1. Diabetes and FootCare

2. 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.

3. Diabetes
“Mild Disease”
Serious consequences

4. 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

5. 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

6. 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

7. 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)

8. 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)

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

17. 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)

18. 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

19. 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

20. 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

21. 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

22. 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

23. Foot At High Risk
Callused skin
Bunion
Corn

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

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

31. Outro