Foot care in Diabetes

February 2017

Diabetes can lead to foot ulcers.

Ulcers can lead to infection and should be considered very seriously because they can, in some patients, lead to amputation .

It is very important to take care of your feet and try to prevent ulcers in the first place.

Statistics


  • 20 to 25% of diabetics consult a doctor at least once in their lifetime for problems regarding their feet
  • In developed countries, nearly 5% of diabetics suffer from a foot problem
  • Foot lesions or ulcers are responsible for 25% of a diabetic's hospitalisation
  • Diabetes increases the risk of lower extremity amputations (toe, foot or leg) by 15 fold, making it the second leading cause
  • Over 50% of amputations could be avoided
  • 5 to 10% of diabetics undergo amputation
  • Gangrene of the extremities is 40 times more common in diabetics

How does diabetes affect your feet?


A foot ulcer is an area of skin which has broken down and does not heal as you would expect.

Due to complications of reduced sensation and circulation in your feet, you are more likely to develop a foot ulcer if you are diabetic.

Due to your diabetes, the nerves in your feet are less sensitive, so you may not feel injury, hot temperatures, or sharp objects.

Feet which have lost their sensitivity are more susceptible to injury.

As diabetes have an increased risk of developing narrowing of the blood vessels in the feet (peripheral vascular disease), there is less blood flow to help to heal wounds or ulcers.

A neglected foot injury or ulcer can develop infections and, if untreated, can unfortunately have serious consequences such as amputation.


Avoiding ulcers and amputation


The best ways to avoid foot complications are to control your diabetes and to have regular foot care.
  • Monitor your diabetes and aim for glycaemic targets set by your GP and/or diabetic specialist
  • Do not smoke
  • Monitor and control your blood pressure as advised by your GP
  • Monitor and/or treat your cholesterol

For more information: http://www.brochurespatients.com/scripts/browse_key.php

How to look after your feet


It is good practice to examine your feet daily. You can use a mirror or relative to help you.

You must check for any breaks in the skin, hardened thickened skin (calluses), and colour changes.

Hygiene

  • Wash your feet daily with warm water and soap.
  • Do not soak your feet as your skin will become soggy and then dry.
  • Using a clean dry towel, dry your feet, especially between your toes to avoid any fungal infections.

Skincare

  • Inspect your feet for any wounds or infection. This includes flaky skin in between your toes which may be a common fungal infection called Athlete's foot.
  • Apply a moisturiser to your feet to prevent dry skin
  • Try to avoid putting cream between the toes as it will become moist and attract fungal infection.
  • You can use small amounts of talcum powder between the toes to dry this area.
  • If there are areas of thickened skin, you can use a pumice stone gently.

Nail care

  • Cut your nails with a nail cutter or file them with an emery board every 6 to 8 weeks.
  • The nails should be cut to the shape of your toe.
  • Avoid cutting them too short or cutting down the edges to form a "v".
  • Try not to use nail scissors
  • You can clean under your nails with a nailbrush or even an old toothbrush
  • If you find it difficult to care for your own feet, a podiatrist or chiropodist would be happy to help.

Footwear



Socks

  • NEVER walk barefoot
  • Wear socks all year round, even in summer
  • Change your socks daily
  • Never wear socks with holes or rips - this is a common cause of ulceration
  • Choose socks made of cotton or natural fibre
  • Avoid folds, wrinkles or socks with prominent seams
  • Do not buy socks with elastic at the top as this can restrict the circulation in your legs

Shoes

  • Choose shoes that are slightly generous in size to avoid your feet feeling too tight
  • Purchase your shoes late in the day when your feet are most swollen
  • You should buy a few pairs, if possible, to alternate and vary the step and friction to your feet
  • Feel inside your shoes before wearing them to ensure there no sharp objects or stones inside
  • The heel should be flat or low to minimise pressure on your toes
  • The shoes should be soft and broad with a deep and rounded toe area
  • Laced, Velcro or buckled shoes are preferable to prevent your foot from rubbing and sliding in the shoe
  • If you are unsure or need assistance in buying shoes, a podiatrist would be able to advise you.
  • There are also specialist organisations that will also be able to help you:

Things to avoid

  • Avoid cutting your nails too short or too sharp
  • Do not use a sharp instrument for calluses
  • Avoid extended foot baths which makes your skin soggy
  • Try to avoid cracking of your heels by using lots of emollient creams
  • Avoid walking barefoot
  • Avoid foot burns by checking the bath or shower temperature before stepping in
  • Do not use hot water bottles or electric blankets and avoid sitting next to hot fires
  • Do not forget to update your tetanus vaccination

Podiatry and Chiropody

  • You should have feet reviewed by doctor and foot specialist at least once a year. They will check the circulation and sensation in your feet.
  • Podiatrists are foot specialists, and are also known as chiropodists.
  • Podiatrists only treat feet whereas chiropodists care for hands and feet.
  • It may be possible for consultations and treatment at home, but ensure to ask your specialist.
  • For more information, please contact The Society of Chiropodists and Podiatrists by phone (020 7234 8620) or visit their website http://www.feetforlife.org
  • Useful recommendations were also published by Foot in Diabetes UK (FDUK) http://www.footindiabetes.org/guidelines

Related


Pied du diabétique - Eviter les plaies et les blessures
Pied du diabétique - Eviter les plaies et les blessures
El pie diabético
El pie diabético
Der diabetische Fuß
Der diabetische Fuß
This document, titled "Foot care in Diabetes," is available under the Creative Commons license. Any copy, reuse, or modification of the content should be sufficiently credited to CCM Health (health.ccm.net).