For happy feet and toes, take these foot care steps
You may have heard that diabetes can lead to foot problems. It can be tempting to ignore your feet, especially if they’re feeling OK. But when your feet are OK is exactly the right time to head off problems.
Diabetes can be hard on the feet over time because high blood glucose levels may lead to neuropathy, or nerve damage. Nerve damage can make your feet numb. So you may not feel a small cut or a tight-fitting shoe that can lead to calluses, blisters, or other wounds. Such wounds can get infected and be slow to heal, especially if you have high blood sugar levels and poor blood flow in your feet and legs (peripheral artery disease or PAD).
But My Feet Are Fine!
A few steps will help keep your feet feeling their best:
1. Check your feet every day.
Look for calluses, blisters, scaling (dry skin), cracks in the skin (especially between toes and on your heels), redness, and swelling. If you can’t turn your leg to see the bottom of your foot, Allen Raphael, DPM, a wound-care specialist with Village Podiatry Centers in Georgia, suggests putting a mirror on the floor and holding your foot above it to check the bottom for trouble spots.
You can avoid dry skin and cracking by using a thick moisturizer on your feet. Rub it in well, but don’t put it between your toes—those dark, moist areas are great hosts for infection.
3. Wear shoes that fit your feet and don’t go barefoot.
You want a snug but not tight shoe fit, with room to wiggle your toes in the shoe. For hard-to-fit feet or if you already have foot problems, you may need a therapeutic shoe (“Who Needs Therapeutic Shoes?” below).
4. Show your feet to your health care provider at every office visit.
The American Diabetes Association recommends a comprehensive foot exam at least annually for people with diabetes. The American Podiatric Medical Association estimates that from 45 to 85 percent of diabetes-related foot wounds can be prevented with podiatric care. Other specialists suggest visiting a podiatrist every 90 days (three months), if you are prone to foot issues or need help clipping your toenails.
With these conditions, your feet deserve even closer attention:
5. Foot deformities, such as hammer toes, overlapping toes, and bunions, can put you at a greater risk for developing calluses and ulcers (open wounds).
Pay extra attention to foot care if you have any of these issues.
6. Wearing shoes that rub or pinch makes it more likely for a blister or wound to form.
7. Neuropathy can result in both pain and loss of sensation in your feet.
When you can’t feel pain, you won’t feel a wound forming (that’s why daily checks are so important!).
8. Poor circulation means you won’t get enough blood flow to heal wounds, so it will take longer to get well.
Some signs of poor circulation include weak pulses in your feet or legs, shiny and hairless skin, and discolored skin.
9. High blood glucose levels can lead to slow-healing foot wounds and slow the body’s ability to fight infection.
“It’s much more easy for those infections to become powerful and spread quickly, because the sugar in the blood is literally a food source for the bacteria in infections,” Raphael says.
When You Have a Wound
Don’t risk your health. Get treatment for foot wounds as soon as possible:
10. Get help for open wounds.
Visit a podiatrist, a doctor specializing in foot care, if you have an open cut, blister, or sore on your foot that isn’t healing. Do not try to treat yourself with over-the-counter antibiotic ointments. Experts consider a wound that won’t heal to be a problem that needs aggressive treatment. “The longer things go, the more chance people have of losing a toe or losing a foot,” says Michele Kurlanski, DPM, a wound-care specialist at Lighthouse Foot and Ankle Center in Portland, Maine, who is certified by the American Academy of Wound Management. She says her patients may try “self-inflicted bathroom surgery” that makes problems such as blisters, corns, and calluses even worse. Leave the treatment to professionals.
11. Follow treatment instructions.
When you do go to a podiatrist or other specialist for wound care, staff members might take an X-ray of your foot to see how far an infection has spread. They’ll clean the wound and cut away any dead tissue. They’ll most likely take a tissue culture, and the doctor may suggest you use a walking boot or crutches to keep your weight off the foot as it tries to heal. You’ll probably visit your podiatrist weekly during the healing process.
12. Try to hit your blood glucose targets.
Your podiatrist will also ask about your diabetes management. “You treat a wound, but the wound’s attached to a patient, and that patient might have risk factors that are contributing to that wound,” Raphael says. Your podiatrist might team up with your diabetes educator, endocrinologist, primary care provider, or others to help you manage your diabetes.
13. Be prepared for intensive treatment.
If you haven’t healed in four weeks, your doctor may want to hospitalize you for more intensive treatment, including tissue grafts, in which healthy tissue is removed from other parts of your body and attached to your foot to promote healing.
Who Needs Therapeutic Shoes?
Not everyone with diabetes needs special shoes, but Medicare will cover the cost of one pair of therapeutic shoes per year for patients with one or more of the following: a previous amputation or partial amputation; poor circulation; numbness of the feet; or feet with a callus, previous ulceration, or foot deformity. Many insurance companies will cover the cost of a pair of therapeutic shoes for those who qualify, too—check with your plan to see if you can receive these benefits.