Health Society of South Africa

Diabetes And Your Feet

Are Your Feet In Trouble?

Whether rushing to a business meeting or standing in line at the post office, you depend on your feet to keep you standing and moving throughout your day. But because diabetes increases your chances of developing foot problems, you can't afford to take your feet for granted. Keep your feet out of trouble by giving them the special care they deserve - and need.

Foot Problems Won't Just Go Away
Because you have diabetes, your feet have fewer defenses against everyday wear and tear. Reduced sensation may mean that you can't feel injuries. Reduced blood flow may prevent injuries from healing. In fact, even minor injuries may quickly progress to serious infections. So, take a look at your feet. What kind of shape are they in? A "yes" answer to any of these questions means that your feet may be heading for trouble and you could benefit from podiatric care.

Do you see red spots?
Do you have blisters, corns, or calluses?
Do you feel tingling?
Are your feet cold?
Are your toenails thick or ingrown?

Pressure problems, such as calluses or blisters, can develop without your being aware of them. To relieve pressure, your podiatrist may recommend padding or special shoes.

Take Lifelong Care of Your Feet
Whether you have injuries that need special attention or you just need routine foot exams, your podiatrist - a foot doctor who is specially trained to treat diabetic foot problems - can start you out on a foot health programme. Begin by learning about your feet and how diabetes can damage them. Understand your podiatrist's role in preventing and treating foot problems through regular podiatric exams and treatment. And practice foot self-care to monitor your foot health and guard your feet from harm.

A View Of A Healthy Foot

Imagine: With each step, a healthy foot withstands the pressure of three to four times your body weight. A healthy foot can take all this pressure because it is strong and flexible, and can "bounce back" quickly from daily wear and tear.

Nerves let you feel sensations such as pain, vibration, pressure, heat, and cold.
Blood vessels carry nutrients and oxygen to your feet to nourish them and help them heal from injuries.

Bones give your foot shape and help distribute the pressure from your weight.

Joints are the connections between your bones. They help absorb pressure and enable the parts of your foot to move. Your arch is a group of joints that provides stability for your entire foot.

Skin and fat form a protective "cushion" that absorbs pressure and protects your foot from infection.

Pressure areas absorb the pounding pressure from the body's weight.

Diabetes And Your Feet

When you have diabetes, daily wear and tear can take its toll on your feet - especially in areas that absorb the most pressure. Because of poor blood circulation or loss of feeling in your feet, even a minor problem, such as a tiny break in your skin, may develop into a serious infection.

Damaged nerves may make it difficult to feel pain, pressure, heat, and cold. You may not notice irritated skin, pain, or pressure caused by collapsing joints.

Blocked blood vessels bring fewer nutrients to your feet. Without nourishment, sores may not be able to heal.

Weakened bones may slowly shift, causing your foot to become deformed and changing the way your foot distributes pressure.

Collapsed joints, especially a collapsed arch, can no longer absorb pressure. The surrounding skin may begin to break down.

Broken-down skin, caused by too much pressure coming from either the outside or inside of your foot, can lead to sores or, if bacteria is present, infections.

Blisters or calluses start as red or warm spots. They are often caused by unrelieved skin pressure.

Ulcers (sores) may result if blisters or calluses reach the skin's inner layers. Ulcers may become infected.

Bone Infection may occur if infected ulcers spread. Untreated bone infections may lead to loss of the foot.

Your Podiatrist's Role: Evaluating Your Feet

A thorough podiatric evaluation is the first step in your foot health programme. Your podiatrist reviews the history of your diabetes, and evaluates your overall health and the condition of your feet. He or she also checks your medical history, examines your feet, and, in some cases, takes x-rays and other tests.

Medical History
In addition to asking questions about your diabetes, your podiatrist wants to know about any foot problems you have now or had in the past. He or she may ask about medications you're taking. Your answers help your podiatrist begin to determine the level of care your feet need.

Foot Examination
A foot exam determines whether you have circulation, nerve, skin, bone, or joint problems. Your podiatrist takes each foot's pulse to check how well blood circulates, and also checks for how sensitive your feet are. Your podiatrist examines the condition of your skin and looks for any weakness or collapse in your bones and joints.

Diagnostic Tests
Your doctor may request these or other tests to help pinpoint your specific foot problems.

The Doppler test measures blood flow.
A turning fork and the Semmes-Weinstein test each check your level of feeling.
X-rays show bone weakness or other bone abnormalities.
Scans, such as bone scans, MRI (magnetic resonance imaging), and CT (computed tomography), can point out bone and skin infections.

A tuning fork checks your sensitivity to vibration, often the first sensation to be lost.

The Semmes-Weinstein test uses a wire to check your sensitivity to pressure.

The Doppler test uses harmless sound waves to measure the blood flow in your foot.

Your Treatment Plan
Your podiatrist uses the results of your evaluation to develop an individual foot care programme for you. Your programme may range from developing an effective self-care routine to treating minor foot problems to surgery.

Your Podiatrist's Role: Preventing Infections

Preventing foot infections is the best step toward protecting the health of your feet - a step you can take with the help of your podiatrist. Your podiatrist examines your feet regularly, teaches you about self-care, provides foot "maintenance," and may even recommend special footwear to help relieve extra pressure.

Examining Your Feet Regularly
Even if you don't have symptoms now, they could develop quickly. By following your doctor's schedule for regular podiatric exams, you give your doctor the opportunity to monitor the blood flow and feeling in your feet, as well as catch small foot injuries before they develop into larger infections.

Teaching You Self-Care
The more you know about diabetes and your feet, the better you can monitor your foot health. Your podiatrist teaches you warning signs and foot inspection, as well as many other foot care tips. Your podiatrist is also available, either during your regular appointments or by phone, to answer your questions about your foot health.

Providing Routine Foot Care
Routine foot care helps keep thick and ingrown nails, blisters, corns, calluses, and other skin irritations from developing into ulcers or infections. Your podiatrist may:
Trim or thin nails to keep them from becoming ingrown or thick.
Treat blisters so they won't become infected.
Trim corns and calluses so they won't develop into ulcers or infections.

Providing Customised Footwear
If your podiatrist identifies areas of your feet that may be damaged by extra pressure, he or she may provide you with customised footwear that protects pressure-sensitive areas of your feet and helps keep existing skin irritations from worsening.

Custom inserts can provide extra cushioning for your feet.

Your Podiatrist's Role: Treating Infections

Any minor foot problem - from corns and calluses to cuts and cracks in your skin - can become infected. And if left untreated, infections can become life-threatening. However, prompt treatment by your podiatrist - either at the office or in the hospital - can help clear up the infection and restore your foot health.

Minor Infections
If your podiatrist diagnoses a minor infection, you'll be started on an individualised treatment programme. Your podiatrist's goal, like your own, is to help the infected area heal and keep the infection from spreading.

Treatment
At the office, your podiatrist cleans the infected area. You may be given antibiotics to further combat the infection. Take the full course of antibiotics your podiatrist has prescribed, even if the sore begins to look better; otherwise the infection may continue to spread.

Follow-up Visits
Even with antibiotics and other treatment, infections may take a long time to heal. So that your podiatrist can continue to monitor and treat the infection until it's under control, be sure to keep all of your follow-up appointments.

A prescription for antibiotics may be given to you by your podiatrist to help fight foot infection.

Severe Infections
Infections that spread to bones can also travel throughout your foot and up your leg. To clear up a severe infection, your doctor usually recommends surgery at an outpatient surgery facility or at a hospital as an inpatient. A hospital stay may last a week or longer, depending on the infection's severity and your recovery from surgery.

Surgical Treatment
The goals of surgery are to remove the infection, halt its spread, and save as much of your foot or leg as possible. In addition, expect IV (intravenous) antibiotics to help control infection.

Wound Care
Regular wound care after your surgery helps keep your foot free of infection and aids healing. Dressings are changed often - usually daily - to protect your foot from infection. Also, you may take special medication to help your foot heal more quickly.

A home care nurse may be recommended by your podiatrist to shorten your hospital stay and help you change dressings at home.

Self-Care: Inspecting Your Feet

Inspecting your feet helps you catch small skin irritations before they become serious infections. Check daily for these warning signs that could mean your feet are in trouble. If you can't see your feet, ask a relative or friend to help. And see your podiatrist right away if you find a problem.

Color Changes
Redness with streaks is often a sign of an infection. Pale or blue tones may mean poor circulation. Black skin is a sign that tissue has died.

Swelling
Swelling, sometimes with color changes, may be a sign of poor circulation or infection. Symptoms include tenderness and an increase in the size of your foot.

Temperature Changes
Warm areas may mean that your feet are infected. Cold feet often are a sign that your feet aren't getting enough blood.

Sensation Changes
Odd sensations like "pins and needles," numbness, tingling, burning, or lack of feeling may mean nerves are damaged.

Hot Spots
Red "hot spots" are caused by friction or pressure. Hot spots can turn into blisters, corns (thick skin on toes), or calluses (thick skin on the bottom of the foot).

Cracks, Sores, Ulcers
Cracks and sores are caused by dry or irritated skin. They're a sign that skin is breaking down, and can also lead to ulcers.

Ingrown Nails
Ingrown toenails are often caused by tight-fitting shoes or incorrect nail trimming. Symptoms include nails that are growing into the skin, swelling, redness, or pain.

Drainage and Odor
Drainage and odor may develop from untreated ulcers. White or yellow moisture, bleeding, and odor are often signs of infection or dead tissue.

A hand help mirror is useful for checking the bottom of your feet.

Call your podiatrist immediately if you notice:
Increased heat
Fever and chills
Swelling
Redness or streaking

Self-Care: Keeping Feet Healthy

Keeping your feet healthy is a task you share with your podiatrist. One of the best ways to keep your feet in shape is to protect them with the correct shoes and socks. What else? Do daily foot exercises, give your feet extra special care, and control your diabetes. And ask your podiatrist for other self-care tips.

Check Shoes and Socks
Shoes and socks that fit properly can both prevent foot problems and keep existing problems from getting worse. When shopping for shoes, make sure the toe box is roomy enough so you can wiggle all your toes. Avoid open-toed or open-heeled shoes. When buying socks, choose soft, padded socks with seams that don't irritate your feet. Your podiatrist can make sure your shoes and socks fit well.

Exercise Your Feet
Exercising regularly can help the blood flow into and out of your feet and increase your flexibility. Special exercises for feet, as well as walking, swimming, and bicycling, are good types of exercise. Call your podiatrist if exercising is uncomfortable, or if you notice any warning signs such as redness, burning, or tenderness during or after exercise.

Do your ABCs with each foot by spelling out the alphabet in the air. Doing ABCs can increase blood flow and keep feet flexible.

Walk frequently. It's the best overall conditioner for your feet. Walking improves both your circulation and your general health.

Take Special Foot Care
These self-care tips can help prevent foot problems:
Use warm water to wash feet that have lost feeling.
Avoid heating pads if your feet are cold. You could burn your feet.
Check socks to make sure objects or seams aren't rubbing against your feet.
Don't cross your legs if you have poor circulation. It could reduce blood flow even more.
Avoid over-the-counter medications for corns and calluses. They could burn your feet.
Never walk in bare feet.

Control Your Diabetes
A good foot care programme includes controlling your diabetes. Eat low-fat, sugarless foods, monitor your blood sugar levels, take prescribed medications, and exercise daily. Regular checkups by your health care team can also help to control your diabetes.

Keeping Feet Fit

Diabetes doesn't have to lead to serious foot problems. Your podiatrist, as part of your diabetic health care team, can work with you to keep your feet healthy and treat any problems that occur. But remember, keeping your feet fit takes effort and commitment from the most important team member - you.