Diabetes decreases blood flow, so injuries heal slowly. A foot wound as small as a blister from wearing tight shoes can lead to severe complications. According to the American Diabetes Association, almost 6 percent of the U.S. population has diabetes (5.9 percent, about 15.7 million people). Neuropathy, or nervous system damage, is a major complication that affects about 60 to 70 percent of diabetics, and may cause numbness, or the loss of feeling, in their feet or hands.
Diabetics are at a large risk for foot problems, and must constantly monitor their feet to avoid serious complications that can lead to amputation. Diabetics heal more slowly because of decreased blood flow, so small injuries can quickly become severe, as unhealed wounds are at increased risk for infection. Infections spread quickly in those suffering from diabetes, and can quickly become serious.
Diabetics need to inspect their feet every day for puncture wounds, bruises, pressure areas, redness, warm spots, blisters, ulcers, open sores, scratches, cuts, and problems with the nails. If you have a hard time seeing your feet, use a mirror, or have someone help you.
Neuropathy, or numbness, increases the risk of feet becoming deformed. Open sores can easily become infected, developing into ulcers. Neuropathy can also lead to Charcot foot (pronounced “sharko”), one of the most serious foot problems that can develop. Charco foot is caused by bones fracturing and disintegrating, warping the foot. The condition gets worse as you continue to walk on it because you can’t feel the pain.
Both foot ulcers and the early stages of Charco fractures can be treated using a total contact cast. The cast is molded from the shape of your foot, and is changed regularly, every one to two weeks, until your foot heals. In order to be effective, the contact cast requires good blood flow in the foot. The cast allows ulcers to heal by more evenly distributing weight, and relieving the pressure against the sore. In the case of Charco foot, the cast supports the foot, and controls movement. Charcot foot can also be treated with a custom walking boot, which supports the foot until the swelling goes down, a process that can take up to a year. With both the contact cast and walking boot, you should try to keep from putting weight on the affected foot. If the warping of the foot is too severe for a brace, cast, or shoe, surgery may be considered.
Basic foot care:
- Keep your feet warm.
- Avoid getting your feet wet in snow or rain.
- Don’t put your feet on radiators or in front of the fireplace.
- Don’t smoke, and don’t sit cross-legged. Both decrease blood supply to your feet.
- Don’t soak your feet.
- Don’t use antiseptic solutions, drugstore medications, heating pads, or sharp instruments on your feet.
- Cut your toenails straight across; avoid cutting the corners. Use a nail file or emery board instead of clippers or scissors. If you find an ingrown toenail, contact your podiatrist
- Moisturize the skin on your feet with good quality lotion, but avoid getting any lotion between your toes.
- Wash your feet with mild soap and warm water daily.
- Wear loose socks to bed.
- Wear warm socks and shoes on cold days.
- Pat each foot dry with a towel, making sure to carefully dry between the toes.
- Buy shoes that are comfortable even before they are “broken in.” Make sure they fit widthwise and lengthwise, at the back, bottom of the heel, and at the sole. Avoid shoes with pointed-toes or high heels. Shoes with leather uppers and deep toe boxes are better. While breaking in shoes, wear the new shoes for a maximum of two hours at a time.
- Alternate your shoes: don’t wear the same pair every day. Check the inside of each shoe for rips, tears, or anything that could cause friction and rub against your feet, causing blisters or irritation. Don’t lace your shoes too tight or too loose.
- Wear appropriate socks and stockings. Wear clean, dry socks every day. Do not wear wrinkled socks, or socks with holes in them. Thin cotton socks are more absorbent, and will keep your feet dry, especially on warm days. Socks with square toes are roomier, and will not squeeze your toes. Do not wear socks or stockings with elastic tops.