Health Society of South Africa

DIABETIC FOOT CARE
Treatment and Self-Care for Healthy Feet

Are Your Feet In Trouble?

Whether you're rushing to a business meeting or standing in line at the post office, you depend on your feet to keep you moving. But diabetes increases your chances of developing foot problems, so you can't afford to take your feet for granted. Give them the special care they need.

Foot Problems Won't Just Go Away
Because you have diabetes, your feet have fewer defenses against everyday wear and tear. Nerve damage 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" to any of the following questions means that your feet may be in trouble and you could benefit from medical care.

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

Take Lifelong Care of Your Feet
Whether you have injuries that require special attention or you just need routine foot examinations, your primary care physician and other members of your diabetes health care team can start you out on a foot health programme. Begin by learning about your feet and how diabetes can damage them. Understand your health care team's role in preventing and treating foot problems. In some cases, you may also be referred to a podiatrist - a foot care specialist. 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 a person's body weight. A healthy foot can take all this pressure because it is strong and flexible, and can "bounce back" quickly.

Nerves let you feel 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 body's weight.
Joints are the connections between your bones. They help absorb pressure and allow your foot to move. Your arch is a group of joints that provides stability for your entire foot.
Skin and fat form a "cushion" that absorbs pressure and protects your foot from infection.

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, even a tiny break in your skin may develop into an infection.

Damaged nerves may make it difficult for you to feel pain, pressure, heat and cold.
Blocked blood vessels bring fewer nutrients and oxygen 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 or provide stability. The surrounding skin may begin to break down.
Broken-down skin, caused by too much pressure, can lead to sores or a serious infection, if bacteria are present.

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.

Evaluating Your Feet

A thorough evaluation is the first step in you foot health programme. It includes a review of the history of your diabetes and your overall health. A foot examination and x-rays or other tests are also often part of the evaluation.

Medical History
Your doctor and other health care team members want to know about any foot problems you have now or have had in the past. You may also be asked about medications you're taking. Your answers help your doctor determine the level of care your feet need.

Foot Examination
A foot examination can reveal circulation, nerve, skin, bone or joint problems. By taking each foot's pulse, your doctor can check how well blood circulates. Your doctor or another health care team member examines the condition of your skin and looks for any weakness or collapse in your bones and joints. The sensitivity of your skin may also be checked.

Possible Tests
Your health care team may request these or other tests to help pinpoint your particular foot problems.

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

Your Treatment Plan
Your health care team uses the results of your evaluation to create 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.

Preventing Foot Infections

Preventing foot infections is the best step toward protecting the health of your feet. Your doctor or another member of your team examines your feet regularly, teaches you about self-care, provides foot "maintenance" and may recommend special footwear to help relieve extra pressure.

Examining Your Feet Regularly
Even if you don't have symptoms now, they could develop quickly. Follow your schedule for regular examinations. Give your health care team the opportunity to monitor the blood flow and feeling in your feet, as well as to 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. A member of your health care team can teach you warning signs and how to inspect your feet, as well as many other foot care tips. But make sure to ask any questions you have 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. A member of your health care team may do the following:

Trim or thin nails to keep them from becoming ingrown or thick. (Ask how to trim your nails the right way.)
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 areas of your feet have been damaged by extra pressure, you may be referred to a podiatrist for customised footwear. It protects pressure-sensitive areas of your feet and helps keep existing skin irritations from worsening.

Treating Foot Infections

Any minor foot problem - from a corn or callus to a crack in your skin - can become infected. If left untreated, infections can become life threatening. Prompt treatment by your doctor can help clear up the infection and restore your health.

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

Treatment
Your doctor examines and cleans the infected area. You may be given antibiotics to further combat the infection. Take the full course of antibiotics your doctor has prescribed, even if the sore begins to look better; otherwise, the infection may continue to spread. You may also need to soak and dress your foot to aid healing.

Follow-up visits
Even with antibiotics and other treatment, infections may take a long time to heal. Be sure to keep all of your follow-up appointments to ensure complete treatment and proper healing.

Severe Infections
Infections that spread to bones can also travel throughout your foot and up your leg. To treat a severe infection, your doctor will likely refer you to a podiatrist or surgeon for surgery at an outpatient facility or hospital. You may be hospitalised for 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 foot 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 need to take special medication to help your foot heal more quickly.

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 doctor right away if you find a problem.

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

Swelling. Swelling, sometimes with colour 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 and ulcers. Cracks and sores are caused by dry or irritated skin. They're a sign that skin is breaking down, which could lead to ulcers.

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

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

Self-Care: Keeping Your Feet Healthy

Keeping your feet healthy is a task you share with your health care team. One of the best ways to keep your feet in shape is to protect them with the right shoes and socks. What else? Do daily foot exercises, give your feet extra special care, and do what you can to control your diabetes.

Check Shoes and Socks
Shoes and socks that fit properly can prevent foot problems from getting worse. Your doctor can make sure your shoes and socks fit well. When shopping for shoes, check that the toe box is roomy enough so you can wiggle all your toes. Avoid open-toed or open-heeled shoes. Choose soft, padded socks with seams that don't irritate your feet. Inspect your shoes and socks for anything that could rub against your feet.

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 doctor if exercising is uncomfortable, or if you notice any warning signs such as redness, burning and tenderness during or after exercise.

Take Special Care
The self-care tips below can help prevent foot problems:

Use warm water and mild soap to wash your feet every day, but don't soak. Dry well.
Inspect your feet daily for cracks, blisters, scratches or dry skin. If your feet are dry or scaly, use moisturising cream.
Avoid heating pads and hot water bottles. You could burn your feet.
Don't cross your legs. It can reduce blood flow to your feet.
Don't use razors or over-the-counter medications to treat corns and calluses. They could damage your feet.
Don't smoke, since smoking can reduce blood flow to your feet.
Never walk barefoot.

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 Your Feet Fit

Diabetes doesn't have to lead to serious foot problems. 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.