|"It's essential that I take care of my feet."|
It is imperative that diabetics take special care of their feet. Bear in mind that, if you are diabetic, you need a doctor's care to protect your feet — and that this page is not intended as a substitute for a medical diagnosis or suggested course of treatment. Please see your doctor!
Diabetes is a serious condition which can have many effects on the feet, including:
(1) Nerve damage, resulting in numbness, extensive burning, pain, coldness, "pins and needles" or tingling while at rest. These nerves may actually affect the "position" sense, so that the joints or bones actually collapse with time.
(2) Blocked blood vessels or decreased blood flow with fewer nutrients reaching the feet. Without proper nourishment, sores on the foot may not heal in the normal time period, or may be vulnerable to secondary problems such as infection.
(3) Weakened bones, causing a shift in the foot, which may become deformed, changing the way the foot distributes pressure.
(4) Collapsed joints, especially in the area of the arch. As a result, the arch can no longer absorb pressure. The surrounding skin may also begin to break down.
(5) Blisters and Calluses. Diabetics are much more vulnerable to blister or callus formation, which generally stars as a warm or red spot caused by unrelieved skin pressure and the failure of the diabetic to feel the area.
(6) Ulcers or sores more easily occur as a result of the breakdown of several layers of skin. These ulcers may also become infected, and require a long time period to heal.
(7) Bone Infection. The final manifestation of all this is a bone infection, where the breakdown of tissue goes all the way to the bone, and secondary bone infection can occur, in some cases resulting in loss of the foot.
Our office performs routine diabetic foot care which involves:
(1) Nail Trimming. Regular trimming or thinning of nails to prevent them from becoming thickened and ingrown.
(2) Blisters. Treatment of blisters so they do not ultimately become ulcers and infections. (Medicare covers these services every two months.)
(3) Education. Due to the seriousness of diabetes and the potential severity of its effects, we also educate diabetics on a regular basis about the manifestations of decreased circulation, decreased nerve sensation, weakened bones and collapsed joints.
(4) Examination. The patient is examined with regard to these areas, and fully informed of what is occurring with his or her feet during each visit.
(5) Customized foot wear or gear. Custom shoes, insoles and devices can be constructed for diabetics in order to relieve pressure and pain to abnormal sensitive sites on the feet.
(6) Points of skin irritation. Diabetics can have elective podiatric surgery in many cases, as long as the diabetes is under control and the circulation status is excellent. However, any abnormality for the diabetic, such as infection, laceration, or manifestations of a foreign object in the foot are treated as emergencies, and diabetic patients are instructed to contact our offices immediately for treatment of these areas of difficulty.
When diabetics inspect their feet, they should be aware of the following:
(1) Color changes in Feet. Paleness or bluishness of the toes and decrease of circulation. Black skin is a sign of dead tissue, and redness with streaks is often a sign of infection.
(2) Swelling. Abnormal swelling may be the result of poor circulation or swelling. Other symptoms are extreme tenderness and increase in foot size.
(3) Changes in Temperature. These would include extra-warm areas, which may mean that an infection has started. Extra coolness may mean a general decrease of circulation, and that the patient is not getting enough blood flow.
(4) Change of Sensation. This often involves sensations of "pins and needles," numbness, tingling, burning, or lack of feeling, which may be a result of nerve damage or changes in the nerve status of the foot.
(5) Hot Spots. Various red hot spots are caused by friction or pressure. These may also turn into blisters, corns or calluses.
(6) Cracks, Sores and Ulcers. These are caused by dry or irritated skin, decrease in circulation, or abnormal pressure which is the most common cause of ulceration of the diabetic foot.
(7) Ingrown Toenails. An ingrown toenail is often the result of a genetic problem involving the nail. However, certain closed-in shoes — which the patient cannot properly feel — can be a contributing factor. This includes extra penetration of the skin by the nail, swelling, redness and pain.
Podiatrists are trained to treat each and every one of these conditions, most of which are considered medical emergencies. If a diabetic contacts our office for one of these conditions, he or she will be seen immediately, as these often require immediate evaluation. Otherwise, any infection present may spread, and any decrease in circulation may result in loss of a portion or all of the foot.
Dr. Scortt is also specifically trained to recognize when the situation is serious enough to require the expertise of a vascular doctor who in many cases has the skills to save the digit (toe).
Properly Fitting Shoes and Socks. Make sure that shoes and socks fit appropriately and properly. Check the toe box (portion of the shoe that covers the toes) to make sure there is adequate room. Wear shoes that absorb pressure, and make sure that shoes have proper fitting of the heel, without extra slippage of the heel up and down. Make sure that a shoe has the proper instep that conforms to the foot and causes no irritation. Ensure that there are no objects in shoes and socks which might rub against your feet.
Exercising the Feet. Walking frequently is a good idea for most diabetics. This improves circulation in the feet, improves the general health of the diabetic, and in many cases may assist with the control of sugar. Exercising the feet as outlined by the patient's podiatrist can also increase blood flow and keep the foot flexible. Additional exercises such as swimming and bicycling are also excellent and do not require extensive weight bearing on the feet.
Avoid Heat and Cold. Avoid extensive heat and cold on the feet. Utilize only warm water to wash your feet. Avoid heating pads that cause severe burns.
Avoid Crossing the Legs. Avoid extreme crossing of the legs which may affect already-decreased blood circulation.
Avoid Over-the-Counter Medications. Avoid over-the-counter medications for corns and calluses, as these can burn the feet.
Avoid Walking Barefoot. Diabetics can injure their feet by walking barefoot and stepping on sharp objects, nails or glass, particularly if they have extensive numbness.
Control Your Diet. The most important thing that diabetics can do to help themselves is to control their diets. Eating low-fat, sugarless foods and monitoring their blood levels is the key to controlling not only the potential problems of the feet, but their overall medical status.
Regular checkups with the family doctor are absolutely essential to the diabetic.