Diabetes and Foot Problems

Introduction:
For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications, including foot problems.

How Can Diabetes Affect My Feet?
Diabetes can cause two problems that can affect your feet.

Diabetic neuropathy
Uncontrolled diabetes can damage your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain. This lack of feeling is called "sensory diabetic neuropathy." If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that up to 10% of people will develop foot ulcers. Foot ulcers occur because of nerve damage and peripheral vascular disease.

Peripheral vascular disease
Diabetes also affects the flow of blood. Without good blood flow, it takes longer for a sore or cut to heal. Poor blood flow in the arms and legs is called "peripheral vascular disease." Peripheral vascular disease is a circulation disorder that affects blood vessels away from the heart. If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).

What Are Some Common Foot Problems of People With Diabetes?
Anyone can get the foot problems listed below. For people with diabetes, however, these common foot problems can possibly lead to infection and serious complications, such as amputation.
Athlete's foot, Fungal infection of nails, Calluses, Fungal infection of nails, Foot ulcers, Hammertoes, Ingrown toenails, Plantar warts.

Can These Foot Problems Be Prevented?
Proper foot care can help prevent these common foot problems and/or treat them before they cause serious complications. Here are some tips for good foot care:
1. Take care of yourself and your diabetes. Follow your health care provider's advice regarding nutrition, exercise, and medication. Keep your blood glucose level within the range recommended by your doctor.
2. Wash your feet in warm water every day, using a mild soap. Do not soak your feet. Dry your feet well, especially between the toes.
3. Check your feet every day for sores, blisters, redness, calluses, or any of the other problems listed above. If you have poor blood flow, it is especially important to do a daily foot check.
4. If the skin on your feet is dry, keep it moist by applying lotion after you wash and dry your feet. Do not put lotion between your toes. Your doctor can tell you which type of lotion is best to use.
5. Gently smooth corns and calluses with an emery board or pumice stone. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction.
6. Check your toenails once a week. Trim your toenails with a nail clipper straight across. Do not round off the corners of toenails or cut down on the sides of the nails. After clipping, smooth the toenails with an emery board.
7. Always wear closed-toed shoes or slippers. Do not wear sandals and do not walk barefoot, even around the house.
8. Always wear socks or stockings. Wear socks or stockings that fit your feet well and have soft elastic.
9. Wear shoes that fit well. Buy shoes made of canvas or leather and break them in slowly. Extra wide shoes are also available in specialty stores that will allow for more room for the foot for people with foot deformities.
10. Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
11. Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles several times a day, and don't cross your legs for long periods of time.
12. If you smoke, stop. Smoking can make blood flow problems worse.
13. If you have a foot problem that gets worse or won't heal, contact your doctor for advice and treatment.
14. Make sure your diabetes doctor examines your feet during each check-up. An annual foot exam should be performed which should include an inspection of the skin -- he or she may check for redness or warm of the skin. The exam will also be to check for pulses and temperature of your feet and an assessment of sensation to the foot with something called a monofilament.
15. See your podiatrist (foot doctor) every two to three months for check-ups, even if you don't have any foot problems.

When Should I Contact My Doctor?
Contact your doctor if you experience any of the following problems:
Changes in skin color.
Changes in skin temperature.
Swelling in the foot or ankle.
Pain in the legs.
Open sores on the feet that are slow to heal or are draining.
Ingrown toenails or toenails infected with fungus.
Corns or calluses.
Dry cracks in the skin, especially around the heel.
Unusual and/or persistent foot odor