Diabetic Foot Care

Diabetes has the potential to cause great harm to the feet. As we have discussed in the previous chapter, neuropathy, or nerve damage, and peripheral artery disease, are the two most common contributing factors to the manifestation of diabetic foot ulceration in patients. However, once the ulcer appears there are numerous other factors that influence the progression of the disease. These include macerations, or cracks that appear on the feet due to repeated trauma: infections due to gangrene or necrosis of the surrounding tissue; co-morbidities such as kidney or heart failure; and the age of the patient, among other things.

Research has identified that older males with a history of uncontrolled diabetes mellitus and other related health conditions are most vulnerable to the development of diabetic foot ulceration. In such patients, even a minor injury of the foot may progress into a chronic ulcer. Also, the constant movement of the affected feet during walking impedes the healing process. If the patient is suffering from a vascular disease, the injury can turn ischemic, leading to the development of a festering ulcer that may never heal.

In the case of patients with ischemic ulcers caused as a result of nerve damage, they cannot feel any symptoms of warmth, pain, or tenderness of the feet, as they have lost all sensation in the affected area. The absence of symptoms may, at times, confuse both the patient and the treating physician, leading to a misdiagnosis. This is why the treatment and prevention of diabetic foot ulceration is so important. Patients must follow a strategic NO approach to foot care for the preservation of their feet. Let us now observe these foot care strategies in greater detail.

Regular Foot Examination

It is a must for all patients suffering from diabetes to examine their feet on a daily basis. The macerations or cracks that occur between the toes are caused by fungal infection, and close attention should be paid to such occurrences. Patients are recommended to use a mirror while examining their feet so that the plantar surface or base of the feet can be inspected thoroughly. In the event that the patient’s vision has been compromised due to diabetes-induced retinopathy, they should have their feet examined by a qualified medical practitioner or physician.

Keep Feet Clean & Dry

Special attention must be paid to keeping the feet clean and dry at all times. Patients are advised to wash their feet at least once a day. The temperature of the water used to rinse the feet should not exceed 370 C. Physicians recommend that patients use their forearm or elbow to gauge the temperature of the water. This is the best way to avoid producing an accidental burn of the feet by using too hot water, taking into account the loss of sensation that is so common

Pay attention to your feet

Seek help from your podiatrist for bunions, calluses, corns, hammertoes, and other foot problems as soon as possible.

in diabetic patients. The feet should then be well dried, with special care given to the skin between the toes, because moisture can create a fertile breeding ground for bacteria. A hairdryer set to ‘Low’ may be used to dry the spaces between the toes.

Use Diabetic Footwear

Patients who are at high risk of developing foot ulcers are instructed to invest in special diabetic footwear, for both indoor as well as outdoor use. The shoes should be big enough to allow the toes to wiggle freely. They should not produce constriction of the toes and feet. In addition, patients should also invest in comfortable diabetic socks and stockings for added care. Also, patients suffering from neuropathy should use footwear that is enclosed in front to prevent minor trauma to the toes and connecting ligaments, such as follows a stubbing.

Daily Examination of Shoes

Along with a foot examination, diabetic patients must conduct a daily examination of their shoes as well. This will help detect the presence of any sharp brambles, or other objects that might have slipped in, or embedded themselves in the soles of the shoes, while the patient was walking. These external objects have the potential to cause wounds and ulceration to the feet. If pressure engorgements develop on the feet, the shoes should be examined to see which part of the feet sustains the most amount of pressure.

Use Lubricants Daily

As a result of autonomic neuropathy, there is an increased amount of perspiration in the region of the upper chest, but markedly reduced perspiration in the lower extremities. Because of this, diabetic patients typically experience an acute dryness of the plantar surfaces, which are the heels and the base of the feet. Dry skin easily develops cracks, especially when subjected to minor trauma, giving leeway for various microorganisms to invade and cause foot infections. In order to prevent dryness, patients should apply lubricants containing salicylates or urea to the base of the feet. Given their chemical properties, these lubricants are able to permeate the dry layers of the skin, and effectively moisturize and heal the cracked surface. However, it is wise to keep from applying lubricants between the toes.

Use Clean Socks

Diabetic patients should make it a point to wear clean comfortable socks. Ideally, they should choose special diabetic socks.

Patients must wash and change their socks daily to maintain a sterile bacteria-free environment for their feet. The use of tight or ill-fitting socks is discouraged as these can worsen the situation.

It is not advisable for patients to wear stockings that extend up to the knees, as these promote constriction of the blood vessels.

Keep Your Skin Dry

Make sure that drying your feet is part of your hygiene routine. You can still use moisturizer to prevent dry, cracked skin but avoid putting it between your toes. This can lead to a breakdown of skin due to excess moisture and can lead to infection.

Nail Care

Proper nail care is of paramount importance, particularly for female diabetic patients. They suggest that diabetic patients should have their podiatrist cut their toe nails to avoid issues. Nails should be cut straight across the top, rather than in a circular fashion.

Additional Care and Precautions

Patients are discouraged from treating calluses with the use of un-prescribed chemical products, or with heated commercial pads and plasters, as these could aggravate the injury or infection. Also, patients suffering from severe nerve damage should never use heating pads on their bodies as they put themselves at risk of self-inflicted accidental burns. As a precautionary measure, patients should avoid placing their feet on or near heaters, especially during the winter months.

FUN FACT Walking is the best exercise for your feet. It contributes to your general health by improving circulation and weight control.

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