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Tips On Foot Care In Diabetes

What can happen to the feet in diabetics?  Diabetes can affect the sensation to various areas of the feet, causing areas of numbness which are more easily injured, a condition known as diabetic neuropathy.  It can also affect circulation to the feet so that the feet tend to be cold, and infection comes on more easily.  The peripheral limbs, especially the lower limbs meaning the legs and feet, are known to be more easily contaminated with bacteria, and have a higher chance of getting infected.  Diabetes is well known to result in a slower healing of wounds as well.

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.

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