Don't Get Knocked Off Your Feet

August 05, 2014

Foot and lower limb problems are frequent complications of diabetes. In fact, poor circulation and/or infection in these extremities can lead to amputations. The American Diabetes Association has a slogan, “Stop Diabetes from Knocking You Off Your Feet.”  To avoid foot problems that can lead to medical complications or even amputations, daily foot care should be part of your self-care routine and foot exams by a health care provider should be part of your ongoing health care.

Why is the foot so critical to diabetic care? Over time, people with diabetes can lose sensitivity in their feet. This loss of sensitivity makes it difficult to detect an injury (like a cut, blister or sore) on the foot. Uncared for, this injury can become infected and spread throughout the limb. Something as simple as pressure on the bony parts of feet that are insensitive can lead to sores called “ulcers.”

The feet become insensitive as a result of diabetic neuropathies (nerve damage) which people with diabetes can develop over time. It is not fully understood as to how the disease impacts the nerves to cause the damage, but it is known that a majority of people with diabetes have some form of neuropathy. These nerve problems can develop in every organ system, but are most common in the hands, arms, feet and legs. Symptoms of nerve damage can range from no symptoms to pain, tingling, numbness or loss of feeling in the affected body part. A health care provider can test the sensitivity of your feet using a variety of methods.  

There are some basic steps for foot care. The “Foot Care For a Lifetime” booklet (http://www.diabetes.org/assets/pdfs/community/foot_care_for_a_lifetime.pdf) developed by the US Department of Health and Human Services , Health Resources and Services Administration (HRSA) is an excellent resource for comprehensive care of the feet and should be part of the diabetic’s library. It highlights several areas: Daily foot care; Nail care tips; Socks and shoes; and foot care warnings. 

It is important to keep your feet clean. It is also important to use caution when cutting your nails. You should never use knives, scissors or razor blades to trim toenails or calluses. Medicare patients can have their toenails clipped by a podiatrist a few times a year. Other insurances may cover the cost of a podiatrist visit as well.

The shoes and socks you wear can make a huge difference in your foot health, especially if your feet are insensitive or beginning to lose sensation. Socks can be protective if worn correctly by providing a protective barrier between your skin and your shoe. They should not be too big or wrinkled to avoid extra pressure on the foot. The type of shoes you wear when you have diabetes is important. The National Library of Medicine, a Division of the National Institutes of Health (NLM.NIH) suggests: Wear shoes made out of canvas, leather, or suede. Do not wear shoes made out of plastic, or other material that does not breathe. Wear shoes you can adjust easily. They should have laces, Velcro, or buckles. Wear shoes that fit properly and have plenty of room in them. You may need a special shoe made to fit your foot. Do not wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals. The Footcare For a Lifetime booklet suggests that you never go barefoot, not even in the shower or bath. It explains that walking barefoot puts excessive pressure on the bottom of the foot and can cause an ulcer.

The question has been raised: should diabetics get pedicures? A review of literature on this question results in conflicting answers. Most medical professionals believe that diabetics should not get pedicures. However, they also recognize that people are going to get pedicures despite their recommendation. Therefore, several resources suggest ways to decrease your chance of infection if you are intent on getting a pedicure. Use good judgment about the facility you are using. Does it look clean? Connecticut has an inspection program for nail salons. Look for a certificate of compliance. Another thing you can do is to bring your own tools with you. Check the foot basin. Does it look clean? Is it cleaned between clients? How is the water temperature? You don’t want it to hot if your feet have lost sensitivity. This can lead to burns or blisters. Do not use a foot basin if you have an open sore or ulcer on your foot. This is an invitation for bacteria to enter. Let the nail technician know that you are diabetic.

Visit the Centers for Disease Control (www.cdc.gov/diabetes) or The American Diabetes Association (www.diabetes.org) websites for great information on living with diabetes. If you do not have internet access and are a resident of Quinnipiack Valley Health District member towns (Bethany, Hamden, North Haven and Woodbridge) you can call QVHD, 203 248-4528 for a copy of the Foot Care Book and other materials or request by email, dculligan@qvhd.org