DIABETES AND FOOT DISEASE 

In a recent survey, it was found that about 86,000 lower limbs are amputated annually due to complications from diabetes. Most people with diabetes are aware that their condition may lead to foot numbness, foot ulcers, foot infections and, potentially, an amputation.

What can go wrong?

If you have diabetes, you would want to avoid serious foot problems that can lead to a toe, foot, or leg amputation. What should be done? It's all about taking good care of your feet.

Foot care is very important for each person with diabetes, but especially if you have:
 

1 Loss of feeling in your feet.
2 Changes in the shape of your feet.
3 Foot ulcers or sores that do not heal.
 

Nerve damage can cause you to lose feeling in your feet. You may not feel a pebble inside your sock that is causing a sore. You may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers which may lead to amputation.

Keeping your blood glucose (sugar) in good control and taking care of your feet every day can help you avoid serious foot problems.

There is a lot you can do to prevent serious problems with your feet. Here's how.

1. Take care of your diabetes. Make healthy lifestyle choices to help keep your blood glucose (sugar), blood pressure, and cholesterol close to normal. Doing so may help prevent or delay diabetes-related foot problems as well as eye and kidney disease.

2. Check your feet every day. You may have serious foot problems, but feel no pain. Check your feet for cuts, sores, red spots, swelling, and infected toenails. Find a time (evening is best) to check your feet each day. Make checking your feet part of your everyday routine. If you have trouble bending over to see your feet, use a plastic mirror to help. You also can ask a family member or caregiver to help you. Make sure to call your doctor right away if a cut, sore, blister, or bruise on your foot does not begin to heal after one day. If your toe looks blue or dusky, beware it may be early gangrene.

3. Wash your feet every day. Wash your feet in warm, not hot, water. Do not soak your feet for too long, because your skin will get dry. 

Before bathing or showering, test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow.

Dry your feet well. Be sure to dry between your toes. Use talcum powder or cornstarch to keep the skin between your toes dry.

4. Keep the skin soft and smooth. Rub a thin coat of skin lotion, cream, or petroleum jelly on the tops and bottoms of your feet.

Do not put thick lotion or cream between your toes, because this might cause an infection.

5. Smooth corns and calluses gently. If you have corns and calluses, check with your doctor or foot care specialist about the best way to care for them. If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.  Do not cut corns and calluses. Don't use razor blades, corn plasters, or liquid corn and callus removers -- they can damage your skin.

Make sure to call your doctor right away if a cut, sore, blister, or bruise on your foot does not begin to heal after one day.

6. Trim your toenails each week or when needed. Trim your toenails with clippers after you wash and dry your feet.

Trim toenails straight across and smooth them with an emery board or nail file.

Don't cut into the corners of the toenail.

If you can't see well, if your toenails are thick or yellowed, or if your nails curve and grow into the skin, have a foot care doctor trim them.

7. Wear shoes and socks at all times. Wear shoes and socks at all times. Do not walk barefoot -- not even indoors -- because it is easy to step on something and hurt your feet. This may be hard to do in Singapore, if you feel it is not possible to wear shoes and socks all the time, be extra careful.

Choose clean, lightly padded socks that fit well. Socks that have no seams are best.

Check the insides of your shoes before you put them on to be sure the lining is smooth and that there are no objects in them.

Wear shoes that fit well and protect your feet.

8. Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement.  Keep your feet away from radiators and open fires. Do not put hot water bottles or heating pads on your feet. Wear socks at night if your feet get cold. Lined boots are good in winter to keep your feet warm. Check your feet often in cold weather to avoid frostbite. In Singapore, people are fond of doing the "pebble" walk to massage their feet. This is not advisable if you have diabetes!

9. Keep the blood flowing to your feet.  Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs.

Don't cross your legs for long periods of time.

Don't wear tight socks, elastic or rubber bands, or garters around your legs.

Don't smoke. Smoking reduces blood flow to your feet. Ask for help to stop smoking.

Work with your health care team to control your HbA1c, blood pressure and cholesterol.

10. Be more active. Ask your doctor to help you plan a daily activity program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid activities that are hard on the feet, such as long-distance running and jumping.

Always include a short warm-up and cool-down period.

Wear athletic shoes that fit well and that provide good support.

11. Be sure to ask your doctor to check the sense of feeling and pulses in your feet.  This should be done at least once a year.

What can I do about the numbness in my feet?

Some patients have persistent tingling or numbness or even pain in their feet. This may be due to nerve damage (neuropathy). Be sure to tell your endocrinologist. New medications like gabapentin have been found to be helpful for this problem.