Diabetes can be dangerous to your feet – even a small cut can result in serious consequences. People with diabetes need to be careful with their feet and its care to prevent these complications.
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If complications do occur, daily attention will ensure that they are detected before they become serious. It may take time and effort to build good foot care habits, but self-care is essential. In fact, when it comes to foot care, the patient is a vital member of the medical team.
This article presents a general overview of diabetic foot complications and guidelines for good foot care.
Diabetes & Foot Complications
Long-term high blood sugar can damage blood vessels, decreasing blood flow to the foot. This can weaken the skin, contribute to the formation of ulcers, and impair wound healing. Some bacteria and fungi thrive on high levels of sugar in the bloodstream, and bacterial and fungal infections can break down the skin and complicate ulcers.
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More serious complications include deep skin and bone infections. Gangrene (death and decay of tissue) is a very serious complication that may include infection; widespread gangrene may require foot amputation. Approximately 5 % of men and women with diabetes eventually require amputation of a toe or foot. This tragic consequence can be prevented in most patients by managing blood sugar levels and daily foot care.
Elevated blood glucose levels over time can damage the nerves of the foot, decreasing a person’s ability to notice pain and pressure. Without these sensations, it is easy to develop callused pressure spots and accidentally injure the skin, soft tissue, bones, and joints. Over time, bone and joint damage can dramatically alter the shape of the foot.
Risk Factors
Patients who have had a previous foot ulcer are more likely to have future foot complications. Nerve damage, poor circulation, and chronically high blood sugar levels also increase the likelihood of foot complications.
It is important to wear shoes that fit well. Shoes that are too tight can cause pressure ulcers. Going barefoot, even in the home, should be avoided as this increases the risk of injury to the foot.
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Foot Examination
People with type 1 diabetes for at least 5 years should have their feet examined at least once a year. People with type 2 diabetes should have their feet examined once a year.
During a foot exam, a healthcare provider checks for poor circulation, nerve damage, skin changes, and deformities. Patients should mention any problems they have noticed in their feet. An exam may reveal decreased or absent reflexes or decreased ability to sense pressure, vibration, pin pricks, and changes in temperature.
Preventing Foot Problems in Diabetes
Foot care is important, although patients should also continue to follow other general guidelines for managing diabetes. The following strategies can reduce the chances of developing foot problems.
Quit smoking. Smoking can worsen heart and vascular problems and reduce circulation to the feet.
Avoid activities that can injure the feet. Some activities increase the risk of foot injury and are not recommended, including walking barefoot, using a heating pad or hot water bottle on the feet, and stepping into the bathtub before testing the temperature.
Careful while trimming the nails. Trim the toe nails along the shape of the toe and file the nails to remove any sharp edges. Never cut the cuticles. Do not open blisters, try to free ingrown toenails, or otherwise break the skin on the feet. See a healthcare provider or podiatrist for even minor procedures.
Wash and check the feet daily. Use lukewarm water and mild soap to clean the feet. Gently pat your feet dry and apply a moisturizing cream or lotion. Check the entire surface of both feet for skin breaks, blisters, swelling, or redness, including between and underneath the toes where damage may be hidden. Use a mirror if it is difficult to see all parts of the feet or ask a family member or caregiver to help.
Choose socks and shoes carefully. Select cotton socks that fit loosely, and change the socks every day. Select shoes that are snug but not tight, and break new shoes in slowly to prevent any blisters. Ask about customized shoes if the feet are misshapen or have ulcers; specialized shoes can reduce the chances of developing foot ulcers in the future. Shoe inserts may also help cushion the step and decrease pressure on the soles of the feet.
Ask for foot exams. Screening for foot complications should be a routine part of most medical visits, but is sometimes overlooked. Don’t hesitate to ask the healthcare provider for a foot check at least once a year, and more frequently if there are foot changes.
What are common diabetes foot problems?
Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.
Corns and calluses
Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.
Blisters
Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become infected.
Ingrown toenails
Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.
Bunion
A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.
Plantar
Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.
Hammertoes
Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Wearing shoes that are too short can also cause hammertoes.
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