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Diabetes and Feet Problems by Shu Golda.
Diabetic foot problems are among the most common and most serious complications of diabetes mellitus. It affects about 6% of diabetes patients and about 50% of older patients with type 2 diabetes are at risk of developing foot problems (1). They are a major source of pain and financial burden to patients. These foot problems include; Infection, ulceration, and destruction of foot tissue. Diabetics can reduce their chances of getting foot problems by controlling blood glucose to target levels and taking proper care of their feet daily.

How can diabetes affect my feet?

Prolonged hyperglycemia can lead to diabetic neuropathy or nerve damage. This can cause loss of sensation, tingling, and pain in your feet. In patients with nerve damage, minor trauma such as pressure from ill-fitting shoes, acute injury, and walking barefoot, can cause foot ulcers (2). Also, this loss of sensation and foot deformities causes high pressure in some parts of the foot. The body responds to this by forming callus (thickened skin). This abnormal loading can eventually result in ulcers. Ulcers or sores may become infected over time.

Peripheral artery disease (PAD) is one of the causes of diabetic foot problems (3). It results from accelerated atherosclerosis in diabetics and an eventually lower amount of blood flow to the feet. Inadequate blood flow to the feet causes slow wound healing, and sometimes the wounds never heal. An infection that never heals might end up being gangrene. PAD is a prominent risk factor for amputation.

Foot ulcers and gangrenes which do not heal or become seriously infected can lead to amputations of your toe, foot, or an entire leg. These amputations are performed to prevent the spread of infection to other parts of the body (3).

In rare cases, diabetic neuropathy can cause changes in foot shape such as Charcot’s foot. Charcot’s foot usually begins with warmth, redness, and swelling of the foot. Bones in toes and feet may later break or shift, giving your feet an odd shape.

Identification of the at-risk foot.

The examination of feet is an integral part of diabetes routine checks. Doctors should endeavor not to rely only on symptoms alone to identify patients at risk because most patients do not show symptoms of either neuropathy or ischaemia (4). Patients at risk of diabetic ulcers include;

  • Confirmed ischaemia (no blood flow to the feet)
  • Confirmed neuropathy
  • Impaired vision (patients with poor vision can incur injuries when trying to take care of themselves. Also, nephropathy is predominant in patients with retinopathy and kidney disease)
  • Presence of callus or thickened skin
  • Patients with a history of foot ulcers
  • Foot deformity

Preventing Nerve Damage.

Keeping blood sugar at target levels is the most important thing you can do to prevent nephropathy (5). Other preventive measures include:

  • Having a healthy diet plan which involves eating more fruits, vegetables, and less refined carbs, fats, and salt
  • Being physically active
  • Avoid smoking as it reduces blood flow to the feet
  • Take your diabetes medications as prescribed

Risk factors for nerve damage?

All diabetes patients are generally at risk of developing nephropathy. However, prominent risk factors include:

  • Prolonged diabetes
  • Persistent blood sugar spikes, which are difficult to be regulated
  • High blood pressure
  • High blood cholesterol
  • Overweight
  • Over 40 years of age

Nephropathy and ischaemia put the patient at risk of getting diabetic foot ulcers. If not well managed, the ulcer can get infected and not heal. Infected ulcers usually lead to amputation if they don’t get better.

What can I do to keep my feet healthy?

Making a diabetes self-care plan for diabetes management will prevent complications of diabetes, including foot problems. Foot care should be a major inclusion in your diabetes management plan.

The steps below if properly followed, will help keep your feet healthy.

Check your feet every day.

Examine your feet daily to identify any risk of ulcers. Checking your feet often will help you identify any abnormalities. Pay attention to cuts, swellings, sores, redness, callus, and blisters. In case you have any challenges with seeing the bottom of your feet, you can use a mirror or ask someone to help you.

Never go barefoot. 

Ensure you wear shoes and socks at all times. Never go barefoot or walk with just socks. Moving barefoot can hurt your feet, which may later lead to an infection. Also, check for any objects inside your shoes before putting them on to avoid injury. When buying shoes, ensure they are soft enough for your feet and toes to prevent blisters.

Wash your feet every day.

Wash your feet daily in warm water. After washing, completely dry and apply lotion. Do not apply lotion in between your toes, instead apply talcum powder to keep them dry. Also, don’t soak your feet in water for long before washing.

Trim your toenails straight across.

When necessary, use toenail clippers to trim your toenails across not inwards, and gently smoothen them with a non-sharp nail file. Also, avoid cutting the corners of your toenails. Trimming across prevents you from cutting your skin

Don’t remove corns or calluses yourself.

If you have calluses, seek your doctor’s advice on how to take care of them, do not remove them by yourself. Corns or calluses if not properly taken care of can lead to ulcers if you have damaged nerves.

Get your feet checked at every health care visit.

Do a thorough footy examination at least once a year and more often if you have nephropathy. The examination should include checking of pulses or blood flow and feeling in your feet. Also, see your doctor if you experience any of the following:

  • Loss of feeling in feet
  • Change in foot shape
  • History of ulcers or amputations
  • Peripheral artery disease

Your doctor should teach you how to take off your feet routinely

Keep the blood flowing. 

Try to put your feet up on a flat surface when sitting. Also, wiggle your toes several times during the day. Staying physically active will increase blood flow to your feet as well. Smoking reduces the amount of blood that flows to your feet, try to quit smoking especially if you are diabetic.

Wear shoes that fit well.

When buying ensure they are not too tight or too loose. Comfortable shoes will reduce the risk of foot injuries. Always wear your shoes with socks to reduce pressure.

Protect your feet from hot and cold.

When you have diabetic nephropathy, you can step on a hot or object and not feel it. To protect your feet from heat, stay away from hot objects or fires. Also, use sunscreen to prevent sunburns and wears shoes on hot pavements.

In extremely cold weather, wear socks and lined waterproof boots to ensure feet are warm and dry.

When to See Your Doctor

See your doctor urgently if you experience any of the following symptoms:

  • A blister, cut, or bruise that does not begin to recover in a few days

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  • Burning, tingling, or foot pain
  • Any changes in the shape of your foot
  • A wound that becomes black or smelly
  • Foot skin becomes red and painful
  • Loss of feeling on the foot
  • Athlete’s foot between your toes
  • Toes, feet, or legs begin to lose hair
  • Thickened yellow nail

Foot problems are one of the most prevalent and serious complications of diabetes mellitus. However, proper care of feet at home and regular visits to the doctor can prevent the occurrence of these foot problems, or prevent the problems from becoming more complications. Most importantly, maintaining blood sugar are target levels can prevent complications of diabetes mellitus, including foot problems.

Reference.

2. American Diabetes Association. Microvascular complications and foot care. Diabetes Care. 2016;39(Suppl. 1):S78.