Diabetes Foot Care
Diabetes is a disease in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also lead to decreases in the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems can develop and quickly become serious.
- With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop.
- Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life threatening.
- People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention, including good control of blood sugar, remains the best way to prevent problems.
- Diabetics should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems.
- They should also learn what is reasonable to do at home as far as routine foot care, how to recognize when to call the doctor, and how to recognize when a problem has become serious enough to seek emergency treatment.
Diabetic Foot Care Treatment
Self-Care at Home
- Foot examination: Examine your feet daily and also after any trauma, no matter how minor, to your feet. Report any abnormalities to your physician. Use a water-based moisturizer every day (but not between your toes) to prevent dry skin and cracking. Wear cotton or wool socks. Avoid elastic socks and hosiery because they may impair circulation.
- Eliminate obstacles: Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night—indoors and outdoors.
- Toenail trimming: Always cut your nails with a safety clipper, never a scissors. Cut them straight across and leave plenty of room out from the nailbed or quick. If you have difficulty with your vision or using your hands, let your doctor do it for you or train a family member how to do it safely.
- Footwear: Wear sturdy, comfortable shoes whenever feasible to protect your feet. To be sure your shoes fit properly, see a podiatrist (foot doctor) for fitting recommendations or shop at shoe stores specializing in fitting diabetics. Your endocrinologist (diabetes specialist) can provide you with a referral for a podiatrist or orthopedist who may also be an excellent resource for finding local shoe stores. If you have flat feet, bunions, or hammertoes, you may need prescription shoes or shoe inserts.
- Exercise: Regular exercise will improve bone and joint health in your feet and legs, improve circulation to your legs, and will also help to stabilize your blood sugar levels. Consult your physician prior to beginning any exercise program.
- Smoking: If you use any form of tobacco, quitting can be one of the best things you can do to prevent problems with your feet. Smoking accelerates damage to blood vessels, especially small blood vessels leading to poor circulation, which is a major risk factor for foot infections and ultimately amputations.
- Diabetes control: Following a reasonable diet, taking your medications, checking your blood sugar regularly, exercising regularly, and maintaining good communication with your physician are essential in keeping your diabetes under control. Consistent long-term blood sugar control to near normal levels can greatly lower the risk of damage to your nerves, kidneys, eyes, and blood vessels.
When to Seek Medical Care
Write down your symptoms and be prepared to talk about them on the phone with your doctor. Following is a list of common reasons to call your doctor if you have a diabetic foot or leg problem. For most of these problems, a doctor visit within about 72 hours is appropriate.
- Any significant trauma to your feet or legs, no matter how minor, needs medical attention. Even minor injuries can result in serious infections.
- Persistent mild-to-moderate pain in your feet or legs is a signal that something is wrong. Constant pain is never normal.
- Any new blister, wound, or ulcer less than 1 inch across can become a more serious problem. You will need to develop a plan with your doctor on how to treat these wounds.
- Any new areas of warmth, redness, or swelling on your feet or legs are frequently early signs of infection or inflammation. Addressing them early may prevent more serious problems.
- Pain, redness, or swelling around a toenail could mean you have an ingrown toenail—a leading cause of diabetic foot infections and amputations. Prompt and early treatment is essential.
- New or constant numbness in your feet or legs can be a sign of diabetic nerve damage (neuropathy) or of impaired circulation in your legs. Both conditions put you at risk for serious problems such as infections and amputations.
- Difficulty walking can result from diabetic arthritis (Charcot's joints), often a sign of abnormal strain or pressure on the foot or of poorly fitting shoes. Early intervention is key to preventing more serious problems including falls as well as lower extremity skin breakdown and infections.
- Constant itching in the feet can be a sign of fungal infection or dry skin, both of which can lead to infection.
- Calluses or corns developing on the feet should be professionally removed. Home removal is not recommended.
- Fever, defined as a temperature greater than 98.6°F, in association with any other symptoms or even fever alone should prompt an immediate call to your doctor. The degree of fever does not always correlate with the seriousness of infection. You could have no fever or a very low fever and still have a serious infection. People with diabetes need to be especially cautious of fever.
If time and your condition permit, write down your symptoms, a list of your medications, allergies to medicines, and your doctor's name and phone number prior to coming to the hospital's emergency department. This information will greatly assist the emergency physician in the evaluation and treatment of your problem.
Following are some common reasons to seek immediate medical attention for diabetic foot and leg problems.
- Severe pain in your feet or legs is often a sign of acute loss of circulation to the leg, serious infection, or may be due to severe nerve damage (neuropathy).
- Any cut to your feet or legs that bleeds significantly and goes all the way through the skin needs proper cleaning and repair to aid healing.
- Any significant puncture wounds to your feet (for example, stepping on a nail or being bitten by a dog or cat) carry a high risk of becoming infected.
- Wounds or ulcers that are more than about 1 inch across on your feet or legs are frequently associated with limb-threatening infections.
- Redness or red streaks spreading away from a wound or ulcer on your feet or legs are a sign of infection spreading through the tissues.
- Fever higher than 101.5°F in association with redness, swelling, warmth, or any wound or ulcer on your legs may be a sign of a limb or life-threatening infection. If you have diabetes and you simply have a fever more than 101.5° F, and no other symptoms, seek immediate emergency care to determine a source and treatment plan. Because the degree of fever does not always correlate with the seriousness of the illness, people with diabetes should take even low-grade fevers (less than 101.5°F) very seriously and seek medical attention.
- Alteration in mental status (confusion) may be a sign of life-threatening infection that could lead to loss of a leg or foot, when associated with a leg wound or foot ulcer. It may also be a sign of either very high or very low blood sugars, which are more common when there is infection present.
