Diabetes

Diabetes and Foot Care

Diabetes can have a significant impact on the feet and can lead to nerve damage and reduced blood flow. This means that people with diabetes require special care to prevent infections and foot ulcers that can cause pain and further complications. It is crucial to prioritize prevention in order to avoid these issues.

Diabetic Feet

 Diabetes has significant impacts on foot health, leading to nerve damage, compromised blood supply, Charcot foot, and foot ulcers. High blood glucose levels cause peripheral neuropathy, which damages the nerves and results in insensitivity or numbness in the feet. The lack of feeling can make it difficult for diabetics to detect injuries such as cuts or blisters, which can lead to serious ulcers and, in extreme cases, foot amputation. Symptoms of diabetic foot nerve damage include numbness, coldness, pins and needles, and burning pains in the feet and legs, often occurring at night. It is crucial for diabetics to receive proper care and attention to prevent these conditions from manifesting.

Peripheral Vascular Disease / Blood Supply

 Diabetes can lead to changes in the arteries and blood vessels, reducing blood flow to the hands and feet. This condition, called peripheral vascular disease, can cause problems with wound healing, cramps, and pains in the feet and legs. Cuts and sores may also take longer to heal. It's worth noting that smoking and high blood fats can further worsen circulation problems. Symptoms of poor blood supply include cold feet, reddish-blue discoloration, slow-to-heal cuts, pain and discomfort in the feet (even when resting), and leg cramps after walking short distances or up stairs.

Charcot Foot / Rocker Bottom Foot

 Charcot foot, also known as rocker bottom foot, often occurs in people with diabetes who have peripheral neuropathy. This condition weakens the bones in the feet, making them susceptible to fractures and dislocation. Because of the numbness caused by peripheral neuropathy, people may continue to walk and stand, causing further damage. Over time, the joints in the foot may collapse or dislocate, leading to a change in the foot's shape and the characteristic rocker bottom appearance.

Diabetic Foot Ulcers

Diabetic foot ulcers can be caused by a variety of factors, such as nerve damage, poor circulation, Charcot foot, high glucose levels, and irritated or wounded feet. These ulcers are open sores or lesions that take a long time to heal or do not heal at all, and can easily become infected with the breakdown of the skin and tissue of the feet.

Foot ulcers can range in severity, from small and superficial to large and deep, potentially affecting tendons, bones, and causing abscesses, osteomyelitis, or tendonitis. In extreme cases, the entire foot may be involved with gangrene, appearing as a deep circular hole on the underside of the foot where pressure is applied during walking.

All people with diabetes have an increased risk of developing foot ulcers. At Peakfeet Podiatry, we offer comprehensive foot assessments to prevent and treat existing foot ulcers. However, some factors increase the likelihood of developing this debilitating condition, such as poorly fitted shoes, poor hygiene, alcohol consumption, heart disease, obesity, smoking, kidney disease, eye disease from diabetes, and improperly cut or neglected toenails.

Assessing the Risk of Foot Complications in Diabetic Patients

Each diabetic patient has a unique set of factors that can increase or decrease their risk of developing foot complications. At our Peakfeet Podiatry clinic, we conduct a painless and straightforward assessment to determine each patient's risk level and provide ongoing care and check-ups accordingly.

Low-Risk Diabetic Patients

Diabetic patients who don't smoke, consume only small amounts of alcohol, maintain a healthy weight through a balanced diet and regular exercise, and take good care of their feet by checking them daily and maintaining good hygiene are at a lower risk of experiencing foot complications.

High-Risk Diabetic Patients

On the other hand, several personal factors can increase the risk of developing foot complications in diabetic patients, such as having diabetes for a long time, smoking, drinking alcohol regularly, having an inactive lifestyle, being overweight or obese, having high blood glucose levels for an extended period, and having a history of foot ulcers or amputations. Poor feeling in the feet and decreased blood flow, as well as inconsistent foot hygiene and care, can also contribute to a higher risk of developing foot complications.

How regularly should you see a podiatrist to check your Diabetic Feet?

The risk factors and personal circumstances of each individual determine the frequency with which they should receive podiatry checks to ensure the health of their diabetic feet. A podiatrist will conduct an assessment to determine the level of risk and develop an ongoing healthcare plan. The table below provides a general guideline for the recommended frequency of podiatrist checks for low and high-risk individuals:

Low Risk:

Daily self-checks for signs of infection, swelling, redness or breaks in the skin.
Thorough professional foot assessment and treatment every 6-12 months.

High Risk:

Daily self-checks for signs of infection, swelling, redness or breaks in the skin.
Thorough professional foot assessment and treatment every 3-6 months.

Self-Care for Diabetic Feet

For people with diabetes, practicing daily self-care routines and regularly checking their feet is crucial in addition to seeing a podiatrist for check-ups. Here are some self-care practices to follow:

• Wash and dry your feet daily, especially between the toes.
• Examine your feet for marks, cuts, swelling, and discoloration using a mirror if necessary.
• Wear shoes that fit correctly and have enough depth, width, and length to avoid rubbing or blisters.
• Use only diabetic-specific socks that have anti-microbial, moisture-wicking, hypoallergenic properties, a seamless design, extra padding, and ankle bands that don't cut into the skin.
• Always wear supportive footwear and avoid going barefoot, even at home.
  Check toenails regularly and cut and file them carefully.
• Moisturize the feet, especially dry areas, but avoid applying lotion between the toes.
• Feel the inside of your shoes for stones or foreign objects that could cause injury.
• Do not use over-the-counter treatments for corns, warts, and calluses; seek professional assistance first.
• Maintain a healthy weight range through exercise for at least 30 minutes a day, as excess weight can place undue pressure on the feet's skin, tendons, ligaments, and bones.
• Stop smoking, as tobacco can worsen circulatory problems.
• Limit or eliminate alcohol consumption, as it can contribute to neuropathy (nerve damage), deaden the nerves, and increase the likelihood of overlooking seemingly insignificant injuries or cuts.
• Follow a healthy diet and avoid sugar-sweetened drinks and juices.
• Reduce stress.
• Test foot sensitivity by brushing a feather or another light object over the foot to feel the sensation.

Diabetic Footwear

Selecting the right footwear is a crucial aspect of a thorough self-care regimen for diabetics. It's important not to feel pressured into making a footwear decision that doesn't completely meet your needs. It's advisable to avoid high heels, open-toed shoes, narrow shoes, flip-flops, or walking around barefoot. The ideal footwear options are closed-in joggers/athletic shoes or closed-in leather shoes with a cushioned sole.

For the best results, visit a professional footwear shop that specializes in accurately measuring, assessing, and fitting feet. Some stores allow you to buy a pair of shoes and try them at home in a hygienic environment for an hour or so. This extended period of wearing the shoes will enable you to assess their fit and comfort more accurately. If you have reduced foot sensitivity, always thoroughly examine your feet visually for any signs of damage such as blisters, redness, or pinched skin after wearing new shoes for the first time.