Common Disorders

Tips for the Diabetic Patient

Ulcerations, infections and gangrene are the most common foot and ankle problems that the patient with diabetes must face. As a result, thousands of diabetic patients require amputations each year. Foot infections are the most common reason for hospitalization of diabetic patients. Ulcerations of the feet may take months or even years to heal. It takes 20 times more energy to heal a wound than to maintain a healthy foot.

There are two major causes of foot problems in diabetes:

1. Nerve Damage (neuropathy): This causes loss of feeling in the foot, which normally protects the foot from injury. The protective sensations of sharp/dull, hot /cold, pressure and vibration become altered or lost completely. Furthermore, nerve damage causes toe deformities, collapse of the arch, and dry skin. These problems may result in foot ulcers and infections, which may progress rapidly to gangrene and amputation. However, daily foot care and regular visits to the podiatrist can prevent ulcerations and infections.
   
   
2. Loss of circulation (angiopathy): Poor circulation may be difficult to treat. If circulation is poor, gangrene and amputation may be unavoidable. Cigarette smoking should be avoided. Smoking can significantly reduce the circulation to the feet significantly. There are certain medications available for improving circulation (Trental) and by-pass surgery may be necessary to improve circulation to the feet. Chelation therapy is an alternative form of treatment for circulatory problems that is not well recognized by the medical community at large. Daily foot care and regular visits to the podiatrist can often prevent or delay the need for amputation.

Do the Following to Protect Your Feet

1. Examine Your Feet Daily

• Use your eyes and hands, or have a family member help.
• Check between your toes.
• Use a mirror to observe the bottom of your feet.
• Look for these Danger Signs:
  
           Swelling (especially new, increased or involving one foot)
           Redness (may be a sign of a pressure sore or infection)
           Blisters (may be a sign of rubbing or pressure sore)
           Cuts or Scratches or Bleeding (may become infected)
           Nail Problems (may rub on skin, cause ulceration or become infected)
           Maceration, Drainage (between toes)
  

  If you observe any of these danger signs, call your podiatrist at once.

2. Examine Your Shoes Daily

• Check the insides of your shoes, using your hands, for:
  
           Irregularities (rough areas, seams)
           Foreign Objects (stones, tacks)

3. Daily Washing and Foot Care

• Wash your feet daily.
• Avoid water that is too hot or too cold. Use lukewarm water.
• Dry off the feet after washing, especially between the toes.
• If your skin is dry, use a small amount of lubricant on the skin.
• Use lambs wool (not cotton) between the toes to keep these areas dry.

4. Fitting Shoes and Socks

• Make sure that the shoes and socks are not too tight
• The toe box of the shoe should have extra room and be made of a soft upper material that can "breathe"
• New shoes should be removed after 5-10 minutes to check for redness, which could be a sign of too much pressure: if there is redness, do not wear the shoe. If there is no redness, check again after each half hour during the first day of use.
• Rotate your shoes
• Ask your podiatrist about therapeutic (prescription) footwear, which is a covered benefit for diabetic patients in many insurance plans.
• Tell your shoe salesman that you have diabetes.

5. Medical Care

• See your podiatrist on a regular basis
• Ask your primary care doctor to check your feet on every visit.
• Call your doctor if you observe any of the above danger signs.

  Do Not Do These Dangerous Acts

  • Do Not Walk Barefoot - Sharp objects or rough surfaces can cause cuts, blisters, and other injuries.
  • Do Not Use Heat on the Feet - Heat can cause a serious burn, especially if the patient has neuropathy.
  • Do Not Apply a Heating Pad to the Feet
  • Do Not Soak Your Feet in Hot Water
  • Do Not Use Chemicals or Sharp Instruments to Trim Calluses - This could cause cuts and blisters that may become infected.
  • Do Not Cut Nails into the Corners - cut nails straight across.
  • Do Not Smoke - smoking reduces the circulation to your feet.