Diabetes Foot Care

[KickStart101]

Foot care for diabetics


If you have diabetes you are more prone to foot problems, because the disease can damage your blood vessels and nerves. This, in turn, may make you less able to sense injury or pressure on your foot. You may not notice foot injury until severe infection develops.

Diabetes also alters the immune system, decreasing the body's ability to fight infection. Small infections may rapidly progress to death of the skin and other tissues (necrosis ), which may require amputation of the affected limb to save the patient's life. Foot problems can be prevented in part with improved blood sugar control.

If you have diabetes, you are at higher risk for developing foot problems if you:

Have had diabetes more than 10 years
Are male
Have poor glucose control
Have eye, kidney, or heart problems
All diabetics should get regular foot exams -- at least twice yearly -- by their health care provider and should learn whether they have nerve damage.

To prevent injury to the feet when you have diabetes, you should adopt a DAILY routine of checking and caring for your feet, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.

DAILY CARE ROUTINE

Check your feet every day. Inspect the top, sides, soles, heels, and between the toes.
Wash your feet every day with lukewarm water and mild soap. Strong soaps may damage the skin.
Test the temperature of the water before putting your feet in, because the normal ability to sense hot temperature is usually impaired in diabetics. Burns can easily occur.
Gently and thoroughly dry the feet, particularly between the toes, because infections can develop in moist areas.
Because of skin changes linked with diabetes, the feet may become very dry and may crack, possibly causing an infection. After bathing the feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your toes.
Ask your health care provider to show you how to care for your toenails. Soak your feet in lukewarm water to soften the nail before trimming. Cut the nail straight across, since curved nails are more likely to become ingrown.
Exercise daily to promote good circulation. Avoid sitting with legs crossed or standing in one position for prolonged periods of time.
If you smoke, stop. It decreases blood flow to the feet.
TIPS ON SHOES AND SOCKS

Wear shoes at all times to protect your feet from injury. Otherwise, if you have poor vision and less ability to feel pain, you may not notice minor cuts or bumps.
Wear comfortable, well-fitting shoes. Never buy shoes that do not fit properly, expecting the shoes to stretch with time. Nerve damage may prevent you from being able to sense pressure from improperly fitting shoes.
Check the inside of your shoes for rough areas or torn pieces that can cause irritation.
Change your shoes after 5 hours of wearing during the day to alternate pressure points.
Avoid wearing thong sandals or stockings with seams that can cause pressure points.
Wear clean dry socks or non-binding panty hose every day. Socks may provide an additional layer of protection between the shoe and your foot.
Wear socks to bed if your feet are cold. In cold weather, wear warm socks and limit your exposure to the cold to prevent frostbite.
MORE HELPFUL TIPS

Avoid using antiseptic solutions on your feet since these can burn and can injure skin.
Avoid applying a heating pad or hot water bottle to the feet. Avoid hot pavement or hot sandy beaches.
Report sores, changes, or signs of infection to your doctor immediately. Report all blisters, bruises, cuts, sores or areas of redness.
Remove shoes and socks during visits to your health care provider. This is a reminder that you need a foot exam.
Make an appointment with a podiatrist to treat foot problems or to have corns or calluses removed. Never attempt to treat these yourself using over-the-counter remedies.
If obesity prevents you from being physically able to inspect your feet, ask a family member, neighbor, or a visiting nurse to perform this important check.

[mg_2204]

Very helpful Carlie, thank you for posting this! :) :) :)

It is one aspect of life with diabetes people will neglect. Me being the first! I am careful in the choices I make for shoes but I have yet to find (and stick to!) a routine for my feet. Funny but I am more careful during summer time, because I wear sandals. I'll pamper my feet a lot more. Prevention is the way to go. It's always better (and easier!) to treat little problems than be stuck with major ones.

[KritterMom]

Very good post Carlie!
One product I have found that really helps me is Bag Balm. You can find it at WalMart. My heels are soooo dry, so when I notice that they are getting to the point where they are going to crack, I lather on the Bag Balm, and by the next morning my feet are young again, lol. I try not to wait until they crack, but sometimes that happens more quickly than I realize.

[babs2000]

Carlie-That's a great post. I work for 2 podiatrists so I/ve seen it all. Thanks. Beth

[cdngoose]

Good post Carlie. A friend who has Type 2 diabetes was told last year she should have one of her legs amputated. She has been on antibiotics for the past year and they haven't the infection and now has to have the amputation.

[Injecto]

I tend to get very sensitive when I'm told that my feet will get cut off for going barefoot in the summer. From the numerous foot (and other complication) threads I've read it seems that going barefoot and eventually losing your feet is not super highly correlated but rather poor control and damage is.

That said, I check my feet everyday in the shower (all over my feet) and clean and dry them thoroughly (with a dryer), but after that I have full plans on going barefoot in the summer on my lawn, or at the beach, or the pool, and even in the house. Perhaps not the driveway or sidewalk, but then again it's stiffling hot.:eek:

I'd like to know what the actual percentages of eventual foot loss is across diabetics? 1%? 2%? 4%? For some reason stats like that are always missing. We are told that good control will decrease our chances by a given percent, but what was the likelihood in the first place?

[KickStart101]

TY :)



Krittermom: Thanks for mentioning the Balm.
I'll see if they have it here.
It sounds better that the unscented lanolin
lotion I use. I've not had any cracks in my
feet yet.(kow) Thanks.


I'm sorry to hear about your Friend cdngoose.
I can't imagine what she's going through that.
I just hope and pray that the surgery and
recovery go well for her. Keep us posted please.


Ya, I bet you've seen it all Beth. Unfortunately,
there will be so many more in the future if more
Diabetics don't get pro-active.

[KickStart101]

Hi Injecto: Can I suggest that you get a pair
of skimmers( verythin rubber sockets that do
come in cool colours :D )to stop the chance
of getting plantar warts when walking in pool
areas and public showers?

I got those twice while on vacation. I ended
up spreading them to the Family when I showered
at home since I didn't know I had them.
The roots of the warts go deep into the foot and
hurts like heck even before they go deep. Also hurts
to get them removed. :D Just thought I'd mention it.

Here's some percentages. They are a few yrs. old so
just add a few points to each number. Close enough.
I had this up the other day but just wanted to remove
some unnecessary stuff from it.



DIABETES AND THE FOOT
Chronic hyperglycaemia (raised blood glucose levels) is usually associated with long-term damage to the body and the failure of various organs and tissues. People with diabetes are at risk of nerve damage (neuropathy) and problems with the blood supply to their feet (ischaemia). Nerve damage results in a reduced ability to feel pain, and injuries often go un-noticed. Ischaemia can slow down any wound healing. Both neuropathy and ischaemia can lead to foot ulcers. Infections in these wounds may ultimately result in amputation.
A few facts and figures
• People with diabetes are 25 times more likely to lose a leg than people without the condition.
• Throughout the world, up to 70% of all leg amputations happen to people with diabetes.
• Somewhere in the world a leg is lost to diabetes every thirty seconds
• It is estimated that up to 85% of all amputations due to diabetes can be prevented.
• 85% of diabetes-related lower extremity amputations are preceded by a foot ulcer.
• Many foot ulcers can be prevented with suitable healthcare and informed self-care.
• In developed countries one in every six people with diabetes will have an ulcer during their lifetime.
• In developing countries, foot problems related to diabetes are thought to be even more common.
• Foot problems account for up to 15% of healthcare resources in developed countries. In developing countries, it has been estimated that foot problems may account for as much as 40% of the total available resources.
Incidence of diabetic foot ulcers and amputations in North America
In North America, diabetic foot disease is a major cause of morbidity and mortality and contributes significantly to increased health costs.
• Foot complications are a major reason for admission to hospital and account for 20% of diabetes-related admissions.
• More than 60% of non-traumatic lower-limb amputations occur among people with diabetes. In the USA, there are approximately 82,000 non-traumatic lower-limb amputations performed annually among people with diabetes.
• More than 80% of lower-limb amputations are preceded by foot ulceration.
• There is a two-fold increased risk of ulcers and amputations among Hispanic/Latino Americans and African Americans, and a four-fold increased rate among Pima Indians.
• The rate of lower-extremity amputation (LEA) in men has been found to be 2.6 higher than in woman, adjusted for age and duration of diabetes.
Page 4 of 6
• In 2000, the LEA rate was highest for toe amputations (3.0), followed by below-the-knee (2.3), above-the-knee (1.4) and foot (1.0). In 2001, the LEA rate was 6.5 per 1000 people with diabetes.
• Caribbean countries have a high prevalence of diabetes and a high rate of diabetes-related lower-extremity amputations, particularly in the Caribbean black population. In Barbados the amputation rate is 9.4 per 1000, similar to rates for African Americans (9.5 per 1000).
• The habit of going barefoot is common in Caribbean countries and accounts for many diabetic foot problems. In individuals with previous foot ulceration, 47% report that they go barefoot in the home, and 17% go barefoot outside the home.
Management of the diabetic foot
The ideal management for the prevention and treatment of diabetic foot problems includes:
• Regular inspection of the diabetic foot
• Identification of the foot at risk
• Education of people with diabetes and healthcare professionals
• Appropriate footwear
• Rapid treatment of all foot problems
What are the warning signs?
It is important to know the warning signs in order to identify the foot at risk. These include:
• Swelling of the foot or ankle
• Very cold feet or legs
• Color changes: red, blue or black discoloration
• Pain in legs at rest or while walking
• Open sores, no matter how small
• Non healing wounds
• In-growing toe nails
• Corns and calluses
• Lack of hair growth on the foot

[HelenM]

I'd like to know what the actual percentages of eventual foot loss is across diabetics? 1%? 2%? 4%

I found this, I don't think the figures in the post above
During their lifetime, 15 percent of people with diabetes will experience a foot ulcer and between 14 and 24 percent of those with a foot ulcer will require amputation.Foot Health Foundation of America (http://www.foothealthfdn.org/diabetes.htm)

I have also read, but can't find where that the majority of amputations are to diabetics who smoke.

For the moment like Injecto, I'm slightly ambivalent about advice about being overcareful with my feet. At the moment, I know that they heal very quickly (thank goodness as I've had some nasty blisters from running).That said, I do think people need to be aware of the possible problems and the signs to look for.

[Injecto]

. .

[Injecto]

I found this, I don't think the figures in the post above


I have also read, but can't find where that the majority of amputations are to diabetics who smoke.

For the moment like Injecto, I'm slightly ambivalent about advice about being overcareful with my feet. At the moment, I know that they heal very quickly (thank goodness as I've had some nasty blisters from running).That said, I do think people need to be aware of the possible problems and the signs to look for.

Thank you, what you have posted above is much closer to what I was really looking for. And I to feel the same way you do about being ambivalent. On one hand it appears that it's not AS much of an issue as it's made out to be. Threatening that we are 99.9999999999999 times more likely to get a foot cut off is daunting. Finding out that only 3.6% (using the numbers you provided above and assuming the highest % of 24 and still NOT including smoking) will eventually have an ampution of SOME sort (perhaps just a toe and not the whole foot) after 20-30 years of uncontrolled BGs (high in the 12-20s+) is a totally different story.

Actually, using another variation on the stats fromthat website, each year 88,000 amputations are performed. Assuming that each one is unique (not doubled on a person) and assuming the diabetic population of 15.7Million in the USA, that is only .5% have amputations.

So, anywhere from .5% to 3.6% will have an amputation (again, not including stats on poor BG control and smoking).

Yes, people should be made aware of what to do to help themselves stay in good health and know what signs to look for in order to catch a problem. However, this fear tactic of frightening new and old diabetics is borderline criminal as it causes more anxiety/depression/hopelessness than it helps.

[princesslinda]

The amputation complication has always been such a big fear of mine, as both my grandfather and my mother had a leg amputated secondary to a foot ulcer. The statistics you mentioned, injecto, made me breathe a big sigh of relief at the percentages. Both mom and grandad did not work very hard at controlling their diabetes and suffered severely from that. I think it all boils down to controlling blood sugars, whether from meds, diet and exercise or all three.

[Cyborg]

On the Bernstein CDs, he says to avoid getting your callouses shaved when getting a pedicure as it can be a cause of infection.

[sweetblood]

i notice when im on feet all day and take off shoes...my big toenail on rt foot is almost white...i do have a bunoin there...could it be circulatin issies...

shold i try to get a special pair of shoes made...i think i shold...my feet hurt if im on then for more than a few hrs...i have trouble finding comfy shoes...plus i have odd gait

any input appreciated

[sweetblood]

btw...i always wear closed-toe shoes...and i STILL have problems...

[sweetblood]

can feet be MORE SENSITIVE ...when i accidentally hit my foot/step on smthing...it hurts like the dickins.....

[sweetblood]

toe nail s STILL PALE/...think i NEED to get feet checked out...

[ladytaz]

sweetblood, I don't know. I have ULTRA sensitive feet, always have, I feel the tiniest thing under them, and I can barely even walk on cement barefooted without it hurting my feet. My feet are often cold, and have been like that since I can remember as well. The white toenail, could be a circulation issue, but then again, it could just be that your shoe is too tight? But if this is a new thing for you, I suggest you go to a foot doctor. If you need special shoes, they'll let you know and can get them for you. My mother in law just got a pair of 'diabetes shoes' as she calls them ;) a little over a week ago.

[sweetblood]

seems to be new occurrance...i AM prob gonna try to get diabetis shoes...my feet always hurt when i have shoes on...regardless of the shoe...gotta do smthng...my poor feet...i could even tolerate a massage...and i HATE mt feet being touched by others...must be all that tickling i endures wen i was younger...brother tickled my feet till i peed on self...im gonna get hin back one of these days....oooooh, i STILL cringe wen i think of that

[ladytaz]

seems to be new occurrance...i AM prob gonna try to get diabetis shoes...my feet always hurt when i have shoes on...regardless of the shoe...gotta do smthng...my poor feet...i could even tolerate a massage...and i HATE mt feet being touched by others...must be all that tickling i endures wen i was younger...brother tickled my feet till i peed on self...im gonna get hin back one of these days....oooooh, i STILL cringe wen i think of that

Might be a good idea then! ;)

LOL, yes, I hate to have my feet tickled too! I've had only ONE person who could ever touch my feet just right and that was my daughter when she was about 10 years old. I was working at a barcode printer manufacturing plant at the time, and I was standing on my feet 12 hours a day, they hurt SO bad! Every evening after I got home, she would get the lotion and massage my feet and I'd fall asleep! I guess her little hands had just the right amount of pressure to not hurt or tickle ;) Course, I had to bribe her with a dollar every day to do it! LOLOL

[slipperyelm]

Sweetblood, I do think you need to have your feet looked at. Sounds like they do have problems. Bunions can just get worse and cause other problems. I think if a diabetic might need any sort of foot surgery (bunions sometimes need surgery), they should do it while they are as young as possible, as early in the course of diabetes as possible, and when you have as good control over BG as possible. In other words, take care of your foot problems while you can heal well and before the problems become so bad that the healing process becomes a big deal.

[sweetblood]

the foot that has the bunion has beem itching for last few days...at joint of big toe...its driving me wacko...gonna call for appt on monday...to get feet looked at...&@*# diabetes!!