Diabetes foot care

How can diabetes affect your feet?

Peripheral neuropathy
Peripheral neuropathy occurs when the nerves in the feet or legs are damaged. It is a common complication with diabetes and once this damage has occurred it cannot be reversed. It can lead to dry skin, discomfort, pain and deformity. Loss of sensation makes the feet feel numb. This makes them vulnerable to injury, which can lead to a foot ulcer.

Poor blood supply
Ischaemia is the name for a lack of oxygen to the skin. This occurs when the arteries in the lower leg become narrow or blocked, so blood cannot flow as easily into the foot. This is known as peripheral arterial disease. If the circulation is poor, any injury to the skin may struggle to heal. Gangrene occurs when the skin dies due to the blood flow being completely obstructed. Smoking, high blood pressure and high cholesterol can make the circulation worse. If your leg arteries are blocked it is often a sign that your other arteries are narrowed, increasing the risk of a heart attack or a stroke.

Infection
Diabetes alters the body’s ability to fight infection. This means that not only are the feet more prone to infection, but also that it is more difficult to clear infections once they have established. You should seek medical advice (from your GP, nurse or podiatrist) straight away if your feet show any signs of infection, such as new pain, swelling, redness, pus or heat.

Deformity
Foot deformities, such as bunions or hammer toes can increase the risk of rubbing, blisters and pressure areas. This can lead to corns and callus (hard skin) as well as foot ulcers. Even when sitting, pressure against the ground or footwear can cause problems.

Advice for keeping your feet healthy

Footwear
Shoes should be the right shape for your feet. Ill-fitting footwear can cause damage to the feet. It is therefore necessary to ensure that your footwear fits well, is long enough, wide enough and deep enough. Feet should be measured to get the correct size. Make sure that there is plenty of room around the toes. If you have lost sensation, you will not be able to feel if the shoe doesn’t fit. Shoes should have a good fastening, e.g. lace-up or Velcro, to help minimise the movement of the foot within the shoe. Friction and shear stresses can cause blisters or over long periods calluses and corns. Excessive pressure over an area can cause the skin to breakdown and ulcerate.

Remember, to check the sole and inside your footwear for loose objects and rough areas before wearing them. If you have lost sensation in your feet, do not walk around barefoot.

Socks, stockings and tights
Try to wear hosiery with as small a seam as possible or wear them inside out. Thick seams can damage fragile skin. When wearing socks, make sure they have a soft top which does not restrict your circulation and that they are not too tight around the toes. They should preferably be made of cotton (better for hot feet) or wool (better for cold feet) and change them on a daily basis. If you wear thick hosiery in the winter, ensure your footwear has enough space.

Hygiene

• Wash your feet every day
• Do not soak your feet
• Dry thoroughly, especially between the toes

Nail Care

• Cut your nail to the shape of the toe, do not cut down the sides as this may cause an ingrown toenail
• Do not cut them too short
• Gently file the nails to remove any rough edges

Your skin

• Use a moisturizing cream every day avoiding the area between your toes
• Check the skin for any cuts, blisters or cracks. Do not ignore minor injuries (see first aid below)
• Do not use medicated corn plasters, pull off hard skin or use anything sharp to remove corns or callus yourself
• Corns and call us should be treated by a podiatrist
• If you are unable to manage your own footcare, consider private podiatry/chiropody. The NHS Podiatry Department do not provide routine basic nail care.

 

Danger signs : ‘Foot Attack’

If you develop any of the following problems, or suspect a ‘FOOT ATTACK’ it is important that you contact your local Multi-disciplinary Diabetes Foot Service, Podiatrist or GP for advice immediately.

• Is there new redness or swelling?
• Is there new pain or throbbing?
• Does your foot feel hotter than usual?
• Is there a skin break or any discharge?
• Is there a new smell from your foot?
• Do you have flu like symptoms- hot, shivery?

If your Multi-disciplinary Diabetes Foot Service, GP or Podiatry Department are not available, and there is no sign of your foot healing within 24 hours, go to your local emergency department or ring NHS 111.

First aid
Cover any cuts, grazes or blisters with a sterile dressing. If they do not show signs of healing within 24 hours seek medical advice as soon as possible.

Remember, do not delay if you have a foot problem or are concerned about your foot health. If problems can be dealt with in their early stages it may prevent future deterioration. Help and advice can be obtained from your doctor, nurse or podiatrist