash, but DO NOT SOAK your feet in warm soapy water every day. Soaking softens the skin and makes it more susceptible to infection. Always test the temperature of the water using your elbow or wrist to prevent burning your feet. Rinse your feet well after washing. Dry them carefully, making sure to dry between the toes. Daily examination. Check your feet at least twice every day in a well-lit area. If your vision is poor, or if you are unable to bend over, have someone examine your feet for you. A mirror can help you see the bottom of your feet. Look for dryness or cracks in the skin. Be sure to check between the toes. Daily Skin Care. Lubricate your feet every day using a good moisturizing lotion. Do not use perfumed lotions as they contain alcohol and dry the skin. Do not put lotion between the toes as it causes the skin to become soft and more susceptible to openings in the skin. If your feet perspire, use a mild foot powder to absorb wetness. Care of toenails. File your nails with an emery board or nail file. File nails straight across and never shorter than the toes. Never use clippers or scissors, which could cut the skin. If your nails are thick or tend to split, or if your vision is poor, have your podiatrist trim them for you. Care of corns and calluses. NEVER cut or use chemicals to treat corns or calluses. After washing your feet, rub any corns or calluses hard with a towel. Do not tear off any loose skin. Pumice stone or skin files can be used to treat these problems. See your podiatrist if you have questions or concerns. Footwear. Wear shoes that protect and cover the feet. Avoid wearing sandals, clogs or flip-flops. Shoes should allow room for all the toes to be in their natural positions. Inspect the insides of shoes for torn linings, foreign objects or exposed nails. When you wear slippers around the house, make sure they are sturdy enough to protect stubbing the toes. Wear clean cotton or wool socks that are machine washable. They should be the correct size and free of seams and constricting tops. Garters and girdles should also be avoided. First aid treatment. Cuts and scratches should be treated promptly. Wash the area in warm water mixed with Phisoderm anti-bacterial soap. Apply a mild antiseptic such as Triple ABX Ointment, and cover the area with a dry sterile dressing and paper tape. Never use adhesive tape on your skin. Never apply a hot water bottle or heating pad to the area. Stay off your feet as much as possible and if you see no improvement in 24 to 30 hours call your podiatrist. Do not assume the condition has improved because there is no pain. People with diabetics should take special notice if any of the following conditions exist:
  • Athlete's foot
  • Sores or wounds on the feet
  • Ingrown nails
  • Numbness or pain in the feet or legs.
The feet of the diabetic patient deserve the best of care. With proper management and personal care a person with diabetes should not have to limit his activities. Physical activity is as important as taking proper precautions. Consult your doctor if you have any questions regarding an exercise program or diabetic foot care.

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