Cheryl loved to walk barefoot–in the grass, on wet sand, across the kitchen floor. When she was diagnosed with diabetes, her doctor told her that barefoot walking was not advised.
Diabetes brings on the risk of several severe complications, including heart disease, vision loss and kidney failure. Ranking equally high are complications involving the feet.
There are two major reasons why Cheryl’s feet are vulnerable:
NERVE DAMAGE: Uncontrolled blood sugar has a tendency to damage nerves throughout the body, a condition known as diabetic neuropathy. When nerves are damaged, they may stop sending signals, send the signals too slowly or send the wrong signals at the wrong time.
In your feet and legs, nerve damage is often experienced as tingling, burning or weakness. Even worse, it can cause loss of feeling. If you’re developing a blister on your heel, you may not feel it even after it starts to bleed.
Even a small sore on the foot, if unnoticed and untreated, can become infected. And if you still have excess sugar in your blood, the glucose feeds the infection and makes it worse.
POOR BLOOD FLOW: Uncontrolled blood sugar also damages blood vessels throughout the body. Since blood vessels in the feet are somewhat small and located far away from the pumping heart, poor blood flow is common.
Poor blood flow can cause skin to become dry enough to peel and crack. When a sore develops, it is less likely to get the circulation needed for healing. And if an infection occurs, poor blood flow makes it more difficult for antibiotics to reach the site.
Most of the foot problems experienced by diabetics can be traced back to these two effects of high blood sugar–damage to nerves and blood vessels. Ulcers most commonly occur on the ball of the foot or the bottom of the big toe. They can also occur on the sides of the feet, probably a result of poorly fitting shoes.
If Cheryl walks around barefoot, she could step on a stone or a piece of glass and get a sore that leads to an infection. Many diabetics each year develop foot infections that eventually result in amputation. The risk of amputation for a person with diabetes is 15 times greater than that of a person without the disease.
Other Foot Problems
Aside from ulcers, there are many other foot problems that persons with diabetes are particularly likely to develop:
• corns and calluses,
• blisters,
• ingrown toenails,
• bunions,
• hammertoes,
• plantar warts,
• athlete’s foot and
• fungal nails.
Again, many of these can be traced back to nerve damage and poor blood flow. Foot muscles become weak and unbalanced. Bones of the feet and toes shift, and the shape of the foot changes.
One particularly severe deformity is known as Charcot’s foot. Symptoms develop quickly: warm, red skin; swelling and pain. Joints become stiff, fluid accumulates, bones are forced out of place and the foot becomes increasingly misshapen. If you keep walking on the foot (because of failure to feel pain), you can make the condition worse.
Treatment of Charcot’s foot may require immobilizing the foot in a cast and using crutches, a walker or wheelchair. Surgery may be required.
In addition to avoiding barefoot walking, Cheryl was advised to get a foot examination at least once a year–and more often if she noted foot problems. During the exam, the physician or podiatrist tests blood flow and the sense of feeling in the feet and shows you how to care for your feet.
It’s important to check your feet every day for cuts, sores, blisters, redness, calluses and infected toenails. If special shoes or inserts are required, the doctor will prescribe them. They are made to protect the feet and, for feet that have changed shape, to adjust the biomechanics and pressure. Medicare Part B ordinarily pays a portion of the cost for special shoes and orthotics.
If you smoke, it’s critical that you quit since smoking narrows and hardens blood vessels, making it difficult for nerves to get the nutrition they need.
Quitting will also help you control your cholesterol and blood pressure and lower your risk for heart attack, stroke, kidney disease, neuropathy and amputation.
Even if you have not yet developed diabetes-related foot problems, it’s important to take preventive action.
Wash your feet in warm water every day using a mild soap. Letting water run over them in the shower is not enough. Don’t soak your feet, however, as it eventually can make the skin even drier. Dry your feet thoroughly after washing. If the skin is dry, you can apply lotion, but don’t use it between the toes where it can set up an environment for fungal and other infections.
After bathing, gently smooth corns and calluses with a pumice stone or emery board. Trim your toenails once a week, straight across with nail clippers. Don’t round off the corners.
Check your feet every day. Look for bruises, redness, warmth, pressure areas, swelling, ulcers, cuts, scratches or nail problems. Check between your toes, the tip of your big toe, the base of the middle and smaller toes, the heel, the outside edge of the foot and across the ball of the foot. Check each foot for sensation.
If you find any injury or abnormality, don’t try to treat it yourself; see your doctor.
Buy and wear shoes that fit well, with plenty of room at the sides and toes. Avoid high heels and pointy toes. Also try to avoid open toed shoes or sandals since they leave the foot too vulnerable.
For every day wear, athletic or walking shoes are a good choice. They support your feet and can correct for gait problems such as over-pronation. They also allow a good flow of air inside the shoe.
Always wear socks or stockings that fit well and do not have bumps or knots that can irritate your feet.
Exercise is important to improve blood flow, but you may want to avoid activities such as running and jumping that put stress on the feet. Walking, swimming and biking are better.
Finally, the most important thing you can do is to control your diabetes and blood sugar. Eat a good diet, follow your treatment plan and keep your blood sugar under control.
REFERENCES:
American Diabetes Association, “Foot complications,” last edited, May 22, 2014.
“Diabetes and foot problems,” WebMD Medical Reference, reviewed by Ann Edmundson, M.D., Ph.D., May 12, 2012.
eMedicinehealth, “Diabetic foot care,” medically reviewed by a doctor, May 29, 2014.
Thanh Dinh, et al, “Mechanisms involved in the development and healing of diabetic foot ulceration,” Diabetes, 2012;81(11):2937-2947.
Jose Luis Lazaro-Martinez, et al, “Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial,” Diabetes Care, 2014;37(3):789-795.
Becky McCall, “Magic wand? 2 novel systems for diabetic foot enter clinical trials,” Medscape, May 22, 2014.
Becky McCall, “New drug a possible breeakthrough for diabetic foot ulcers?” Medscape Medical News, March 5, 2014 (Journal of Clinical Endocrinology and Metaboliusm, January 31, 2014).
Lisa Nainggolan, “Diabetic foot: a Cinderella condition, needs a team approach,” Medscape Medical News, June 20, 2014 (American Diabetes Association 2014 Scientific Sessions, June 15, 2014).
National Diabetes Information Clearinghouse (NDIC), “Prevent diabetes problems: keep your feet healthy,” NIH Publication No. 14-4282, February, 2014.
Krystnell Storr, “Diabetic foot wounds are likely to recur,” Reuters Health, April 14, 2014 (Diabetes Care, 2014).
Miriam E. Tucker, “Diabetic foot ulcers recur less with custom-made orthoses,” Medscape Medical News, April 28, 2014 (Diabetes Care, April 23, 2014).
09/19/2014
For more information, sample newsletters or to get on our mailing list contact:
Community Relations
West River Regional Medical Center
1000 Highway 12
Hettinger, ND 58639-753