Diabetic Foot Care
Diabetic foot complications are the No. 1 cause of non-traumatic foot amputations in the United States and cause one in five people with diabetes to enter the hospital. Learning to do proper foot care can help prevent or delay this occurrence.
What causes foot problems with diabetes?
In patients with diabetes, blood flow to the feet may be impaired. This means that your foot is less able to fight infection or heal itself.
Nerve damage (neuropathy) may be present, causing a lack of sensation in the feet. Pain may not be felt even with injury, predisposing you to foot ulcers and infection. The skin may also become dry, cracking and peeling easily, since neuropathy may cause sweating to be impaired.
The following guidelines will help you protect your feet and should be done daily.
1. Good Blood Sugar Control
Keeping your blood sugar under good control can help prevent or delay foot complications as well as other diabetes-related problems. This will mean self-management of blood sugars with diet, exercise medication, monitoring blood glucoses, and education in other techniques of controlling blood sugar.
2. Inspect Your Feet Daily
Visually checking your feet is important, since you may not feel injuries if you have neuropathy. Look for cuts, sores, red spots, infection, swelling or unusual appearing areas. You can use a mirror to help see the bottom of your feet, or ask a family member or caregiver for help. Set a time daily (such as after your bath or shower) to perform this check.
3. Wash and Moisturize Your Feet Daily
Warm (about 90-95 degrees) water is best, instead of hot. You can use a thermometer or your elbow to assess the temperature. Dry your feet afterwards, with special attention between the toes (to prevent athlete's feet). Rub a think layer of a good moisturizer or lotion that does not contain alcohol (which can be drying), avoiding the area between the toes. Moisturizing will help prevent your skin from drying and cracking, which can lead to infection. Also, do not soak your feet, since this will also dry out the skin.
4. Smooth Corns and Calluses
After your bath or shower, when the skin is soft, use a pumice stone to gently rub in one direction, smoothing off corns or calluses. Avoid tearing the skin, and never cut corns or calluses. Never use liquid corn and callus removers, since they can create a chemical burn. If the calluses become thick, see your health care provider for a referral to a podiatrist (foot doctor) who can trim these for you. They may indicate a pressure area, and the need for special shoes or inserts to relieve the pressure.
5. Trim Your Toenails Regularly
Once a week is usually enough. After washing and drying your feet, trim your toenails straight across, then smooth them with an emery board so there are no sharp edges. Do not rip off hangnails, and don't cut into the corners, or trim into the quick. You may need a podiatry consult if the nails are thickened and yellow.
6. Never Go Barefoot
Even going barefoot indoors can cause injury. Good fitting shoes and socks are one of your feet's best protection. Choose socks made of cotton or wool, since they will "wick" moisture away from your skin, and make sure there are no seams or bumps. Be sure to check inside your shoes before putting them on for objects, rough spots or exposed nails.
It is best to break in new shoes slowly (one hour a day the first week, increasing time gradually). Choose shoes made of canvas or leather, that let your feet "breathe," with good support at the ankles. Don't buy pointed toes or high heels, which put pressure on the feet. Keep slippers with good soles by your bed to use at night if you get up.
7. Avoid Thermal Injury
Never use hot water bottles or heating pads on your feet, which cause tissue injury or burns. Wear socks at night if your feet get cold.
Put sunscreen on the top of your feet to prevent sun burn. In the winter, lined boots can help keep your feet warm. Check for frostbite if exposed to the cold.
8. Don't Constrict Circulation
Avoid crossing your legs, or wearing tight socks, garters or constricting garments.
Exercise helps promote blood flow. Check with your health care provider as to which activities are best for you. Walking, swimming and bicycling can help blood flow and do not put pressure on the feet. Avoid high impact exercises such as running or jumping. Wear good fitting, supportive athletic shoes.
10. Have Your Health Care Provider Check Your Feet at Every Visit
At minimum, a yearly foot check of pulses, sensation and visual inspection should be done by a health care professional. If you are at higher risk, the foot-check should be done more frequently.
Any time infection, inflammation, an ingrown toenail or a foot ulcer occur, see your health care provider immediately.
Every ulcer should be seen by your health care provider immediately, even if there is not pain. If sensation in your feet changes, if you develop severe pain, or the color changes, tell your health care provider.
Sheridan Waldrop, from rural North Texas, has more than 18 years of experience as a registered nurse both in critical care and more recently, diabetes education. She has worked the past three years on the diabetes team at a teaching hospital, dealing with complex diabetic clients.