Diabetes and FootCare

What is Diabetes? Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem. Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.

Diabetes “Mild Disease” Serious consequences

Diabetes Mellitus A Serious Disease Leading cause of new cases of blindness 25 times more prone to eye problems 6 times higher risk for Paralysis (stroke) 2-3 times higher risk for heart attack 20 times more prone to lower limb amputation Nerve damage causes loss of sensation 5 times more prone to Kidney failure

Diabetes and Feet Why people with diabetes require good care of their feet? There are several reasons Loss of sensation with increased risk of injury Poor circulation causing delayed healing Higher likelihood of developing infections that go unnoticed and spread widely leading to gangrene Diabetes foot ulcers are the most common cause for prolonged hospitalizations Diabetes is the most important cause of non traumatic foot amputations

Prevention Is Better Than Cure Learn to take good care of your feet Practice what you learn every day Foot problems must be detected and treated properly Take help of a Foot Care specialist or your Diabetes Care Team

Daily Foot Care You can prevent major foot problems, if you Learn to recognize signs of early foot problems Inspect your feet daily Keep your feet clean and dry Trim your toenails carefully Protect you feet with appropriate footwear Have your doctor or nurse examine your feet regularly (especially if you have any loss of sensation in your feet or toes or have a poor eyesight)

Recognize the Symptoms of Foot Problems Pay attention to peculiar sensations such as Tingling, like a feeling of “ants crawling” or “pins and needles” Numbness and heaviness “feeling of walking on cotton”, or feeling of “wearing tight socks” even when the feet are bare Reduced ability to sense heat and cold Stabbing or burning pain A persistent “restlessness” in the feet and legs (These are tell tale signs of impending serious foot problems)

Inspect Your Feet Daily Examine feet in good light after bath Check for in-grown nails, corns and calluses, swelling of the leg and feet, dry skin or areas that are irritated. Check to see that the nails are well trimmed. Use a mirror to see the bottom of the feet. Look and feel carefully for possible injuries, for breaks in the skin, cuts, scratches, bruises, blisters, sores, and discolouration especially between the toes. Using Mirror

Inspect Your Feet Daily Learn to recognize the early signs of Infection Unusual warmth over the injured area Redness Swelling Pain (if you still have good sensation) Drainage of pus from an opening in the skin (If you find any of these immediately take Doctor’s advice or ask your Diabetes Care team) Blister on the foot Fungal infection between the toes

Keep your feet clean and dry Wash feet daily as you wash your hands, using soap and lukewarm water Dry feet carefully with a soft towel after bathing, especially between the toes where moisture can lead to a fungal infection Apply a moisturising cream to keep skin over the feet smooth and soft

Take Care of Your Toenails Helps avoid ingrown toenails, which lead to infection Trim and cut toenails with a nail cutter after a bath, when soft and pliable Cut your toenails straight across the top and not too far back on the sides Do not use a sharp instrument to clean under the nail, or in the grooves If your toe nails are too thick to cut, you can have them cut by the foot specialist in your Diabetes Care team

Protect Your Feet With Appropriate Footwear Many foot problems can be avoided if you are careful to protect your feet at all times Don’t walk barefoot even at home especially when there is loss of sensation Choose proper footwear of the correct shape and size Always shop for shoes in the evening when the feet are the largest Check the size of the shoes wearing the thickest socks Choose cotton or woolen socks Socks should be free of wrinkles and holes, elastic should not be tight

Proper Footwear Shoe should be comfortable and should fit well Never wear Shoes which are too short or too narrow Rounded toes give more space to the feet Always choose flat shoes with thick, sturdy soles to protect the feet from sharp objects

Proper Footwear Leather shoes let the foot breathe freely Do not wear chappals without back support especially when there is loss of sensation When buying a pair of shoe, take in to account any bunions or other irregularities. These will require wider and deeper shoe to avoid pressure points

Proper Footwear Take a paper cut of the foot shape Place the paper inside the shoe Paper must fit without folds Ill-fitting shoes

Pressure Sores or Ulcers It starts with a callus, which is a sign of continuous pressure or friction on a particular part of feet It is always advisable to treat the callus before an ulcer occurs. See your Doctor or Diabetes Care Team immediately If not treated properly, such ulcers can lead to serious foot problems like gangrene Gangrene often leads to the removal of a toe or foot (Amputation)

Feet At High Risk Red marks on the foot Inflammed toe Blister Black discoloration Early sign of gangrene Ulcer Cramped toes Ingrown toenails Red marks on the foot Inflammed toe Callus

Cuts and Injuries Keep the affected area or injury clean and apply a sterile bandage If you have decreased sensation in your feet, you have to be more careful to avoid injuries such as minor accidents, burns etc In absence of pain (alarm system), these minor injuries may become serious and can lead to amputation or removal of that part of the foot

Blisters and Cracks Never squeeze or puncture a blister Proper dressing and careful inspection is most important If the blisters appears to contain blood or becomes inflamed see your doctor or Diabetes care team Cracks are difficult to heal and infections occur easily Daily use of foot cream to soften the skin as well as a shock absorbing insole is recommended

Ingrown Nails Often caused by improper nail trimming or poorly fitted shoes The problem can be solved by correcting the footwear. Ask you Diabetes Care Team for assistance As with all foot problems, prevention is the best cure for ingrown nails

Corns and Calluses Usually Corns and calluses result from poorly fitted footwear that puts pressure on a certain area of the foot A deep ulcer or crack can result if the callus is left untreated Do not apply corn caps or self treat Consult your doctor or Diabetes Care Team for further treatment of corns and calluses

Foot At High Risk Callused skin Bunion Corn

Nerve Problems Lead to Foot Deformity Nerve damage in your feet may lead to loss of sensations and muscle weakness It affects the way you walk, and increases pressure on certain parts of the feet leading to fractures and bony deformities that occur without any apparent accident or reason It decreases your ability to sweat and impairs blood flow to your feet

Who Is at Risk of Foot Ulcers? Some People with Diabetes have a greater risk of developing foot ulcers than others The factors which may play a role are: Long standing poorly controlled diabetes Loss of sensation in the feet Poor blood circulation Bunions or other foot deformities Impaired Vision Smokers

Poor Vision Poor vision puts your feet at risk, because you may not be able to see the minor sores and other foot problems at the bottom of the feet Ask your diabetes care team for complete inspection of the feet Smoking Do not smoke as nicotine causes blood vessels to shrink and slows down the blood flow to the foot Impaired blood circulation can increase the foot problems

Examination of Your Feet Insist that your doctor examines your feet from time to time to Assess the general condition of your skin and nails Check for signs of poor circulation - Cold extremities, absent or weak pulsations Check for signs of decreased sensation Look for the deformities such as bunions Note any pressure points that lead to calluses Check for signs of infection, injury and ulcers Watch the way you walk and note any changes

Examination of Your Feet Insist that your doctor examines your feet from time to time to Test for the loss of protective sensation Check your ability to feel vibration Test light touch with a monofilament Check for impaired blood circulation Check for foot pulses Test toe blood pressure Perform an angiogram of arteries if needed

Blood Sugar Control Poor blood sugar control is a risk factor for the development of foot ulcers Good control can prevent the development and progression of nerve problems (loss of sensations) Good control ensures continued good blood supply Good control prevents minor injuries getting infected The better your blood sugar control, the better your body can take care for itself. Take Insulin, if advised

Conclusion Achieve good blood sugar control - save your feet. Take Insulin, if advised.

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