The Diabetic Foot
Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal everyday functions. Insulin is a substance produced by the pancreas gland that helps process the food we eat and turn it into energy.
Diabetes presently affects over 2 million Canadians (projected 3 million by 2010) and is classified into 2 different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked to heredity. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have not attended to their diet properly.
Many complications can be associated with diabetes. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet. People with diabetes should pay special attention to their feet.
Of the over 2 million Canadians with diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.
It is very important for diabetics to take the necessary precautions to prevent all foot related injuries. Due to the consequences of neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative foot care measures, he or she reduces the risks of serious foot conditions.
Diabetes often leads to peripheral vascular disease that inhibits a person’s blood circulation. With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, causing injuries to heal poorly. Poor circulation can also lead to swelling and dryness of the foot. Preventing foot complications is more critical for the diabetic patient because poor circulation impairs the healing process and can lead to ulcers, infection, and other serious foot conditions.
Foot care & Diabetes
Proper foot care is especially critical for diabetics because they are prone to foot problems such as:
- Loss of feeling in their feet
- Changes in the shape of their feet
- Foot ulcers or sores that do not heal
Steps to Preventing Problems with Your Feet
Daily Foot Care is Essential. A simple regimen of daily foot care for people with diabetes is crucial for lessening or preventing foot problems. The basic essentials of foot care include: Foot Hygiene, Foot Inspection and Appropriate Footwear.
Keep your Feet Clean. Wash your feet thoroughly and carefully every day using a mild soap and medium temperature water. Dry carefully, especially between your toes. Be careful of water temperature – if you have any loss of sensation in your hands, use your elbow or a thermometer to test water temperature. Also, keep your toenail trimmed, but remember to cut them straight across to avoid ingrown toenails. If you have corns, calluses, thick nails, fungus or other more severe problems you should have your feet professionally treated.
Start with daily foot checks – inspecting all sides, including the bottoms, which can be done best with someone’s help or with a mirror. During a foot check, any changes in the foot’s shape or color, sense of feeling/sensation, painful areas or skin integrity need to be evaluated. Any new bunions, calluses or corns need to be identified and shown to a medical doctor. The overall shape could change due to a bone fracture that would also need the attention of a physician. Stress fractures are very small breaks in the bone that will not usually change the shape of the foot, but may cause pain, bruising or swelling. The color of the foot is important as it helps show any changes in blood flow to the foot. Darkening or loss of hair may indicate that the blood or nerve supply has decreased. Less blood to the foot can mean slower healing of cuts and scrapes. Bruises indicate injuries. Especially important are the bruises or cuts found during a foot check that the person was not aware of at the time of the injury. Any bruises within calluses are particularly important to show to a physician.
To monitor sensation, a feather or facial tissue can be used to brush the foot and test its ability to feel light touch. It is also important to be sure the foot can sense the differences between hot/warm and cold water. Shower water can be first tested with the hand and then with the feet to identify any loss of temperature sensation. Testing for any change in ability to “feel” with the feet is important because diabetics can hurt themselves and not be aware of the injury or its severity. By checking their feet daily, they can see any new wounds and monitor healing areas. Keep in mind the foot may not feel “numb” but a progressive decrease in ability to feel light touch, temperature or the presence of shoes indicates a foot at risk.
Keep the Blood Flowing to Your Feet
Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs:
- DO NOT cross your legs for long periods of time.
- DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs.
- DO NOT wear restrictive footwear or foot products. Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics.
- DO NOT smoke. Smoking reduces blood flow to your feet. If you have high blood pressure or high cholesterol, work with your health care team to lower it.
Tips on Buying New Shoes:
- Feet should be measured each time you purchase new shoes. Feet do tend to swell as the day goes on so being fit in the afternoon is a good idea.
- The Brannock measuring device is only a guide! It is a suggested starting point for the shoe fitter. Every shoe fits different so don’t buy based on size – go by fit. Also the Brannock does not give an accurate width as it doesn’t take into account the girth of a foot.
- Take the insole out of the shoe before you try it on, place under foot and stand. This will show if there’s enough room between your toes and the end of the shoes (should be ½”) and if the last is suitable.
- Before putting a shoe on always check there are no staples or sharp objects inside.
- Be sure to tell the shoe fitter what you’re feeling – especially if they’re tight or slipping. You want to avoid blisters and pressure points.
Things to consider when selecting shoes:
- Last – A last is the metal, wood or plastic form used to create the shape of a shoe. Good lasts are rounded and mimic the shape of your foot. Look at the sole of the shoe.
- Seams on Shoes – Watch where they overlap (especially toes) and Bunion Area.
- Types of Tongues – Bellows tongue (stitched at base) or Blucher (not stitched).
- Leather or Vinyl – Check the tag. Vinyl shoes don’t breath and trapping all that moisture is not good for overall foot health.
- Widths and Removable Insoles – Some shoes now come with 2 sets of insoles in addition to coming in different widths which is good for fitting 2 different size feet.
- Toe Boxes – Deeper is better so they don’t rub on tops of toes.
- Swollen Feet – Stretch Shoes and Slippers made from Lycra are now available.
- Type of Closure – Lace, Velcro or Slip On. Lace up shoes are best to control foot movement. The problem with loafers (elastic) is they can cut off circulation. Velcro is handy – especially with sandals (although sandals leave the foot unprotected).
- Soles – Most shoes now are made with Polyurethane Soles. A sole at least ½” thick is best for cushioning and preventing punctures.
- Socks – Should absorb moisture to keep feet dry and have non elastic tops so as not to impede the circulation.
If you are Diabetic and need a great fitting, comfortable pair of shoes please visit us at Grady’s Feet Essentials Ltd. Our staff are well trained to ensure you get a proper fit and the right pair of shoes for your feet. If you have any questions or comments please contact us at .
Grady’s Feet Essentials is proud to be a member of The Foot Network. Some of the above information courtesy of The Foot Network.