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Guidance for Persons Living with Diabetes

I see loads of persons with this disease. Having diabetes increases the risk of developing a wide range of foot problems, often because of two complications of the disease: nerve damage (neuropathy), and poor circulation.

For those living with diabetes, foot problems, such as the following, can lead to serious complications: 

  • corns
  • calluses
  • cracked heels 
  • hammertoes
  • bunions
  • ingrown toenails
  • ulcers (sores) that do not heal
  • skin infection (cellulitis) from an open wound
  • abscess formation (collection of pus under the skin)
  • osteomyelitis (bone infection)

Untreated diabetes can result in other conditions, such as:

Diabetic peripheral neuropathy – this condition does not emerge overnight. Instead, it usually develops slowly, and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy. It is a condition that affects the nerves and symptoms are usually numbness, tingling, burning, pins and needles.

Charcot foot – is a condition in which the bones of the foot are weakened enough to fracture. It is a sudden softening of the foot’s bones, caused by severe neuropathy, or nerve damage, a common diabetic foot complication. It can trigger an avalanche of problems, including joint loss, fractures, collapse of the arch, massive deformity, ulcers, amputation, and even death. As the disorder progresses, the bottom of the foot can become convex, bulging like the hull of a ship. Since most people with Charcot cannot feel pain in their lower extremities, they continue walking on the foot, causing more injury. With sustained walking, the foot eventually changes shape. The joints then collapse, and the foot takes on an abnormal shape, with a rocker-bottom appearance.

Charcot cannot be reversed, but its destructive effects can be stopped if the complication is detected early. The symptoms of Charcot foot appear suddenly. They include warm and red skin, swelling, and pain. A person living with diabetes who has a red, hot, swollen foot or ankle, requires emergency medical care anyway, because these can also be symptoms of deep vein thrombosis, or an infection.

To prevent complications of diabetes, patients are advised to follow diabetic foot care guidelines. Sometimes special shoes are prescribed to avoid pressure and rubbing on the feet, caused by regular footwear.

Diabetes Foot Care Guidelines

Diabetes can be dangerous to your feet, that even a small cut can produce serious consequences. It  may cause nerve damage that takes away the feeling in your feet. As well, there may be reduced blood flow to the feet, making it harder for healing of injuries, or resisting infection. Because of these problems, you may not notice a foreign object in your shoe. Consequently, you could develop a blister or a sore. This could lead to an infection, or a non-healing wound, putting you at risk for an amputation.

To avoid serious foot problems that could result in losing a toe, foot or leg, follow these guidelines:

  • Inspect your feet daily – Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. See your doctor or podiatrist, if you notice anything unusual.
  • Bathe feet in lukewarm, never hot, water – Keep your feet clean by washing them daily.
  • Be gentle when bathing your feet – Wash them using a soft washcloth or sponge. Dry by blotting or patting; carefully so between the toes.
  • Moisturise your feet but not between your toes – Use a moisturiser daily to keep dry skin from itching or cracking. But don’t moisturise between the toes as that could encourage a fungal infection.
  • Cut nails carefully –Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor or podiatrist.
  • Never treat corns or calluses yourself –No “self-surgery” or medicated pads. Visit your doctor or podiatrist for appropriate treatment.
  • Wear clean, dry socks – Change them daily; proper hygiene is critical in eliminating infections.
  • Consider socks made specifically for patients living with diabetes –These socks have extra cushioning and are seamless, do not have elastic tops, are higher than the ankle, and made from fibers that wick moisture away from the skin.
  • Wear socks to bed – If your feet are cold at night, wear socks.
  • Shake out your shoes and feel the inside before wearing –Remember, your feet may not be able to feel a pebble or other foreign object, so always check before putting them on.
  • Keep your feet dry – Don’t let your feet get wet in rain.
  • Never walk barefooted –Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.
  • Take care of your diabetes –Keep your blood sugar levels under control.
  • Do not smoke – Smoking restricts blood flow in your feet.
  • Get periodic foot exams –Seeing your podiatrist on a regular basis can help prevent the foot complications of diabetes. Do Diabetic Annual Reviews.

Your feet mirror your general health . . . cherish them!

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