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Caring for Your Feet

by Rita Weinstein

When you have diabetes, your feet need extra-careful attention. That’s because diabetes places you at a higher risk of getting foot infections. There are several reasons for this, and they are all related to high blood glucose levels. First, high blood glucose is associated with damage to blood vessels, which can result in reduced circulation to the feet. If you get a cut or sore on your foot, decreased blood flow will slow the healing process. Second, high blood glucose can keep white blood cells from effectively fighting off an infection. In addition, many people with diabetes develop neuropathy, or nerve damage, in their feet. When nerves are damaged, the ability to sense heat, cold, pressure, and pain may be diminished.

Often, changes in sensation in your feet occur over a long period without you even knowing it. You may experience a tingling, “pins and needles” feeling in your feet, or the nerves may become numbed and you may feel very little. When you lose feeling in your feet, you lose the ability to know when you have a sore, blister, or injury. This is called loss of protective sensation. When you don’t feel the pain, you’re less likely to treat the problem — and that could cause serious complications. Leaving a wound untreated can allow it to become infected, and the infection could become serious enough to require amputation.

Unfortunately, diabetes-related lower-extremity amputations are on the rise. The financial and emotional costs of such losses are considerable. The good news is that if you pay attention to your foot health daily, you can do much to prevent the conditions that can lead to amputation. About three-fourths of all diabetes-related amputations are preceded by chronic foot ulcers. Therefore, a person with diabetes has a very good chance of avoiding the loss of a toe, foot, or leg if chronic foot ulcers can be prevented. The following is a list of simple, practical things you can do to take care of your feet. Be sure to contact your health-care team right away if you notice a problem.

Take a good look
Take a good look at your feet daily. What you are looking for are sore spots, cuts, reddened or swollen areas, and infections around or under your toenails. Remember, you might not feel any pain at all, so the visual check is crucial. The easiest way to make sure you don’t forget is to set a definite time, for example, just before bed. Sometimes it’s hard to see all surfaces of your feet, so feel free to use a mirror. You might also ask a family member or caregiver to help you out. If you do notice a sore, cut, blister, bruise, infection, or area of soreness or swelling, don’t hesitate to call your doctor’s office and let the doctor or nurse know, especially if the spot doesn’t begin to heal after the first day.

Keep ’em clean
Keep your feet clean. Using warm — not hot — water and mild soap, thoroughly wash your feet once a day. Soaking your feet is not a good idea, because it makes the skin very soft and vulnerable to injury in the short term, and it causes skin to dry out and crack in the long term. Dry, cracked skin is an open invitation to a variety of bacteria.

After washing your feet, use a soft, absorbent towel to make sure you’ve dried them completely. Pay special attention to drying the areas between your toes (extra moisture here can lead to skin breakdown). A light sprinkling of talcum powder between your toes will help keep that area dry and infection-free.

Moisturize
Moisturize the tops and bottoms of your feet daily, but keep the areas between your toes completely dry. The skin on the tops and bottoms of your feet should be kept soft and smooth with skin lotion or petroleum jelly. There are many good products available at the drugstore. Some are specially formulated for diabetic foot care, but the best product for you is the one that you feel helps and that you can afford to use every day. Massage the lotion in well, and use only small amounts. If you overdo it, you could create a germ-friendly environment.

Use TLC
Use only TLC (tender loving care) on corns and calluses. Corns and calluses form wherever the skin of your feet rubs against your shoes. The best way to smooth these toughened areas away safely is to use a pumice stone after bathing or showering. It’s easy to cut or tear the skin while dealing with these areas, so treat them gently, rubbing the pumice stone in one direction only. Do not cut corns and calluses, and do not use razor blades, corn plaster, or liquid corn and callus removers. These items can damage your skin and lead to exactly the situation you’re trying to prevent. If you have problem corns or calluses, your doctor or foot-care specialist can take care of them safely and effectively. Don’t be reluctant to ask your health-care team to help —that’s why they’re there.

Keep ’em trimmed
Keep your toenails neatly trimmed. A good time to trim your toenails is when they’re soft — right after you’ve washed and dried your feet. Do it once a week or whenever needed. If you use clippers, clip nails straight across or follow the slight curve of the toe, then smooth the rough edges with an emery board or nail file. Some health-care professionals recommend that you avoid clippers entirely and use only a nail file. Whichever method you prefer, make sure you don’t cut into the corners of the toenail. Doing so can open the door to infection. If you have thick, yellowed nails or don’t see well enough to trim your nails yourself, your doctor, nurse, or caregiver can trim them for you.

Never go barefoot
Protect your feet with shoes and socks at all times and in all places, including indoors. Even at home, it’s easy to step on something and cut or bruise a foot. Wearing socks at all times is important because socks keep your shoes from rubbing against your feet and causing blisters. And not just any socks will do; choose socks that keep your feet dry and comfortable. Wool and cotton have long been recommended for their ability to let your feet “breathe,” but now manufacturers are creating lightweight blends with acrylic, rayon, and nylon that increase wicking action (moving moisture away from the skin) while minimizing friction against your feet. There are also socks made with extra padding at the sole. Whatever style of socks you choose, make sure they fit your feet well and don’t have lumpy seams that can rub against and irritate your skin. When you take your socks off at night, give them a quick check for wet spots, stains, or any unusual odor that could be signs of infection.

Remember to check the insides of your shoes before you put them on. If the lining is cracked, it could cause a blister. And check both shoes and socks before you put them on to make sure there are no objects in them that could bruise your feet. People who have lost some sensation in their feet might not feel a pebble, coin, paper clip, or even a house key or car key that has found its way into a shoe or sock.

Choose your shoes
Choose your shoes carefully. Selecting the right footwear is critical to the prevention of serious foot problems. For everyday wear, athletic or walking shoes made of canvas or leather are good choices; they provide your feet with the support they need and allow air to circulate around your feet. Vinyl or plastic shoes trap moisture, thus creating a good environment for bacterial growth. They also don’t flex or stretch well and are therefore more likely to cause corns, calluses, or blisters. Make sure shoes are comfortable when you first try them on. If you take them home thinking you’ll break them in, you’re liable to end up with sore spots or blisters that could lead to more serious problems later. Shoes with pointed toes or high heels create pressure points that can lead to bruises or blisters.

Some feet require custom-fitted shoes or inserts for a comfortable fit. Medicare Part B covers 80% of the cost of certain special shoes and inserts for people with diabetes. If you have Medicare Part B coverage, you may qualify for one pair of custom-molded shoes (including inserts) and two additional pairs of inserts or one pair of depth shoes (shoes with extra room to allow for differently-shaped feet and toes or for special inserts made to fit your feet) each year. Some private insurance carriers cover therapeutic shoes as well. To qualify for Medicare reimbursement, the doctor who provides your diabetes care must sign a statement certifying your need for these shoes, and a podiatrist or other qualified physician must write you a footwear prescription.

Not too hot, not too cold
Protect your feet from temperature extremes. Loss of sensation means you may not know if you’re burning your feet on the beach or getting frostbite in the cold. At the beach, wear light canvas shoes while you’re on the sand and swimming shoes while you’re in the water to protect your feet from sharp objects. Put sunscreen on any parts of your feet that are exposed to the sun. In cooler weather, avoid putting your feet too close to the radiator or the fireplace. Hot water bottles and heating pads can be hotter than you think and cause minor burns, so it’s safer not to use them. They might also compress the small blood vessels of the feet and hinder circulation. If your feet are cold, wear socks and warm slippers. Lined boots are great for the cooler temperatures of winter.

Take care to check your feet often in the winter to make sure you aren’t developing frostbite. Frostbite usually affects the toes before it affects other parts of the feet, and it is characterized by hard, pale, cold, and numb skin that becomes red and painful when warmed. If you experience mild frostbite, wrap your feet in warm clothing or warm them with your hands — but never rub the frostbitten area. If the frostbitten area is larger than the size of a quarter, you should have your doctor look at it. If you experience severe frostbite, characterized by grayish blue or black skin, get medical attention immediately.

Keep the blood flowing
Make sure you have good blood flow to your feet. Loss of blood flow can starve and destroy soft tissues in the foot. Sitting for long stretches of time can restrict the flow of blood to legs and feet. A good remedy is to put your feet up on an ottoman or on the couch while sitting. Every once in a while, rotate your ankles, wiggle your toes, and stretch your feet to get the blood moving. Crossing your legs for long periods can also restrict the flow of blood. Tight socks, elastic or rubber bands, and garters can all be culprits in reducing circulation to your feet and legs. Smoking constricts blood vessels throughout your body, especially in the extremities, so if you smoke, stop. Your health-care team can help you stop smoking. Reducing high blood pressure and high cholesterol levels will also help to maintain the circulation to your feet and legs.

Stay active
If you don’t already get regular exercise, increase your physical activity. You and your health-care team can design a program of activity that not only fits your needs, but also provides enjoyment and enhances your quality of life. Sports that involve running and jumping are hard on the feet, but walking, social dancing, swimming, and bicycling are great exercise and easier on the feet. Low-impact, chair, or water aerobics can also be good exercise choices. A good yoga teacher can help you develop a routine that gently stretches the body and increases circulation all over. Whatever you do, choose your athletic shoes carefully and wear clothing that doesn’t bind.

Maintain blood glucose control
Manage your diabetes. That means making lifestyle choices that help keep your blood sugar levels close to normal. This will promote good circulation, keep white blood cells functioning properly, and help prevent neuropathy. Good blood glucose control requires the following:

  • Learning how and when to check your blood glucose level.
  • Taking prescribed insulin or medicines on schedule.
  • Following a sensible eating plan according to the advice of your health-care team.
  • Being physically active every day (to promote good circulation and better conversion of the food you eat into energy).

Get started now
If you don’t already follow the foot-care tips included in this article, start doing them today. Set a time every day to check your feet. Print out this foot-care checklist and tape it to your bathroom or bedroom wall.

Make sure your health-care team is keeping an eye on your feet as well. The American Diabetes Association recommends that all people with diabetes have their feet examined by a health-care professional at least once a year. The Centers for Medicare and Medicaid Services has approved the coverage of biannual foot exams for people with peripheral neuropathy and loss of sensation in the feet due to diabetes. This benefit is available to those covered by Medicare Part B. For more information, talk to your doctor.

If you’d like to take more control over tracking changes in sensation in your feet, a government program called the Lower Extremity Amputation Prevention Program (LEAP) is giving out free self-testing kits. There’s no cost to you, and it’s both simple and painless. The test consists of you or someone else touching the soles of your feet at various spots with a small piece of synthetic material called a monofilament. You simply record whether or not you feel the touch. If you find you’ve lost sensation, let your doctor know right away. To get a free monofilament and instructions, contact the LEAP program at (888) ASK-HRSA (275-4772), or visit their Web site at www.hrsa.gov/leap/. (Click here for other foot-care resources.)

Lower-extremity amputations among people with diabetes are a serious problem that’s on the rise. But studies suggest that when a person with diabetes takes control of foot care, the risk of amputation is decreased by as much as half. By following the simple steps outlined in this article, you can significantly decrease the risk of losing a precious part of your body.

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Foot-Care Checklist
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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

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