Diabetes

Why is footcare important in diabetes?

  • Diabetes damages the nerves (damage can occur to the foot andnot be detected) - this is called peripheral neuropathy.
  • Diabetes also affects the circulation. Poor circulation can affect the ability of the body to heal when damage occurs.
  • Those with diabetes are more prone to infection - the body's processes that normally fight infection respond slower and often have trouble getting to infection due to the poor circulation.
  • Diabetes can also affect the joints, making them stiffer.
  • Other diabetic complications that can also affect the foot, for example, kidney disease (aspects proteins that are involved in wound healing) and eye disease (can't see the foot to check for damage).

As a consequence of those factors, what are some things that can go wrong?

  • The foot may get damaged and you do not know about (e.g., your shoe rubs a sore onto a toe that gets infected - you can not feel it because of the peripheral neuropathy - you can not heal very well due to the infection and poor circulation.)
  • Foot ulcers are common - this is when you have a breakdown of the skin barrier, allowing bacteria to now invade into sub dermal sterile tissue.
  • Ulcers are caused by too much pressure on an area and the skin just 'breaks down.'
  • This can occur under corns and callus.
  • Prolonged foot ulceration/s may lead to foot/leg amputation, which is why it is imperative that pressure is removed from the area and good wound dressings are used.

If you have diabetes, there are a lot of things you need to do to prevent problems from developing on your feet:

  1. Wash your feet daily (use a mild soap and lukewarm water). Dry very carefully, especially between the toes. Always use a cream such as Gehwal Med Salve or dermal therapy that is diabetic foot - friendly to mosturize the feet. Never use it between the toes.
  2. Inspect your feet daily (check for sores, cuts, bruises, changes to toenails, use a mirror to look under the foot if you can not see it)
  3. Look after your health (loose weight, stop smoking, exercise, reduce your alcohol consumption)
  4. Look after your feet
    • Cut toenails straight across and never cut into the corners and use an emery board to file down the sharp corners.
    • Do not ever attempt to remove corns or callus yourself - see a Chiropodist at the Proactive Centre for this NEVER use commercial corn cures - this isvery important in those with diabetes as it is very easy to damage the skin (i.e. ulcers)
    • Avoid going barefoot, even in your own home (this lessens the chance of some accidental damage)
  5. Fitting of footwear is very important. Poorly fitted shoes are a common cause of problems in the feet of diabetics. Some advice:
    • Get your feet measured each time you buy new shoes (foot size and shape change over time)
    • Make sure the shoe !tter is experienced
    • New shoes should be comfortable when purchased and should not need a 'break-in' period
    • They should fit both in length and width of the foot, withplenty of room for the toes
    • Avoid shoes with high heels, pointed or tight around the toes (these put too much pressure on parts of the foot and can contribute to ulcers)
  6. See a Chiropodist at least annually.

Chiropodists have an extremely important role to play in the prevention and management of the complications involving the diabetic foot. All those who are at risk for a problem should have the risk status assessed at least annually (or more if the risk is greater).

A Chiropodist should communicate this risk status to members of the health care team. Advice should be given on how to reduce the chance of damage happening, what to do to prevent it and what to do if something does go wrong.Regular foot care from a Chiropodist is a key way to prevent problems from developing in those who are at risk.

When something does go wrong, see a Chiropodist immediately. Waiting 'a few days to see what happens' before seeing someone maybe the difference between a good and poor outcome. The sooner treatment starts the better.

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