Foot Complications of Diabetics and Preventative Measures
People with diabetes can suffer from many different foot problems as a result or directly related to the disease. It can even be an ordinary foot problem that develops into a very serious complication. You can learn about proper diabetic foot care to prevent or delay serious foot complications.
Diabetic Neuropathy
Foot problems occur most of the time when there is severe nerve damage, called neuropathy. It can cause painful tingling, stinging or burning sensations and weakness in the feet. It can also cause a loss of feeling in more extreme cases, so you can incur an injury on your feet and not even realize it. Neuropathy is also accompanied by poor blood flow and it can cause changes in the shape of your feet or toes.
Neuropathy can hurt, but the nerves that are damaged in your feet lessen the ability for you to feel cold, heat and pain. The loss of feeling can cause complications that may otherwise not be problematic for a non-diabetic. If you should have a tack or small rock in your shoe, you can walk around on it all day without any discomfort. This can lead to a blister or a foot injury that is not noticed until it breaks down the skin in the foot and becomes seriously infected.
If a diabetic experiences changes in the shape of their toes or feet, they should ask their health care provider about getting special therapeutic shoes and not try to force their feet and toes into their regular shoes.
Changes in the Foot’s Skin
Diabetes can cause different changes in the skin on your feet. It could be extremely dry at times to the point where it will peel and crack. This is due to the fact that nerves control the moisture and oil in your feet and they no longer work. Peeling and cracking skin can allow infections to be introduced to your feet.
After a bath or shower, dry your feet completely and then seal in the remaining moisture in your feet by applying a thin coat of an unscented hand cream or plain petroleum jelly.
Never put oils or creams in between your toes. The extra moisture in this area can easily lead to infections. Also, don’t soak your feet in water or Epsom salts and water unless your healthcare provider tells you to do so. This also can make your feet too dry.
Foot Calluses
People with diabetes notice that calluses occur more often and can build up faster and thicker on their feet. The reason for this is that there are high-pressure areas under the feet that bear your weight. Too many calluses may mean that you should secure some therapeutic shoes and inserts to relieve the pressure. If calluses are not trimmed, they will get very thick, then break down and turn into open sores or foot ulcers. You should never try to cut calluses or corns yourself, as this can also lead to ulcers and infections. Your healthcare provider should cut your calluses for you and some diabetics have them cut their toenails as well to prevent infections. Never use any type of chemical agents to remove corns or calluses, as this can burn your thinner diabetic skin. You can use a pumice stone daily to keep calluses under control. It’s best to use a pumice stone on wet skin, after a shower or bath and before your towel dry your feet. It’s best practice to put lotion on your feet after you use a pumice stone.
Diabetic Foot Ulcers
Most often, ulcers will occur on the bottom of the big toe or the ball of the feet. If you have ulcers on the sides of your feet, this is usually the result from shoes that don’t fit well. Even if an ulcer doesn’t hurt, you need to see a physician or health care professional as soon as you notice one. If you neglect a foot ulcer, it can in turn lead to a devastating loss of a limb.
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Depending on the ulcer, your physician may take x-rays of your foot to make certain the bone does not harbor infections. He may clean out infected and dead tissue and this may need to be done in a hospital setting instead of an office visit. He may also culture the wound to examine the infection further in order to decide which antibiotic will work best in your particular case.
When you have diabetic foot ulcers, it’s best to stay off your feet as much as it is possible. Walking on ulcers will make it get larger and subsequently force the infection deep into your foot. You may also receive a special brace, shoe or cast to protect your feet from farther damage while they are healing.
If you have poor circulation due to diabetes, your physician may refer you to a vascular surgeon. High glucose levels from uncontrolled diabetes make it very hard for your entire body to heal from infections.
After a foot ulcer heals, you need to treat your foot very carefully, as the scar tissue under the healed wound will break down much easier than before and it can become re-infected easily. You may even need to wear special shoes after the wound is healed to protect your foot in the area of the ulcer and to prevent another ulcer from returning.
Poor Foot Circulation
Poor blood flow or circulation in your feet can make you less able to fight infections and heal when you have diabetes. Diabetes causes the blood vessels in both your legs and feet to harden and narrow. You do have some control over some items that cause poor blood flow in your legs and feet. If you are a smoker, try to quit. Smoking makes your arteries harden much faster. You should also follow all of your physician’s advice for keeping your cholesterol and blood pressure under control through diet and exercise, education or medications if you need them.
If your feet are cold, you will likely want to warm them, as diabetics’ feet can ache in cold weather. Since your feet may not be able to feel heat, don’t warm them with hot water, a hot water bottle or a heating pad. Since your skin is likely thin on your feet, these items can actually cause very deep burns before you realize it. Instead, try wearing very warm socks or slippers.
Some diabetics feel pain in their calves when they walk on a hard surface, such as concrete, when walking fast, or when walking up a hill or stairs. This is called intermittent claudication. You can simply stop to rest to a few minutes and the pain will subside. If you smoke, it will make this sensation worse. It helps to get with your healthcare provider and get started on a walking plan to alleviate pain in the calves. Some diabetics find medications to be very helpful for this and to improve circulation.
Exercise is a great help for poor circulation, as it stimulates your feet and leg’s blood flow. When you walk, wear sturdy shoes that fit well and feel comfortable and don’t walk when you have an open ulcer on your feet.
Amputation
Diabetics are much more likely to have a leg or foot amputated than other people are. Many diabetics have peripheral arterial disease or PAD, which reduces the blood flow to the feet. In combination with this, diabetics have nerve damage to reduce sensations in the feet. The combination of these two items makes it very easy to get ulcers and infections that lead to amputations.
Preventative Measures
It’s best to use regular foot care and examinations to prevent complications in your feet. Each day before you put your socks and shoes on, examine your feet thoroughly. You should feel all over the bottom, tops and sides of each foot to feel any skin that is breaking down. If you can see the bottom of your feet, then visually examine them also. If you can’t see the bottom of your feet, you can ask a family member to look at them or use a mirror so you can see your feet bottoms. This simple daily examination can help to prevent complications and even amputation if you are diligent in your foot care.
Make certain to see you healthcare provider immediately, if you have any type of foot problems. You can ask about some prescription shoes that are covered by Medicare and other insurance carriers. Always follow your physician’s advice for taking care of your feet problems and ulcers. In addition, if you smoke, it’s best to quit as most people with diabetes that have amputations are smokers.
Author: Dr. Dipan Samanta
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