For
most of us, the feet are merely a means of getting around and
require little attention. In a diabetic, however, the feet must
be carefully observed and cared for. For several reasons, diabetes
is by far the leading cause of non-traumatic lower limb amputation,
responsible for over 6o percent of cases.
Put
another way, people with diabetes are roughly twenty times more
likely to develop gangrene of the foot than the general population.
The following article discusses proper care of the feet in people
with diabetes, so that these dreaded complications can be avoided.
How
does diabetes cause foot problems?
First,
it is important to understand that diabetes causes multiple
complications in the feet that contribute to an increased likelihood
of infection and poor healing. Peripheral nerves can be damaged,
arteries can become clogged and the blood cells that fight infection
are less effective because of diabetes.
It
is even more important to understand that these "side-effects"
of diabetes can be minimized or even avoided completely by strict
control of the blood sugar. Diabetic foot care starts with controlling
your diabetes itself.
Specific
foot care recommendations are based on years of collective physician
experience and scientific studies which have shown a proven
benefit. It has been shown that people who are taught the basics
of proper foot care have a greater than three times better chance
of avoiding limb amputation than those who are not educated.
|
Diabetic
Neuropathy
|
| Diabetic
neuropathy is a complication of diabetes that affects
the nerves. |
| Peripheral
Vascular Disease |
| Peripheral
vascular disease is a type of atherosclerosis, a hardening
and narrowing of the arteries that supply blood to
the arms and legs. |
|
Whos
at risk?
Risk
stratification helps us understand who is at the highest risk
for foot complications. If you have "diabetic
neuropathy" or "peripheral
vascular disease," your
risk is much higher than a person with diabetes without these
complications.
Those
with diabetic neuropathy have an alteration in their nerves
that supply the feet. This can cause numbness in the feet so
that pain is not felt. This is an ominous sign in diabetics
and means that vigorous foot surveillance is required by both
patient and doctor indefinitely.
Peripheral
vascular disease (atherosclerosis of the blood vessels of the
limbs) is a big risk factor for progression of early lesions,
as poor blood flow delays and can even prevent healing. Smoking
should be discontinued and hypertension and high cholesterol
should be controlled to avoid these additional risk factors
for clogging of the arteries.
What
can be done to prevent foot problems?
Hygiene
and inspection are the keys to avoidance and early recognition.
The feet should be washed daily with a mild soap and lukewarm
water. After washing, the feet should be dried thoroughly with
a clean towel, including the spaces between the toes. Pressure
should be used instead of rubbing, which may break delicate
skin.
After
drying, the feet should be inspected thoroughly, using a mirror
to inspect difficult to see areas of the feet. After drying,
it is recommended that lubrication be applied to the feet using
a non-greasy lotion or cream to avoid cracking of the skin.
|
Type
1 Diabetes Mellitus
|
|
Type
1 diabetes is a disorder that occurs when your body
produces little or no insulin.
Click
here to
Learn
More...
|
| Type
2 Diabetes Mellitus |
|
When
you have type 2 diabetes, your body does not make
enough insulin and/or is unable to use insulin properly.
This problem with insulin affects the way your body
uses food.
Click
here to
Learn
More...
|
|
Toenails
should also be well maintained. They should be cut straight
across or filed with an emery board and should be cut no shorter
than the underlying skin of the toe. Do not cut the corners
of the toenails. If the toenails become deformed, a podiatrist
or physician should trim them.
Other
preventative measures are also important. People with diabetes
should never walk barefooted, even when indoors. This prevents
simple injuries such as stubbing of the toe or a puncture wound.
Do
not apply hot water bottles, heating pads, or ice packs to the
feet, as temperature sensation is often impaired and burns or
other thermal injury may occur. Wear low-heeled, properly fitting
shoes, preferably made of soft leather. Break in new shoes slowly
over several weeks to avoid callous formation. Lastly, have
your feet inspected at least once a year by your doctor.
When
minor skin conditions do occur, such as athletes foot, fungal
infections of the toenails, cuts, calluses, corns, blisters
or slivers, these should prompt a visit to a health care professional.
Once you are shown how to take care of these conditions, you
may be able to do it on your own, but immediate attention for
these conditions is required.
While some of these recommendations may seem a bit much, it
is important to remember that the large majority of severe diabetic
foot infections start with a minor skin irritation, such as
a blister or sliver. By using some basic foot care principles
and keeping tight control over your diabetes, infection and
its consequences (including amputation) can usually be avoided.
So take a few extra minutes a day and get to know your feet!
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