By J. C. Tanenbaum, DPM
Even with diabetes, your feet can last a lifetime, and they stand a better chance of doing so if you treat them with tender, loving care. That includes giving them a daily inspection for cuts and abrasions as well as asking your doctor to examine them periodically for any signs of nerve damage, such as loss of sensation, or reduced blood flow, such as coldness or hair loss on the feet and legs.
The tools or products you use on your feet at home can have profound effects on their health, particularly if you have any degree of nerve damage or reduced blood flow in your feet. Using the right products can help to keep your skin – and feet – intact, while using the wrong ones can lead to breaks in the skin, which can allow bacteria to enter and, in the worst-case scenario, lead to foot ulcers.
Here, then, is your guide to over-the-counter foot products, including some that are safe to use and some to avoid.
Washing your feet with warm or tepid water and soap every day keeps them clean and gives you a good chance to do that daily inspection. (If it’s hard to see your feet, run your fingers over them to feel for calluses or sore spots. The backs of your hands are sensitive to heat and can be run over your feet to find hot spots, which can indicate infection.)
There must be at least 50 varieties of soap on the shelves of most drugstores – liquid soaps, solid bar soaps, scented soaps, unscented soaps, etc. Which to choose? In general, bar soaps are a better choice than liquid soaps, and soaps that have moisturizing lotion in them are the best choice of all. The compound in soap that gives it its lather is a fatty acid called lanolin, and the more lather, the softer the soap. In most cases, bar soaps have more lather than liquid. The moisturizer is important because dry skin can lead to cracking and the entry of bacteria into the skin. It is much safer to be moist than dry.
If a soap feels gritty or granular, don’t use it; you never want to use an abrasive on your feet. Perfumed soaps may cause skin reactions in some people, resulting in redness and swelling, so for these people, unscented soaps are best.
Applying a moisturizing lotion to your feet once or twice a day can also help keep your skin healthy and moist. In general, thick lotions do a better job of moisturizing than thin, “watery” lotions, but it’s important not to overdo it with moisturizer. Skin that is too soft and moist can break down or become a breeding ground for infections. Putting lotion between your toes is generally discouraged, since the skin between toes tends to stay moist naturally; adding lotion there would overmoisturize that area.
Even with the best foot care, it would be hard to go through life without developing a callus or corn on your feet. Both calluses and corns are thickened areas of skin that result from pressure and friction on a part of the foot. Ill-fitting shoes are a common cause of calluses and corns. To a certain degree, calluses and corns protect the foot; without that layer of thickened skin, pressure or friction might cause an open wound. But very thick calluses and corns can press into the foot, causing pain. And in a person with diabetes, a callus or corn can actually be a thin layer of hard skin covering a much deeper wound or ulceration.
With that in mind, it seems like a good idea to remove calluses and corns, but the drugstore is not the place to start. The active ingredient in over-the-counter corn and callus removers – whether packaged as a liquid or a medicated pad – is acid, and acid can eat away live skin as well as dead. If your skin tends to heal slowly, even one application of these products can lead to the creation of a wound that can take months or even years to heal. If you have troublesome calluses or corns on your feet, see your podiatrist for advice and treatment. Never use an acid product on any part of your feet.
Even acid-free callus and corn home treatments are not recommended for people who have diabetes. Pumice stones and files are not sterile and can cause breaks in the skin if you rub too vigorously or remove too much skin. And whatever you do, don’t take a sharp blade to your feet. It’s just too easy to slip and cut yourself.
What if you develop a wart on your foot? Warts are caused by viruses that enter the skin directly. Warts that grow on the bottoms of the feet are often called plantar warts. Plantar warts may occur one at a time, or there can be hundreds of small warts on a person’s foot. Many times, warts resemble calluses, but they can often be distinguished by small black dots in the body of the wart. While most warts will eventually go away with no treatment, a wart on the bottom of your foot can make walking painful, so you may be eager to remove it. Just like callus and corn removers, however, over-the-counter wart removers contain acids and are not recommended for use by people with diabetes. Instead, ask your podiatrist about other options for getting rid of a plantar wart.
The drugstore is a good place to pick up two first-aid essentials: antibiotic ointment and adhesive bandages (such as Band-Aids). To treat a minor wound, first wash your hands with soap and water, then cleanse the wound with soap and water, rinse thoroughly, pat dry, and apply a thin layer of antibiotic ointment with a cotton swab (such as a Q-tips cotton swab) and an adhesive bandage. If you see no appreciable improvement within 24 hours, consult your doctor or podiatrist immediately. Even if a wound appears to be closing up, if you see signs of infection, such as redness, swelling, or pus, see your doctor or podiatrist.
As long as you are not allergic to latex, either fabric or plastic bandages will do. If your skin is very fragile, however, your doctor may advise you to use a gauze pad and paper tape in place of adhesive bandages or to cover wounds with a gauze bandage, taping the gauze to itself, rather than to your skin.
It is not necessary to buy any particular brand of antibiotic ointment; most have the same active components. However, when applying antibiotic ointment, it’s much better to use a cotton swab than your fingers. Using your fingers can contaminate both the wound and the tube of antibiotic ointment.
For many people, the regular toenail trimmers or clippers sold at the drugstore are safe for home use. Toenails should be cut straight across or following the natural curve of the toe. Gently smoothing the toenails with an emery board after clipping can keep them from snagging on socks. When clipping or using an emery board on your toenails, never ”dig” into the sides of your nails. Doing so can break the skin, opening the door to fungal or bacterial infections. Improper clipping can also lead to ingrown toenails, which can also become infected and painful.
If you cannot see or reach your toenails easily, if your nails are hard to cut because they’re thick or you have a fungal nail infection, if the sides of your toenails curve into your skin, if you frequently have trouble clipping your toenails, or if you have reduced sensation or circulation in your feet, it may be a good idea to have your toenails cut regularly by a podiatrist. Toenail trimming every two or three months is usually recommended. In many instances, proper professional foot care can prevent problems from ever happening.
If you want a pedicure, buy your own inexpensive nail instrument set and bring it with you to your pedicurist. Make sure the technician knows never to cut your skin. For infection control, make sure the facility washes the basins that your feet may be placed in.
It’s only logical that drugstores would stock ingrown toenail remover products next to the toenail clippers, but are they an option for people who have diabetes? No, they are not. Just like callus, corn, and wart removers, they contain acids, which work by eating away the skin, in this case on the sides of the toenail. Eroding the skin allows bacteria to penetrate, which can lead to an infection.
No matter how clean a person is, all toenails have bacteria and fungus growing on them. When an ingrown toenail digs into the skin, it pushes this bacteria into the deeper tissues of the affected toe. If the body cannot fight off the bacteria, it multiplies, and an infection results. Putting an acid on skin that is already broken simply makes the opening for bacteria larger.
If you have an ingrown toenail, see your podiatrist for treatment. If you see your toenail looking red or swollen, or you see drainage, blood, or pus on your toe, consult your podiatrist immediately. This is an emergency.
You can help to prevent ingrown toenails by learning to trim your toenails properly, wearing shoes with a wide enough toe box, and wearing socks that are not too tight.
If you have had a wound or ingrown toenail treated by a podiatrist, he may recommend that you soak your foot or feet in a solution of Betadine (or generic povidine iodine) while the wound is healing. This widely used antiseptic helps prevent against infection with bacteria, fungi, and viruses. Use two capfuls of Betadine solution in a big basin of lukewarm water (never use it straight from the bottle). Soak your feet for a maximum of 20 minutes, then dry them well.
Anyone who is allergic to iodine should use Epsom salts in place of Betadine. When a foot soak is necessary, dissolve two tablespoons of Epsom salts in a big basin of lukewarm water, soak for no more than 20 minutes, and dry your feet well afterward. Soaking in Epsom salts is also a good way to reduce inflammation and pain.
Because foot soaks can dry your skin, do not routinely soak your feet every night. And do not use alcohol or hydrogen peroxide as antiseptics on your feet; they will also dry your skin.
A potentially useful drugstore purchase for people with diabetic neuropathy in their feet is capsaicin cream or ointment, which is sold under the brand names ArthriCare, Capzasin, Zostrix, and others. This topical medicine made from hot peppers can sometimes reduce pain associated with diabetic neuropathy if used regularly over the course of several weeks. It can also relieve arthritis pain in some cases.
When you first begin using capsaicin, it’s normal to experience a warm, stinging, or burning sensation where you’ve applied it. This feeling should diminish with continued use. Capsaicin can also cause stinging and burning if it gets in your eyes or mucous membranes (such as your nose or mouth), so be sure to wash your hands thoroughly after applying it to your feet.
Athlete’s foot is a fungal infection that usually causes itching, cracking, and redness between the toes or on the bottoms of the feet. It’s important to take care of it right away because any breaks in the skin can allow bacteria to enter and cause an infection. The good news is that as a rule, people with diabetes can safely use over-the-counter athlete’s foot creams and that all athlete’s foot creams are equally effective.
To use an athlete’s foot cream, wash your feet and dry well between your toes and on the bottoms of your feet. Rub the medicated cream in twice a day. If you see no improvement in five days, call your podiatrist. It might not be an athlete’s foot fungus after all.
You can do a lot to keep your feet healthy. In addition to protecting the skin on your feet by making smart drugstore purchases, you can extend their life by maintaining blood glucose control, following a heart-healthy diet, getting regular exercise, and wearing shoes that fit well. However, if you develop foot pain, wounds that don’t heal quickly, or any other foot problem in spite of your best efforts, don’t hesitate to call your podiatrist or another member of your diabetes care team. Foot problems that are caught early have the best chance of successful treatment.
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