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Guidelines For Critical Diabetic Foot Care

Sometimes you have patients that worry you more than others, due to their particular complications. I had one such patient quite recently. The reality is… you can’t save the world; you can’t help everyone. Unfortunately, this was one such case.  This patient came to me with a toe that already had gangrene present. I, along with a medical doctor colleague, tried  to get the toe to an improved state. Sadly, I had to advise the patient to go to the hospital, and the toe was amputated. How did this all occur? A toenail being cut badly, and an infection developed. The physical and mental pain is a lot for this patient; so it is the toe now, or the leg, if left too long to act.

Why is Foot Care Important?

If you have diabetes, nerve damage, circulation problems, and infections, it can lead to serious foot problems. However, you can take precautions to maintain healthy feet. Managing your diabetes and maintaining a healthy lifestyle helps, and should include:

  • regular medical exams, including foot checks at every visit and checking your ABCs (A1c, blood pressure, and cholesterol)
  • monitoring your blood sugar daily
  • regular exercise
  • eating a balanced diet.

Compliance is a great prevention tool…practise it.

Daily Foot Care

Here are a few foot care habits you can adopt and do.

  1. Inspect your feet

Check your feet and toes, inspecting the tops, sides, soles, heels, and in between the toes. If you’re physically unable to inspect your own feet, use a mirror or ask someone to help. Contact your doctor or podiatrist immediately if you discover any sores, redness, cuts, blisters, or bruises.

  1. Wash your feet

Wash your feet  in warm water with mild soap. Hot water and harsh soaps can damage your skin. Check the water temperature with your fingers or elbow before putting your feet in. Your diabetes may make it difficult to sense water temperature with your feet.

  1. Dry your feet

Pat your feet dry. Infections tend to develop in moist areas, so ensure between your toes are well dried.

  1. Moisturise dry skin

If the skin on your feet feels rough or dry, use lotion or oil, but not between your toes.

Healthy Foot Habits

Good foot care habits contribute to healthy feet. Here are a few helpful tips.

  • Avoid walking barefoot.
  • Never attempt to remove corns, calluses, warts, or other foot lesions yourself. Don’t use chemical wart removers, razor blades, corn plasters, or liquid corn or callus removers. See your doctor or podiatrist.
Toenails

It’s possible for people with diabetes to perform routine toenail care. But visual difficulty, nerve problems, or circulatory changes in the legs or feet can make this unsafe. If you’re able to safely trim your toenails yourself, doing so properly will help you avoid getting an ulcer or foot sore. Do consult with your healthcare provider to see if it’s safe for you to perform routine toenail care; then, the correct way to do it.

Here are a few tips for proper toenail care:

  • Trim your toenails after washing your feet, when the nails are soft.
  • Cut straight across rather than curved to help prevent ingrown toenails.
  • Don’t cut into the corners; use an emery board to smooth the edges.
  • Be careful not to cut the nails too short.
  • Have your nails trimmed by a podiatrist or another healthcare provider if you can’t see well, or the nails are thickened.
Footwear and Socks

 If you have neuropathy, or nerve damage that has affected foot sensitivity, you may overlook cuts or bumps. You can help protect your feet by wearing shoes at all times.

Shoes
  • Choose comfortable, well-fitting shoes with sufficient room, especially in the toe box. Never buy tight shoes hoping they will stretch.
  • Avoid thong sandals, pointed-toe and very high heels.
  • Wear shoes that can be adjusted with laces, buckles, or Velcro.
  • Inspect the inside of your shoes every day for tears or bumps that may cause pressure or irritation.
  • Socks can provide an extra layer of soft protection between your foot and your shoe.
  • Wear clean, dry socks, or non-binding pantyhose. Avoid socks or hosiery with seams that can cause additional pressure points or are too tight on the leg.
  • Wear socks to bed if your feet are cold.
 Signs & Symptoms of Foot Problems

It’s important to recognise early warning signs of foot problems, such as:

  • burning, tingling, or painful feet
  • loss of sensation to heat, cold, or touch
  • changes to the colour or shape of your feet
  • loss of hair on the toes, feet, and lower legs
  • thickening and yellowing of the toenails
  • onset of red spots, blisters, sores, ulcers, infected corns, or ingrown toenails.
 Potential Complications

Following the prevention tips listed can help avoid foot problems. High blood glucose levels over time can cause nerve damage and circulation problems, which  can result in, or contribute to foot problems. Left unnoticed or untreated, sores, ingrown toenails, and other issues can lead to infection. Poor circulation makes infections difficult to heal; eventually skin and tissue die, and turn black. This is called gangrene. Treatment can involve surgery to amputate a toe, foot, or part of a leg.

Visiting the Podiatrist

A podiatrist should examine your feet at every visit, with a thorough foot exam once or twice yearly. If you have a history of foot problems, you should be checked more often. Remember, diabetes-related foot problems can worsen very quickly and are difficult to treat, so it’s important to seek prompt medical attention.

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

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