Foot problems are a well-known risk associated with diabetes. The primary reason is the stark reality of how serious these problems can become. Diabetes is the number one cause of lower limb amputations in the United States, with over half of amputations performed caused by the disease.
The disease can cause reduced blood flow to the feet, depriving them of oxygen and nutrients. This makes it more difficult for blisters, sores, and cuts to heal. Diabetic nerve damage called peripheral neuropathy can cause numbness in your feet. “When you can't feel cuts and blisters, you're more likely to get sores and infections,” explains Tyson Green, DPM, foot and ankle specialist with the Center for Orthopaedics. “If you don't notice or treat these sores, they can become deeply infected. This is what typically leads lead to amputation. Unfortunately, having a toe, foot, or lower leg surgically removed is 10 times more likely in people with diabetes.”
As frightening as this sounds, Dr,. Green stresses that serious foot problems are not an inevitable part of having diabetes. “It is estimated that at least half of the amputations related to diabetes that take place each year could be prevented through proper care of the feet. The key is learning about the risks for foot problems making sure you do everything you need to do to prevent these potential complications.”
Fortunately, an ounce of preventive care is an investment well made when it comes to diabetic foot care. Dr. Green offers the following tips for putting your feet first:
Check feet daily.
Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Dr. Green says checking every day is even more important if you have nerve damage or poor blood flow. “Look over both feet carefully every day, and be sure you check between all of your toes because blisters and infections can start between there, and if you have diabetic neuropathy, you may not feel them until they've become irritated or infected.”
Wash with warm water.
Wash both of your feet briefly each day with warm water. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet, and dry your feet well, especially between your toes.
Make sure your shoes fit well.
If you have diabetes, good shoes are an investment worth making. “Even the slightest tightness or rubbing in the wrong place can cause a blister that could turn into a sore that won’t heal,” says Dr. Green. “Shop for shoes at the end of the day when your feet are bigger, and before buying or putting on shoes, check inside for rough edges or other irregularities that could hurt your feet. Also, when you get new shoes, break them in gradually by wearing them for short periods of time – an hour or two a day.”
No bare feet.
Always wear shoes or slippers, and always wear socks with your shoes. “Direct contact with leather, plastics, and manmade shoe materials can irritate your skin and quickly bring on blisters,” says Dr. Green. “And although you might prefer the look of hose or thin socks, these don't give your toes or heels enough protection.”
Stay soft - but dry.
High glucose levels can cause dry and cracked skin. Dr. Green says this means double trouble for the feet. “It makes it easier for bacteria to get under the skin, and harder for infections to heal.” He advises using a small amount of skin lotion daily, but be sure to rub it in well. “You want your feet to be dry, not damp or sticky, and you don’t want to get lotion in between your toes.”
Practice foot maintenance.
File corns and calluses gently with an emery board or pumice stone after your bath or shower, when skin is softer. Keep your toenails trimmed and filed smooth to avoid ingrown toenails. It is best to cut them to the shape of the toe and not too short, according to Dr. Green, and then to file the edges with an emery board.
If you have bunions (the big toe slants sharply in toward your other toes, with a big bump on the knuckle of your big toe), corns (spots of thick, rough skin on the toes), or hammertoes ( buckled-under toe), these problems need to be addressed with a foot specialist. Dr. Green says all of these problems make it difficult for shoes to fit properly, which can lead to blisters and other problems.
Dr. Green says the underlying message of all these recommendations is to be extra vigilant about your feet if you have diabetes. “This will not only help you prevent problems, but also help you notice any changes at an earlier, more treatable stage.” He adds that it is also important to talk to your doctor if you have any concerns, regardless of how minor it may seem. “Tell them about any changes in sensation in your toes, feet, or legs. Don’t worry that it seems too trivial. It’s far better to be overly cautious than to ignore a symptom that could be a sign of a serious problem. Your feet are your foundation for mobility and independence, and your doctor can only help you maintain this foundation for life if you keep him or her informed.”