Foot Care Tips for People with Diabetes
by Darryl E. Barnes, M.D.
Foot problems are common in those with diabetes because uncontrolled diabetes can cause poor circulation, leading to nerve damage. You need to start caring for your feet as soon as possible to prevent or significantly delay many foot problems. Not making foot care a priority only puts you at greater risk for serious problems, including amputation. If you currently have foot problems, you should see a doctor experienced in foot care, such as a podiatrist, to ensure that you are incorporating the best care possible for your feet.
Your action plan should include daily foot exams. As with all planning, try to find a time of day when you will most likely have the time and will remember to do this task. Many people find it easiest to do their foot checks just after getting ready for bed. You, or someone else if you are unable, will need to carefully inspect your feet. If you are doing this for yourself, then it will be helpful to use a mirror to look at those areas that are difficult to see.
When looking at your feet, be sure that you have adequate lighting so that you don't miss anything. Find a safe place to sit while doing the inspecting. Your goal during these sessions is to detect any evidence of skin lesions such as sores, scratches or cuts, swollen or red areas, calluses, corns, or any problem with your nails (such as ingrown or infected toenails). Look at all parts of your feet from the ankle down, including between each toe. Remember that you may not be able to feel some of the subtle pain that is typically associated with these foot problems. Report all cuts and scratches that do not start healing after 24 hours of discovery, or any painful, red, or warm areas to your physician immediately.
Good hygiene is important in preventing foot problems. You should wash your feet each day. You may want to get a foot tub to clean your feet before you start the inspection process. Use warm (90 to 95 degrees Fahrenheit) rather than hot water, and use nondrying soap to clean your feet thoroughly. Do not soak your feet in water because this can wash away essential skin oils that give your feet natural protection. Dry skin will crack, and any openings in the skin can let bacteria and viruses in, causing infection. When you are finished washing your feet, rinse the soap off and thoroughly dry your feet with a clean and dry towel, being sure to dry between each toe. To ensure that your skin does not become overdry, apply a moisturizing cream or lotion to the tops and soles of your feet, gently rubbing it in and avoiding the areas between your toes. Lotion between your toes can lead to excessive moisture and cause the skin to break down, which may lead to an infection. Many people use talcum power to ensure that the areas between the toes stay dry.
After washing and inspecting your feet, trim your nails straight across to ensure that the edges do not become ingrown in the sides of the toes. If your nails are thick, you should have a podiatrist trim them for you. Before taking care of any corns or calluses (excess thick skin often found on the heel area), ask your podiatrist how you can do this at home. Using a pumice stone while your skin is still moist is helpful to gently smooth excess skin on your heels as well as calluses and corns. Avoid using over-the-counter chemical products to treat your calluses or corns, or using sharp instruments such as scissors, scalpels, or razor blades unless instructed by your doctor. These types of treatments may damage your skin, which can lead to infection.
If you find that you have calluses or corns on your heels and toes, this may be evidence of improper footwear. It is very important that your socks and shoes fit your feet well. Socks without thick seams or those that are seamless are better for your feet. Shoes that offer a wide toe box, smooth liners, good support, and breathable materials will be best for your feet. Vinyl and plastic are not good materials for shoes because they do not allow your feet to breathe. Furthermore, you should not wear shoes without socks because they will allow your foot to sweat and become too moist, which can lead to skin breakdown. Your socks offer extra protection from friction that your skin encounters inside a shoe, which will prevent blisters and cuts. Because of the increased risk of cuts, you should avoid going barefoot, especially in places where there may be broken glass such as in parks or at the beach.
Protect your feet from the heat and the cold. Allowing your feet to become cold will decrease the sensation in them. In cold climates, wear thicker socks and shoes or boots that are lined with soft insulation. In addition, good blood circulation is important in keeping your feet warm. Avoid wearing tight socks or shoes and crossing your legs or standing in one place for extended periods. Especially avoid smoking tobacco because it decreases blood flow, resulting in cold feet. Protecting your feet from heat is just as important as protecting them from the cold. Avoid walking barefoot on heated surfaces such as hot asphalt or concrete. And remember to protect your skin by using sunscreen on your feet as well as on other exposed areas when you're in the sun.
Being proactive by doing foot checks before you encounter a problem is the most important part of good foot care. Talk with your health care team after you come up with a plan for the care of your feet to ensure that you have covered all of your bases. To find more information on foot care, visit www.ndep.nih.gov (a Web site of the National Institutes of Health) and www.diabetes.org (a Web site of the American Diabetes Association), or do a search online for diabetic foot care.
Excerpted from Action Plan for Diabetes by Darryl E. Barnes, M.D. Copyright © 2004 by American College of Sports Medicine . All rights reserved. Excerpted by arrangement with Human Kinetics, Champaign , IL . $17.95. Available in local bookstores or call 800.747.4457 or click here.