Foot Care and Diabetes
A small cut on a toe once sent Stella Anderson* to the emergency room. Most people would have just slapped a band-aid on the "injury" and forgotten about it. But most people don't have diabetes.
Unlike people with normal blood sugar, diabetics need to examine their feet daily for the slightest injury. Since diabetes can cause neuropathy -- nerve death or damage -- a small cut could go undetected and lead to serious infection. After living with type 1 diabetes for 25 years, Anderson knew she had to be careful. The disease had already killed many nerves in her feet, which meant she couldn't feel scrapes, cuts, blisters, or other sores.
"I always joked that somebody could cut off my toes, and I'd never feel it," Anderson says. Worse, the disease had harmed her circulation, so that the blood flow to her feet had slowed to a trickle. As a result, even the most trivial sores would be slow to heal.
Anderson usually checked her feet after her morning shower, but she let the chore slide during a hectic week. She never noticed the small cut on her toe. By the time she saw a thin red streak running from her foot to her ankle, an infection was already raging. It took a trip to the emergency room and intravenous antibiotics to save her foot.
What are diabetes-related foot problems?
Anderson still walks on two feet, but many people with diabetes aren't so fortunate. Every year, about 80,000 diabetics lose a leg, foot, or toes. And in almost every case, this catastrophic injury had very humble beginnings.
If diabetes has already dulled the sensations and slowed down circulation in your feet, just about any break in the skin can turn into a dangerous, festering wound. It may start with a callus, a small blister, a corn, a cut, or a scrape. Often, these seemingly trivial problems turn into open sores or ulcers.
The human foot teems with bacteria and fungi, and the ulcers can quickly become infected. And when the blood supply is very low, the immune system can't send its normal reinforcements. If not treated with antibiotics, the infection can spread to the soft tissue of the foot and, eventually, to the bone. At that point, amputation may be the only option.
But it doesn't have to be that way. By taking a few extra precautions, people with diabetes can prevent infections and save their feet, says Lee Saunders, M.D., president of health care education at the American Diabetes Association.
What can I do to prevent foot problems?
People with diabetes can ward off nerve damage and circulation problems by keeping their blood sugar under control. And if you smoke, try to quit immediately. Smoking hampers blood flow, and 90 percent of diabetics who lose a foot are smokers.
If diabetes has already slowed your circulation and numbed your extremities, you need to give your feet special attention. "When you lose sensation, you tend to ignore that part of your body," Saunders says. "But diabetics can't take their feet for granted."
Have the doctor check your feet at every visit. Taking off your shoes and socks before the exam will help remind both of you about the foot inspection. (Be sure to see the doctor for a diabetes checkup regularly - at least two to four times a year, depending on your condition.)
At home, inspect your feet at least once every day. If you have difficulty inspecting your feet by yourself, enlist the help of a family member. Call your doctor promptly if you have a corn or callus or if you have a cut, scrape, blister, or bruise that doesn't start to heal within one day.
Here are some other tips for protecting your feet:
- Never cut corns or calluses. Don't try treating them or even using a pumice stone on them without consulting your doctor.
- Never use over-the-counter corn removers. These products contain acids that can damage the skin.
- Wash your feet daily in warm water. Test the water with a finger to make sure it's not too hot. Don't soak your feet, though, because soaking may dry the skin.
- If the skin is dry, apply lotion or cream to the tops and bottoms of your feet. Putting cream or lotion between your toes may promote infections.
- Trim your toenail by cutting straight across the nail. Never cut into the corners of the nail, because even a small nick in the skin can allow infection to enter and grow.
- Never go barefoot.
- Wear shoes made of materials that breathe like leather and canvas. Never wear vinyl or plastic shoes.
- Break in new shoes gradually to prevent blisters.
- Wear absorbent wool or cotton socks.
- Make sure your shoes fit properly, with ample room. Avoid high heels or shoes with pointed toes that put too much pressure on the feet.
- Inspect your shoes for pebbles or anything else that can damage your skin.
- Never use heating pads, electric blankets, or hot water bottles that can burn your feet.
- Keep the blood flowing to your feet. When you sit, wiggle your toes for five minutes, two or three times a day. Move your ankles in and out and up and down to improve blood flow.
- Don't cross your legs.
- Never wear tight socks, garters, or any type of elastic bands around your feet.
- Get your blood flowing with walking, swimming, yoga, biking, dancing, and other low-pact activities.
- Avoid high-impact exercise like running and jumping.
*Stella Anderson is a pseudonym.
American Diabetes Association, http://www.diabetes.org
The American Diabetes Association offers many publications with information on neuropathy. One good source of information is its book, The Diabetes Problem Solver, by Nancy Touchette, Ph.D.
Joslin Diabetes Center, http://www.joslin.org
Preventive Foot Care in People With Diabetes. American Diabetes Association. Diabetes Care; vol. 25(90001):S69-S70
Bennett MS. Lower extremity management in patients with diabetes. J Am Pharm Assoc (Wash);40(5 Suppl 1):S40-1.
Mirmiran R, Page JC, Armstrong JR, Killian R. Barriers to podiatric care among diabetic patients in the San Francisco Bay area. J Foot Ankle Surg;39(5):301-4.
Rith-Najarian SJ, Reiber GE. Prevention of foot problems in persons with diabetes. J Fam Pract;49(11 Suppl):S30-9.
National Diabetes Information Clearinghouse. Diabetic Neuropathies: the Nerve Damage of Diabetes. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies
American Diabetes Association. Future Visits. http://www.diabetes.org/whos-who-on-your-health-care-team/future-visits.jsp