Feet 1st

Having diabetes means you’re more likely to experience problems with your feet. Take these simple steps to care for your tootsies and keep them healthy.

Risks

Diabetes can make it harder to feel—and heal—foot injuries. Cuts and calluses can become infected, potentially leading to ulcers, gangrene, and even amputation.

Two conditions associated with diabetes put your feet at risk. The first, poor circulation due to the hardening of arteries, may limit your body’s ability to heal itself, increasing the risk of infection when you get injured. The second, diabetic peripheral neuropathy, involves nerve damage caused by high blood sugar, resulting in a loss of feeling in the extremities.

According to the Canadian Diabetes Association (CDA), diabetic peripheral neuropathy can result in numbness or decreased pain perception in your feet. Someone with CDA may not feel a foot injury—even when it’s infected. Unnoticed and untreated, it’s easy to see how a small wound can turn into a much bigger problem.

Stay a step ahead

The first step in caring for your feet is to manage the diabetes itself—starting with your diet.

Eating whole grains, legumes, vegetables, and fruit—all high in fibre—can help keep your blood sugar in check. Foods containing chromium, including egg yolks, spinach, and wheat germ, may also reduce the amount of glucose in your bloodstream.

Exercise is also crucial. Regular physical activity improves the body’s sensitivity to insulin and aids in managing blood glucose levels. The CDA recommends 150 minutes a week of aerobic exercise.

Finally, don’t smoke. Smoking decreases circulation and healing, which significantly increases the risk of more serious complications.

Check your feet daily

Since diabetes can reduce your ability to feel an injury, it’s important to do daily surveillance on your feet. Make it part of your routine—as you dress for the day, at shower time, or when you get ready for bed. Soon it will become a healthy habit.

First, wash your feet with a mild soap such as castile soap, which is made from vegetable oils and is easy on the skin. Use lukewarm water, testing it first on your wrist to ensure it isn’t too hot. Pat your feet dry, carefully towelling between your toes.

Next, give each foot a once-over, making sure to check between your toes. If you have trouble seeing any part of your foot, ask a friend or family member for help, or use a flexible magnifying mirror to inspect hard-to-reach spots.

Look for areas of skin breakdown, infection, pus, or irritation. Wash any sore or irritation and the surrounding skin with soapy water, and apply a bandage. If you find a blister, never pop or break it, as it will increase your risk of infection. With any open sore, be sure to visit your health care practitioner.

Preventive care

Since diabetic peripheral neuropathy can affect the nerves that control how much you sweat, your feet may perspire less frequently, resulting in dry skin. Treatment should be aimed at restoring moisture to the feet.

Keep your feet reasonably moist to avoid skin breakdown, such as cracking. Cracks in the heels and soles can be an entry point for infection-causing germs and bacteria.

Avoid moisturizers containing alcohol, which may dry out your skin, or fragrance, which can increase sensitivity. Rather, apply a thin layer of unscented lotion to your feet. Wipe off any excess and avoid putting lotion between the toes, as excess moisture could lead to infections.

Treating troubled feet

About 15 percent of Canadian diabetics will develop a foot ulcer in their lifetime. As mentioned above, any sort of foot injury (including swelling, redness, or pain) should be looked at by a health care practitioner as soon as possible.

If an ulcer develops make sure to maintain healthy blood sugar levels and to clean the wound daily. Keep from walking on it as much as possible—as pressure on the wound will only exacerbate it. To minimize the pressure on a foot ulcer, wear shoes that are easy to adjust or that fit properly.

Once a foot ulcer heals, the new tissue will be sensitive and may break down easily, so take extra care of a newly healed wound. It may be necessary to wear special shoes to protect the area and prevent the problem from returning.

Expert advice

There are many ways to care for your feet, but certain symptoms warrant professional advice. Corns (thick or hard skin on the toes), calluses (thick skin on the soles of your feet), ingrown nails, and warts are best treated by a trained expert.

In addition to having your feet checked by a health care practitioner at least once a year, ask your health expert to screen you for neuropathy and loss of circulation annually.

Foot notes

Put your best foot forward with these diabetic dos and don’ts.

• Do wear well-fitting shoes that don’t rub or pinch your feet.
• Don’t wear heels more than 2 in (5 cm) high. Shoes that taper at the toe or expose any part of your foot (such as sandals) should also be avoided.
• Do wear shoes whenever you’re on your feet.
• Don’t walk around barefoot, not even indoors.
• Do wear socks at night if your feet get cold.
• Don’t place hot water bottles or heating pads on or at your feet, as they may cause burns.
• Do elevate your feet when you’re sitting. Wiggle your toes and rotate your ankles a few times each day to improve blood flow.
• Don’t cross your legs for long periods of time or wear tight socks or pants around your legs.
• Do ask your doctor if it’s safe to trim your own toenails; if it is, cut them straight across (never rounded) to help prevent ingrown nails, and then file them so they’re not sharp.
• Don’t have pedicures done by non-health care professionals.