The Effect of Diabetes on the Feet

Skin Changes
Dryness of the skin is one of the hallmark skin changes in diabetics. The skin can become so dry it can crack and peel. This occurs due to damage to the nerves that control your sweat glands which produce the natural lubricants of the skin. The best way to combat this change is moisturizing your skin after bathing and drying your skin. Most over the counter skin moisturizers are effective. Avoid moisturizing between the toes as this can lead to infection. Also avoid excessive soaking the feet as this can this can promote further dryness of the skin.

Calluses
Calluses are dangerous if left untreated. They are a buildup of skin from excessive pressure secondary to a boney prominence. This buildup can become so excessive that it can breakdown of the underlying “good” skin and cause a sore or ulcer. Calluses can be self treated using a pumice stone after bathing, or they can be trimmed by your Podiatrist. Do not attempt to trim the callus yourself as this can lead to a cut which can result in an ulcer and possible infection. Also avoid over the counter callus removers because they can lead to chemical burns which can lead to an ulcer and possible infection.

Foot Ulcers
Pedal or foot ulcers can occur from excessive pressure in one area of the foot. This can happen on the bottom of the due to a boney prominence and the weight of the body or it can happen on the top or sides of the foot also from a boney prominence and a poorly fitting shoe. Any foot or leg ulcer regardless of how it feels should be looked at by your Podiatrist right away. If it is neglected it can result in infection and limb loss.

The treatment of an ulcer includes taking an X-ray of your foot to monitor for a bone infection. We will also remove or debride any dead or infected tissue that will slow down healing. The wound will also be inspected for acute infection and cultures will be taken. This will determine the type of antibiotics necessary for treatment of the infection. If necessary the patient will be taken to the hospital for removing infected tissue and antibiotic treatment. Keeping pressure off of the site is critical in allowing the wound to heal. Further trauma to the area will prevent the wound from healing. This may mean the patient might be placed in a special shoe, boot or cast to prevent pressure on the wound.
Good sugar control is also important in promoting faster wound healing and preventing or treating infection. If the patient’s circulation is poor, we will send the patient for a vascular surgery consultation.

Good sugar control is also important in promoting faster wound healing and preventing or treating infection. If the patient’s circulation is poor, we will send the patient for a vascular surgery consultation.

After the ulcer has healed care needs to be taken to prevent future occurrences. Special shoes will be necessary. Patients who are more prone to ulcerations of the foot are individuals who have had ulcers before, who have diabetes related changes to their eyes, kidneys, nerves and circulation.

Neuropathy
The nerves of the extremities can be affected by Diabetes. The nerves can produce unusual sensation of increase pain without any inciting events or it can damage the nerves so that it will lessen your ability to feel pain, heat, and cold. Loss of sensation to the feet may lead to injuries that might go undetected and can possibly cause infection. For example a diabetic patient with severe peripheral neuropathy can lose sensation to their feet and walk on hot concrete during the summer months and not know that they just sustained second degrees burns to their feet.

Nerve damage can also affect the muscles of the feet which can lead to foot deformities like curling of the toes called hammertoes. In this case special shoes would be needed to accommodate this deformity.

Poor Circulation
Diabetes can lead to the disease of the blood vessels throughout the body. Damage to the vessels of the leg and foot result in narrowing and hardening of the arteries, which carry blood down through the extremity. Diabetics who smoke can cause increasing damage to the blood vessels. Keeping your sugars under control and discontinuing smoking will help extend the life of your blood vessels. Preserving a patient’s circulation will aid in effectively treating infections and ulcers of the lower extremity.

Exercise is good for poor circulation. A diabetic patient should walk in comfortable shoes and if their sensation is poor, they should walk in special diabetic shoes. If open sores are present, walking is not recommended. Physical activity for at least 30 min a day is worth while. Walking vigorously, hiking, climbing stairs, swimming, aerobics, dancing, bicycling, skating, skiing, tennis, basketball, volleyball, or other sports are just some examples of physical activity that will work your large muscle groups, increase your heart rate, and make you breathe harder, which are important goals for fitness. Do the physical activities your really like. Exercising should first be cleared with your family physician. Exercise involving heavy weights may be bad for people with blood pressure, blood vessel, or eye problems. Diabetes-related nerve damage can make it hard to tell if you’ve injured your feet during exercise. Physical activity can lower your blood glucose too much. You can get shaky, weak, confusedm irritable, anxious, hungry, tired, or sweaty. You can get a headache, or even lose consciousness. Check with your family physician about starting an exercise regimen.

Some individuals can have pain in their calves from walking. This can be a sign of a vessel disease called intermittent claudication. If this occurs one should see their podiatrist for evaluation, vascular testing, and treatment.

Amputation
Amputations are preventable. With close monitoring of your diabetes, including maintaining you blood sugar strictly, cessation of smoking, and exercise, one can decrease the likelihood of amputation. Diabetes can affect the blood vessels and so by doing everything mentioned above we can preserve the circulation. Regular visits to your podiatrist or family doctor can help detect vascular disease early. This can be treated with medication or minimally invasive procedures to improve your circulation.

Your Health Care Provider’s Role

Due to the high risk of foot complications with diabetes, your podiatrist is a vital part in managing your diabetes. Podiatrists will perform regular foot exams to monitor for any changes. If you happen to see changes to your feet, like cuts, breaks in the skin, ingrown nails, etc you should contact your podiatrist immediately.

Caring for Your Feet

There are many things you can do to keep your feet healthy.

  • Keep your blood sugar in control.
  • Wash your feet every day. Dry them carefully, especially between the toes.
  • Check your feet every day for sores, calluses, red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
  • Don’t put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby.
  • If your feet are cold, wear socks. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
  • Don’t cut off blood flow to your feet. Don’t wear garters.
  • Do not use chemicals on corns, calluses, or warts. Over-the-counter products are often too strong for use by people with diabetes. They can burn your feet. Also, do not cut corns or calluses yourself.
  • Cut your toenails straight across and file the edges. Do not rip off hangnails.
  • Wear flat shoes that fit your feet. They should be comfortable when you buy them. Break in your new shoes slowly.
  • If you have lost feeling in your feet, ask your health care provider for advice on proper shoes.
  • Consider wearing comfortable walking shoes every day.
  • Check inside your shoes before wearing them. Make sure there are no pebbles, nails, or other sharp objects in them and that the shoe itself is not rough and the lining is not torn.
  • Choose socks carefully. They should not have seams or other bumpy areas. Do not wear mended socks.
  • Pull your socks on gently to prevent ripping a toenail. Choose padded athletic socks to protect your feet and make walking more comfortable.
  • Never walk barefoot. You could burn or cut your feet and not notice it. Keep slippers by your bed to use when you get up at night.
  • Don’t smoke.
  • See your health care provider at the first sign of infection or inflammation.

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