Diabetic Foot Care

As a diabetic, what should I do to care for my feet?

Inspect your feet daily

A lot of diabetic foot care is made of having a team of medical and allied health people to support you in your quest for health while living with diabetes.  Ultimately though, the single most important person in this whole process is you.  Your podiatrist will examine your feet, perhaps every six weeks to 12 months..  Your doctor might check out your feet every each time you visit, or every few months, few years or not at all.  You, however, will have the chance to examine your feet every day and if there is a problem, you will be the first one on the scene.

To maintain good foot health, the dos and don’t do’s for every diabetic include:

DO:

• Inspect your feet every day.  On the top, sole and between your toes.  Use your other senses of touch and sight to compensate for the fact that your feeling may be impaired.
• Wash your feet every day and dry well between toes.  Use a soft wipe and taking care not to rub skin off with a scratchy towel.
• Wear appropriate footwear that fits well and protects you.
• Get educated about foot care.  Reading this series of foot health info is a great start!
• Have any corns and callus regularly removed by a podiatrist.  Pressure on the skin underneath a reasonable sized callus is 30% more than after removal of the callus.  The more thick skin there is, the faster further callus will form because of this increase in pressure.
• Regular removal of hard skin will slow down how fast it reforms.
• Talk to your podiatrist about pressure moderating orthotics and wear them if they are prescribed for you.
• Do tend to dry skin with an ointment recommended for you. Cracks are not good as they can allow bacteria to enter the skin.
• Find out how to cut your toenails properly.  If your nails are not completely normal, get a lesson from your podiatrist.  If they are normal nails, cut them to follow the curve of your toe, don’t change the angle to cut down the side.
• Know who to contact if there is a problem and when. If you don’t have a podiatrist, find one in your local community and have your first check up.
• Be sure to tell your health care providers, particularly your podiatrist, that you have diabetes so appropriate precautions can be taken.
• Pay attention to your blood pressure as well. People with good blood pressure control have a 24% lower risk of foot or leg amputation, a 32 % less chance of diabetes related mortality (ie death) and 50% less degree of visual perception loss than a comparable group of diabetics with poor blood pressure control.
• Keep cholesterol and triglycerides in check through modifying your diet where necessary, medication, exercise and maintaining a healthy weight.
• Follow the guidelines and exercise regularly to avoid weight gain and to improve your circulation.  Exercise results in more opportunities to develop new pathways for blood flow to the extremities if the regular pathways are starting to clog up.
• Know your HLA1c /  blood glucose levels and work with your doctor, nutritionist, and family to keep them in check
• Ask your doctor if you should be having daily aspirin therapy to reduce the chance of clots, stroke and heart attack.
• See a podiatrist – at least once a year if you are in good condition.  If diabetes mellitus has already affected the health of your feet, you will need to be seen more often to be sure of keeping in front of any changes.
• Apart from your feet, have yearly eye and kidney examinations.  Just like the feet, these organs can be affected  by problems in the small blood vessels. If present in one area, are often a sign of these to come more broadly.

DON’T:

• Absolutely do not smoke. Nicotine is a vaso-constrictor which causes quite a large decrease in blood flow to the small vessels of the toes. Smoking is also now known to precipitate a lot of other health conditions- particularly concerned with inflammation – in ways that are not well understood at the moment.
• Don’t drink excessive amounts of alcohol.  Refer to current guidelines as this is often being revised.  When drinking, be wary of sugar in mixers and other, more hidden, sugars in drinks such as rum and white wine.
• Don’t soak for too long in water.  It is probably best not to do this at all, but if you must, keep to a maximum of 20 minutes.  You can cut nails straight after soaking but don’t use an abrasive device for removing skin at this time as the skin can tear. Also don’t grab loose bits of skin as they will usually run deep into the skin and bleed.
• Be aware of slip hazards with wet or oily skin.
• Don’t add chemicals to your foot bath without specific advice from the pharmacist or podiatrist.
• Don’t, Don’t, Don’t use chemist corn treatments or self treat calluses, corns or ingrown toenails. It really can be very dangerous, so Just. Don’t. Do. IT!
• Don’t go barefoot outside (everyone) where you can pick up splinters in the skin or debris in your shoes.
• Don’t go unprotected inside either if neuropathy is present. Be sure that no sharp things that are dropped, ever go ‘unfound’.  Finding sewing needles fully embedded in a foot is, unfortunately, not as uncommon as you might think.
• Don’t dig out hard skin around your nail edges or cuticles at the bottom. The skin in these areas is usually *just* underneath the hard dry layer and is very easy to open up and cause to bleed. This area is heavily colonised by bacteria and is really prone to infection. Painful hard areas in the nail edges are corns which are very common and again, easily infected.  See a podiatrist for removal.

To read this Q&A session as a single document, or to access the downloadable and  printable version of these, please browse to our Diabetes Info Sheet. Alternatively, please use this link if you wish to return to the Podiatry FAQs Blog.