Your Feet

Not all people with diabetes will develop foot problems.

However, it is estimated that 10% of people with type 2 diabetes will have some nerve changes on diagnosis.

Reducing your risk of potential foot problems is the bottom line for all people with diabetes.

People with diabetes are more prone to infection, so even a tiny break in the skin – such as a blister or graze – can potentially lead to infection, gangrene and amputation.

 

Regardless of the type of diabetes you have, putting prevention into practice is an integral part of all diabetes self-care plans.

In my 15 years of practice in diabetes educator I have found that most people have no footcare plan – even after years of being diagnosed. Not knowing the things you can do each day to protect your feet puts you at risk.

Some examples of the things I have seen and heard:

JW: 54yr old, t2 diabetes, driver of heavy machinery – road building equipment / plant. Developed an ulcer where his foot was constantly in touch with the metal footrest in the vehicle. Did not take any action. Ulceration and lower leg amputation.

MC: 26yr old t1 diabetes, salesman. Cut foot at beach on rocks when surfing. Went stratight to local hospital. Antibiotics and stitches. Wound heal uneventfully.

TC: 62 yr old. History of heart disease. Smoker. Had a friend who had a foot ulcer for 4 years. Went walking on the beach in bare feet. Cut foot – infected. No treatment for 3 weeks. Foot ulcer. Healed 10 months later.

RF: active foot ulcer for 4 years. About to have surgery to foot for the 7^th time. Not amputated – yet.

AK: 23yr old t1 diabetes. At the end of a foot-care seminar said “so, I need to look after my feet like my wife looks after her face”

SE: 70 yr old man, t2 diabetes for 30 years. Checked his feet every day – sat on edge of bed and counted his toes. One day in the bathroom he heard a ‘tap tap tap’ on the bathroom floor. He had never looked at the bottom of his foot. Never. He had a drawing pin / thumb tack stuck in an infected wound. 6 months of hospitalisation before he finally had his leg amputated. Checking the bottom of his foot each day (as well as the top) would have saved his leg.

 

This foot care guide will help you identify some simple self-care strategies.

These strategies may help you prevent severe complications such as foot ulcer or leg amputation.

Diabetes has the potential to cause two problems that affect the health of your feet:

 

1. Loss of feeling (Peripheral Neuropathy) – this can happen if diabetes has damaged the nerves to your feet. Damaged nerves prevent pain and temperature sensations reaching your brain, therefore you may not be able to feel an injury to your foot when it occurs.

2. Poor blood flow (Peripheral Vascular Disease) – A reduction in blood flow to the feet will increase the risk of ulceration and amputation. Diabetes affects the elasticity of the blood vessels and can cause narrowing and blockage. This reduces the amount of blood that is supplied to the feet, meaning that there will be a delay in healing.

 

Smoking will damage your feet by reducing the blood supply.

I once saw a cardiologist present the following at a conference:

Diabetes + Smoking = Amputation

CHECK – EVERYDAY

• Your feet for any redness, swelling, blisters or cuts. If you have difficulty reaching your feet, use a mirror or have someone look at them for you.
• Before and after you wear your shoes, check them for objects that may have fallen into them. Objects such as small stones, gumnuts, twigs etc. Also, feel inside them for any material damage such as nails poking through the sole, rough or loose areas of material, which may injure your feet.
• In between your toes to make sure they are not wet.

 

WEAR

• Comfortable, well fitting enclosed shoes. They should fit well in the shop before you buy. Don’t depend on shoes stretching – they may not.
• Good supportive footwear, which has a firm heel counter, flexible in the forefoot, and firm throughout the mid-foot. The shoe should also have a fastening device such as a buckle, velcro or laces.
• With any new pair of shoes, wear the first time for no longer than 15 minutes. When you take them off after this time, check your feet for areas of redness or abrasion. If present return the shoe for a refund. If no redness or abrasion noticed, wear the shoes next time for up to 30 minutes, and check again. i.e. wear your new shoes in slowly.
• Clean socks or stockings every day. Socks without tight elastic or seams are best. Try socks made specifically for people with Diabetes.
• Bed socks or ugg boots if cold feet trouble you.

SELF FOOT CARE

DO’s:

• Wash and dry your feet thoroughly, especially between your toes, every day.
• Use a water-based cream such as sorbolene on your feet every day, but be sure not to apply cream between your toes.
• Cut toe nails straight across and gently file rough edges. Never cut nails shorter than the end of your toe and don’t cut down the sides of the nail as this may leave jagged edges.
• If you use a bath or foot spa check the water temperature with a bath thermometer. This will reduce your risk of causing a burn to your feet.

DON’T’S:

• Don’t Soak your feet for long periods
• Don’t use talcum powder on your feet
• Don’t use any product that hasn’t been recommended by your podiatrist on corns, calluses or warts.
• Don’t go bare-footed. The feet are at a greater risk of injury without shoes. Injury can lead to ulcers, infection, gangrene and possible amputation.
• Don’t wear shoes without socks.
• Don’t wear thongs or flip-flops or sandals.

WARNINGS

• If you use hot water bottles, electric blankets or heaters, you may burn yourself and NOT FEEL it happening.
• In winter do not put your feet near a fire or radiator. It is possible to burn your feet and NOT FEEL it happening.
• If you find a break in the skin (cut, scratch, broken blister etc), you must clean it and keep it covered with a sterile dressing and see your doctor or a podiatrist as soon as possible.

FIRST AID

• If you have a burn, cut, scratch, graze, broken blister, or any other area of broken skin, clean it and put a dry dressing on it to reduce the risk of getting it infected.
• If it doesn’t seem to be getting better, or is deteriorating, see your Podiatrist or Doctor as soon as possible.

Hospital Plan:

• Ask to see a podiatrist if you have a wound of any kind on your foot. My personal experience is having seen (on a number of occasions) a vascular surgeon with a plan to amputate a foot turn to the rescue of the same foot by the podiatrist.
• Ask your family to check your feet for any signs of redness or broken skin (just as would have done yourself at home) if you are incapable of doing this yourself.
• Ask your caring team (doctors and nurses) to refer you to the endocrine team if they have not done this. There is good evidence stating that your hospital recovery wil be less problematic if your BGL’s are well managed. Even for a few short days stay.
• If you are capable, measure your own BGL pre and 2 hours post meals. The nurses looking after you are well meaning caring beings; but they are usually overworked and not in a position to measure your BGL as efficiently as you could yourself. This information can be invaluable in helping your recovery.

 

In your experience of hospitals, what would you be suggesting to include in a hospital admission plan?

Here is a self assessment tool that you can complete to see how your fare at present. I shall publish the scoring sheet next week.

This tool – the Nottingham Assessment of Functional Footcare – was developed by the team in Nottingham. Myself and a colleague podiatrist used it for the first time worldwide in clinical practice. We found that education based on this tool enhances the foot care of all participants. I hope that it can be a helpful guide for you as well.

NAFF unscored

If you would like some individual assistance to further your diabetes self care plan, simply complete one of our eConsul forms.

Safe travels,

David – Diabetes Educator @ Diabetes Counselling Online