Diabetes Care – Down to the Feet

By Ava Eaves RD, CDE
 

Of all the treatments for the long-term management of diabetes, foot care is probably the simplest to do…and the easiest to ignore. Each year about 54,000 diabetics suffer amputations-usually as a result of a seemingly harmless skin sore, so lack of attention can be horrific.

            Foot problems are recognized as one of the major long-term complications of diabetes, and they are related to other complications such as diseased nerves and blood vessels. All are more common in patients who have had diabetes for a number of years and been in poor control.

            The most common diabetic complication is neuropathy, which is actually a group of diseases affecting the peripheral nerves of the legs, feet, arms and hands. It’s present in 12 percent of persons first diagnosed with diabetes and in 25 percent of those who have had eth disease for 25 years or longer.

            At first, the patient may feel a burning or pins and needles sensation in the feet and legs, particularly at night. Eventually, however, the pain or discomfort changes to a loss of feeling, making it harder to feel minor pain or take seriously cuts, scratches, blisters or other injuries to the foot.

            Along with neuropathy, diabetics frequently suffer from peripheral vascular disease-blood vessel changes resulting in blockages or reduced blood flow to the lets, particularly in the area between the knee and the ankle.

            Symptoms of peripheral vascular disease include cold feet, a dusky or bluish appearance of the skin, reduced or blotchy hair on the legs and feet and a cramping leg pain after walking a short distance.

Minor Nuisances Pose Hazard

            Without normal flow of nerve messages and blood, muscles in the feet eventually tend to weaken and atrophy waste away with loss of the protective pad of fat on the balls of the feet. A change in foot structure and walk increases the risk of bunions, hammer toes, corns, calluses and blisters. Minor nuisances for most individuals, these can pose a hazard for a person with diabetes.

            Many diabetics also have poor temperature regulation and diminished sweating in the feet causing the skin to become dry and vulnerable to small breaks through which bacteria can enter.

            An infection may develop under or around a callused area, for example, and quickly become severe before it is noticed. Even with a fairly severe infection, a patient with neuropathy may not have the tell-tale signs of redness and swelling. And reduced blood flow makes it more difficult for any wound to heal and for antibiotics to be delivered effectively to the diseased area.

            An infection that reaches into the bones is particularly dangerous, and the number of small bones in the feet have relatively little skin and soft tissue covering them.

            When an infection gets out of control, amputation may be the only solution. And patients who have had one limb removed have a higher than average risk of losing the other leg within five years.

Preventive Foot Care

            Diabetic foot care requires that you be persistent. That means inspecting your feet carefully every day, using a mirror if necessary to check every square inch-top, bottom, sides and between the toes-looking for cuts, blisters, bruises, red spots, swelling, infected toenails or any other injury. If you see anything out of the ordinary that does not go away in a day or s, you should see your doctor. You should also report any numbness, tingling or pain in your feet.

            In addition to your self examination, the American Diabetes Association recommends a thorough foot examination by your doctor at least once a year (more frequently for individuals at high risk) and a visual inspection at every visit with a health care professional in you have any symptoms of neuropathy.

            Keeping your feet squeaky clean is essential. Wash them with soap and warm water every day, and dry them thoroughly with a soft towel, especially between the toes.

            Merely letting your feet get wet in the shower is not good enough if you have diabetes, but soaking your feet is not a good idea since it can cause your skin to dry and crack. Be aware, tat neuropathy may make your skin less sensitive to water that is too hot so test the water with your elbow or a thermometer before getting your feet wet.

            Lotion or moisturizing cream will help keep your feet from getting too dry, but avoid the area between the toes since too much moisture there can lead to fungal infections. Change your socks frequently, and make sure they don’t have wrinkles or big seams that irritate your feet.

            Trim your toenails regularly or have a health professional trim them. Watch for ingrown toenails, fungal infections or other problems.. Do not walk barefoot even at the beach or in the water. Wear shoes and choose them carefully, making sure they are long enough, wide enough and deep enough so that they don’t rub or constrict any part of your foot. Shoes should feel comfortable when you first try them on and not require breaking in.

            Bunions, hammer toes or any other kind of foot deformity may require custom fittings or footwear prescribed by your doctor or podiatrist.

            Check your shoes for pebbles before putting them on and discard shoes when the inside lining becomes rough or frayed. Your feet are vulnerable to damage from either heat or cold. Wear warm socks and shoes during the winter, but don’t use a hot water bottle or place you feet near a radiator or fire. In the summer, avoid sunburns on your feet by keeping them out of direct sunlight and protected with sunscreen.

            Finally, good foot care requires good control of blood sugar. According to the Diabetes Control and Complications Trial, patients who kept their blood glucose at or near normal levels had a 69 percent reduced risk of developing neuropathy.

            In the face of life-threatening complications such as heart disease and kidney failure, it’s easy to forget about the hazards of diabetic foot problems. It’s well worth taking a little extra care each day to avoid foot problems.

Ava Eaves is the Director of Nutritional Services at Pattie A. Clay Regional Medical Center. She is a registered dietitian and a Certified Diabetes Educator.

November 2004

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