Diabetic Foot

People who have diabetes are more prone to developing foot problems than others.

• The longer a person has had diabetes, the greater the delay in even simple healing and the susceptibility to INFECTION.
  
  
• Persons with diabetes must learn to take special notice of even the most minor injuries.  Even the most trivial injuries to the skin of the feet may result in infections that may have serious consequences.
  
  

The two main causes of these foot problems in diabetics are:

NEUROPATHY (numbness) and ANGIOPATHY (poor circulation)

• NEUROPATHY - is the loss or lessening of feeling in the feet.  It may begin as an annoying tingling, itching, burning, hot or cold sensations.  Eventually, it progresses to numbness or a lack of sensation.  The numbness is dramatically more dangerous to the diabetic, because injuries can occur and progress without the diabetic being aware of the injury.
  
  
• ANGIOPATHY - is the decrease in circulation to the legs caused by narrowing, hardening, and other changes of the blood vessels.  It happens in all individuals eventually, as a normal result of aging, but in diabetics it happens far more severely and much earlier in life.  Blood carries nourishment and infection fighting cells to the body.  When circulation is diminished, so is the ability to repair injured areas and fight infection.
  
  

When small infections are not constantly cleaned up by the body's blood borne defense system, they quickly grow and can take over a limb, if nothing is done.

Both NEUROPATHY (numbness) and ANGIOPATHY (poor circulation) become more advanced the further down the legs you go.  The toes are affected the most.  Here are some examples of injuries that can occur and become serious problems if not cared for quickly.

• Cracks between the toes from minor athlete's foot infections can quickly lead to major infections.
  
  
• Injuries from stepping on small objects while walking.
  
  
• Burn on the bottom of the foot from walking on hot sand or pavement.
  
  

The most important step to take to prevent diabetic foot problems is a daily foot exam.  Besides taking all the other precautions we will mention, it is imperative that the feet be examined daily.  If neuropathy is present, the diabetic will not feel the early injuries that we know can quickly lead to serious problems.  The following is a list of wise precautions.

1. DO A DAILY FOOT EXAM, CAREFULLY.  Since those with neuropathy cannot feel injuries that have occurred, the feet must be examined with the eyes, for signs of cuts, bruises, peeling and red areas, especially between the toes.  Look for redness or other discoloration swelling, discharge, foul odor, each of which can indicate infection.
   
   
2. BATHE FEET DAILY IN LUKE-WARM WATER WITH MILD SOAP.  This should get to be a ritual and is best done at the beginning or end of the day.  It is convenient to combine bathing with the daily foot exam.
   
   
3. SELECT SHOES CAREFULLY.  To avoid injuries to the feet take the following wise precautions.  The feet must be protected, due to their vulnerability to injury.  Selecting shoes that fit properly is extremely important.  Shoes should surround the foot with soft compliant material.  They should be firm enough to protect the feet, but not pinch or constrict.  Most patients with diabetes do not require specially made shoes, although if particular problems develop, they may be recommended by the doctor.  Before putting a pair of shoes on, they should be shaken out to remove any stones or objects which may be in them, and inspect for an irregularities in the inside surface.  New shoes should be broke in slowly and carefully.
   
   
4. DO NOT SMOKE.  Nicotine decrease circulation to the feet significantly.
   
   
5. APPLY A MOISTURIZING CREAM TO THE FEET AND LEGS DAILY.  Diabetics may lose the ability to perspire on the feet and legs.  They may, therefore, need to supplement the skin's natural moisture with cream or lotion.  This helps prevent eventual cracking of the skin and resultant infections.
   
   
6. WALK AS MUCH AS POSSIBLE.  Walking is excellent exercise and actually improves blood flow to the feet by maintaining the width of existing large vessels and widening the small vessels to support the larger ones.  The key instruction here is walk to tolerance.  Walk until you feel tired, rest awhile, then walk again.
   
   
7. TOE NAILS SHOULD BE TRIMMED STRAIGHT ACROSS and to a length which prevents protruding edges from cutting into adjacent toes.  Never probe under the nail or cuticle.
   
   
8. DON'T IGNORE THE MUNDANE.  Corns and calluses are localized areas of skin thickening that form as a result of friction and pressure applied to the skin over a long period of time, usually from shoes or the ground.  They are a sign of abnormal stress on the skin and may lead to skin breakdown if left untreated.  Consult your Podiatrist for ways to reduce the stress on the area.
   
   
9. SEE YOUR PODIATRIST promptly, if you notice any violet skin discolorations, cuts, cracks, sores, peeling skin, or drainage.
   
   

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