Thus when one refers to foot care in diabetics, one has to be aware of possible complications that can come on in the feet as a result of the disease, and take steps toward preventing them from occurring and if they have occurred, to limit the worsening of this problem.

1. Examine your feet daily.  Are there areas of numbness or coldness?  Are there any cracks in the skin, infected oozy or pussy areas, especially in the soles or the toes?  If there are any, get medical help as soon as possible.  Infected areas can worsen, and spread either to involve the whole limb or inwards to affect the bone, causing chronic osteomyelitis, a chronic bone infection which is difficult and often virtually impossible to cure.

2. Keep the skin of your feet smooth, free of cracks and mildly moisturised.  Dry cracked skin can allow the entry of organisms and infection. 

3.  Ensure that your toenails are well trimmed and cut square at the edge to prevent damage to the nail folds. 

4. Ensure that you do not wear shoes that are too tight that will predispose to fungal infections in between the toes because of the humid environment.

5. Thickened skin, corns and calluses need to be taken care of well.  Often one tends to file down corns carelessly, resulting in injury and subsequent infection.  Or one uses corn plasters that cause maceration of the skin and allow infection to set in.

6. Wear well fitting thick absorbent socks as these will help absorb any moisture and also prevent injury.

7. In the event of any occurrence of numbness of the sole (diabetic neuropathy), as can be quite common in diabetics, extra foot care is essential to prevent injury.  Injury is very common as the sole is totally numb and the pain of injury cannot be felt.  One becomes totally unaware of any injury and continues aggravating it, and because of neglect, the wound gets infected.  Wounds in the numb soles do not heal well and the chances are high of these becoming chronic infected ulcers.  Never walk barefooted as the chances of injury are much higher.  Do not wear open slippers as the chances of injuring the toes are higher.

8. Washing of feet.  Use warm water, not hot.  Hot water can cause blistering and subsequent wound infection.  Similarly in some diabetics with numb feet, hot water may damage the skin without the patient being unaware of it.

What happens to infected areas or injuries to the feet?  Injuries can get infected.  Infection spreads, either to surrounding soft tissues (a condition known as cellulitis), or via the lymphatics to the draining lymphnodes with inward spread of infection up from toes to the hip and beyond, or into the bone with resultant osteomyelitis.  Treatment of these complications is with antibiotics, and unfortunately in a lot of cases, especially those with bone infection, the only way to solve the problem is by amputation of the affected part as antibiotics may not work well.  Sometimes amputation has to be progressively more and more inward such as from toe to forefoot to the whole foot, to the ankle, the lower leg, the knee and the thigh.  This is because infection can spread progressively deeper and deeper.

Nutrition of the nerves supplying sensation to the skin of the foot can be compromised resulting in the sensation of numbness or tingling, or an inablity to feel pain, heat or cold. This results to injury to the foot or toes without the patient realising it and taking care of it, and ultimately the toe or foot gets infected and can turn gangrenous. This is complicated by the fact that circulation to the foot in diabetics tends to be poor due to narrowing of vessels.

The ultimate result: gangrene, poor healing ulcers in the foot, and ultimately amputation of the affected limb in order to save the remaining part of the limb from spreading infection and further need for more amputation.

Thus care of the foot is very important, starting from care of the nails to prevent infection of the nail folds, to care of the skin of the feet to prevent injury. Proper walking shoes are important. Socks need to be worn frequently to prevent injury. Make sure you wash your feet in warm, not hot water, as you may not feel the difference and this can result in burns. Make sure that there are no foreign materials in the shoe which can act like pebbles and ultimately damage the foot. Keep circulation good to the foot. Get your doctor to attend to any sores on the skin.

Last but not least, Control Your Diabetes

Result: disaster.

Things just happen.

See the story about a diabetic lady from Melbourne, Florida, who is suing a manicure shop for a botched pedicure that ultimately resulted in the surgical amputation of 2 toes due to gangrene. It’s just an unfortunate occurrence. Who’s at fault? Hard to say…

Diabetic neuropathy

A lot of patients who are told for the first time that they are diabetic have this couldn’t-care-less attitude. This is because they were unable to fathom in the first place the seriousness of the situation, that they could potentially suffer heart attacks or strokes much more easily, that they could face kidney failure and ultimate dialysis, that they might lose limbs due to numbness and infection in diabetic neuropathy, etc. Face it, very often in the beginning they feel perfectly normal, so the worry is not there.

Sometimes one has to present pretty morbid pictures of a diabetic foot with infected ulcers and bone infection and gangrene due to diabetic neuropathy before the realization strikes the diabetic that he or she could also conceivably face the same problem. For example the recent newspaper report that an Illinois woman who had lost sensation in her toes because of diabetic nerve damage woke up one morning and found her right big toe missing, because her pet dog had chewed it off while she was sleeping. And there was no pain. The poor dog had to be put away because of safety concerns (there’s a good possibility it could have got to like the taste of raw human toe).

Diabetic neuropathy

I have seen diabetics who have to keep looking at the ground where they are walking, because the sensation in both feet is gone, and they do not know where their feet are placed on the ground, thus exposing them to a much higher risk of stumbling and falling on uneven ground.

The unfortunate thing about diabetic neuropathy is that the damage to the nerve, thought to be perhaps nutritional in nature, is just not easily reversible or correctable to any extent.