Diabetic Foot is Especially Susceptible to Foot Lesions
The most important effect of neuropathy (nerve damage) on the diabetic foot is the loss of sensation. The foot is vulnerable even to trivial trauma. A diabetic person can step on a tack with bare feet and feel nothing at all. Tight shoes feel comfortable while scalding water may feel merely warm. Because of this loss of sensation, people with diabetic neuropathy can hurt their feet easily, without realising it. Doctors and patients give so much importance to long-term complications involving the eyes, kidneys, and heart that the foot problem of the diabetic is completely ignored.
Neuropathy can also cause bones to shift around, changing the shape of the foot. This causes people to walk differently, creating pressures in those parts of the foot where usually there is none. The resulting skin irritation can sometimes lead to sores. Moreover, once the sores develop they can take unusually long to heal or become seriously infected. Over and above that, if the circulation is poor, gangrene and the possibility of amputation are the likely sequels.
Amputation in people with diabetes results from something as minor as stepping on a tack or a minute and inconspicuous break in the skin. Too often this drastic measure could be avoided through good control of blood sugar, and a commitment to daily home care and regular medical check-ups, including foot examination. No other complication of diabetes can be so effectively prevented by proper patient education as the foot problems. What appears to be a superficial ulceration may be only the tip of the iceberg! There may be a penetration deep into the tissues. Therefore, the management of a diabetic foot problem is complicated and frequently requires the attention of many specialists. It is vital that there is a close liaison between the podiatrist, diabetologist, orthotist, nurse, dietitian and surgeon in the care of the diabetic foot. The diabetic clinic is the optimal forum for this approach.
Instructions for patients with Diabetic Foot:
1. Do not smoke.
2. Inspect the foot daily. The use of mirror can help in seeing the bottom of the feet. Check between the toes.
3. Wash feet daily. Dry between the toes.
4. Avoid extremes of temperatures. Test water before bathing.
5. Do not soak feet in water. Avoid swimming.
6. Do not walk barefoot.
7. Do not use chemical agents or strong antiseptic solutions for removal of corns and callus.
8. Inspect the inside of shoes daily for foreign objects.
9. For dry feet use very thin coat of cream or oil. Apply after bathing and drying the feet.
10. Wear properly fitting socks.
11. Do not wear garters.
12. Footwear should be comfortable. It should have insoles constructed of a soft material to cushion and reduce forces to which the feet are subjected during walking.
13. ‘Break-in’ new shoes slowly by wearing them for short periods of time.
14. Walk with short steps to distribute the pressure of weight bearing over a greater area of the foot.
15. Do not wear shoes without socks.
16. Do not wear slippers with thongs between the toes.
17. Cut nails straight across.
18. Do not cut corns or callus; follow the instructions of your physician.
19. Do not neglect even slight injuries. See your doctor.
20. A final but often neglected foot care tip is to maintain good diabetes control.
Care Begins at Home
Regular check-ups by a professional, helps diagnose problems before they become major complications. If you have neuropathy and with it some loss of sensation in the feet, you need to look at your feet everyday. To spot irritation or infection, do as the doctor advises – notice any swelling, redness, sores. Also look for dryness, cracking and bleeding, all of which can encourage infections to develop. Do not forget to look between your toes when looking for cracks, bleeding or any sign of irritation. Also check the top and sides of the toes for corns.
In addition to checking your feet, pamper them. Keep them clean, wash them daily with warm water (use the back of your hand to test the water) and mild soap. Keep the skin soft by using a lotion and be sure to dry the area between the toes carefully to prevent fungal infections. Trim toenails straight across and file them with the emery board. If the toenails are very thick or deformed, do not try to cut them at the risk of an injury. Foot specialists have tools for this problem.
In general, avoid exposing your feet to extremes of heat and cold. Always wear shoes even in the middle of the night; or during a trip to the bathroom. By doing so, you help to prevent infections and healing problems, and may also avoid or slow down the development of neuropathy or impaired circulation.
Exercises for Diabetics with Foot Problems
Diabetics particularly with previously healed ulcerations should, follow specific and detailed instructions for foot care and techniques for decreasing foot pressure before undertaking an exercise programme. Physical therapists and personnel in exercise centres should discuss with the referring physician, the type of exercise programme suitable for the diabetic.
The Post-healing Treatment
Patients with healed foot ulcerations are at risk for future ulceration. The education programme for these patients should stress on daily examination of the feet and prompt notification of any problem, if it arises. Patients whose work requires them to be on their feet for extended periods may require job modification. Prescribed footwear will benefit patients with a history of foot ulcers.
Patient’s Education
Patients with diabetes must be educated and made to understand proper foot care. In addition, high risk patients and their family members should be taught to perform daily foot inspections. Education should continue until the patient can verbalise and demonstrate proper foot care practices. Neuropathic complications and their relationships to foot problems should be explained.
Footwear
Footwear, engineered exclusively for the diabetic foot, has been designed by firms such as DREW. They claim to provide the following qualities:
• Perfect for sensitive and insensitive feet
• Easy insertion of prescribed Orthotics
• Supple deerskin leathers
• Inserts that prohibit bacterial growth
• Lots of extra toe room
• Materials that wick away moisture
Foot Cradles
To end foot pain, the foot needs to be properly supported and cradled in the shoes. To help ease this problem, foot cradle insole support is being marketed by firms such as Swiss Co. International, Seattle and many other indigenous firms too. Foot cradles are made from genuine leather. They weigh less than an ounce and help support your full body weight, just as the weight shifts naturally, so do the foot cradles. Prevention is better than cure. Eminently treatable and successful treatment of foot lesions may avoid major foot complications.