By Dr. Steven Gershman, DPM
Diabetics are much more vulnerable to major complications such as ulcers, infections and numbness or pain. In previous blogs I have written extensively on this subject.
10 Simple Smart Tips That Focus on Footcare for Diabetics
- 1. Inspect your feet daily. This is probably the most important tip, yet the simplest. Look at the entire foot from ankle to toes, including the bottom. If you can't see the bottom, have someone else you trust do it or use a mirror or a cell phone camera and take a picture. I often take pictures with my phone in the office for patients to show them problems on the bottom of the feet that they can't see. With the camera I can show close ups and enlarge areas. Cell phone cameras are a great tool. Look for irritations such as red areas, calluses, cracks in the skin, new lesions, any changes in general, between toes for white areas or cracks. Any bleeding should be reported to your provider or podiatrist immediately.
- 2. Wash your feet daily in warm, but not hot water. Wash and thoroughly dry between toes as these areas often are neglected. Threads and fluff can easily hide there and lead to irritation and friction. In addition, since these areas are dark and closed, it is the perfect breeding ground for bacteria and fungi. Check the water temperature first with your hands as the feet may not feel too hot water. If your fingers are numb, use your elbow. Do not soak your feet regularly as soaking tends to dry out the skin.
- 3. Don't cut your own toenails. Generally, it is better if you have someone else trim your nails. If the nails are normal and you have someone handy who can cut them for you at home that is ok. If not, have a professional like a podiatrist cut them. If they are thick or deformed, definitely have a podiatrist cut them. By having a podiatrist cut the nails, any other issues or potential problems can be spotted early and dealt with. Whoever trims your nails should always cut them straight across and not too short. This will prevent your nails from becoming ingrown which can lead to other painful problems.
- 4. Don't EVER use a sharp instrument to trim calluses or take off growths on the skin. Using sharp instruments on your own feet is a recipe for disaster. It is easy to cut yourself and create a serious infection. Infections in diabetic feet are more difficult to treat and can lead to serious complications and hospitalizations. Don't use over the counter wart or callus removers either as they usually contain acid which can burn the feet. Any calluses should be treated by a medical professional, usually a podiatrist. Any skin lesions need to be fully evaluated by a professional before cutting off.
- 5. Use a moisturizer on the feet EVERY day, preferably at bedtime so that your feet can soak up the cream. Diabetic feet often are dry due to nerve damage affecting the sweat glands. Dry skin can crack open easily and is less able to handle stresses on it. I recommend a non-scented moisturizer that is petroleum based, like ointment. In severe cases there are prescription strength moisturizers that your provider can prescribe. Bedtime is best as the moisturizer stays on all night. Do NOT use moisturizers between toes. Always dry the skin between toes as moisture traps there and can lead to fungus or bacterial infections.
- 6. NEVER walk barefoot. Many diabetics have poor or no feeling in their feet. It is easy to step on a foreign object and damage the foot when barefoot. Another issue is when walking barefoot it is easy to traumatize the toes and foot by hitting objects such as furniture causing cuts and broken bones. An object that gets into the bottom of the foot from stepping on it can lead to serious limb threatening infections. Diabetics don't handle infections well and heal poorly in many cases. If you prefer not to wear your “outside” shoes inside the house, invest in a good pair of supportive slippers that offer the same comfort and protection as orthopedic shoes. I highly recommend Orthofeet slippers are they are designed with an orthotic insole, customized cushioning and have many adjustable features.
- 7. Keep your blood sugar under control. Elevated blood glucose/sugar can add to or cause neuropathy. Neuropathy can lead to numbness/lack of feeling in the feet. Lack of feeling is the single most dangerous symptom of diabetes on the feet. It can lead to ulcers, infections, and amputation. Also, as the sugar rises it is harder to stop infections as the white cells that fight infection don't work as well. Eat a well-balanced diet and monitor your sugar levels regularly.
- 8. Don't smoke. Smoking is a devastating force to the whole body including the feet. I can always tell if a person smokes in my office by the feel of their feet. Almost all smokers have cold toes as smoking constricts the blood vessels in the feet, especially the toes. Smokers don't heal as well from cuts in the feet and have a harder time with infections. The large blood vessels in the legs often occlude in smokers and can lead to amputations.
- 9. Wear proper shoes and insoles, particularly diabetic extra depth shoes. Shoes for diabetics should be available in multiple widths, even up to extra extra wide to prevent rubbing and excess pressure on wide feet. They should be deep enough to handle diabetic inserts or orthotics. The upper, leather or fabric, should be soft and the inside should be padded and smooth with no seams as to not irritate the skin. 4-way stretch fabric is even better as it conforms to the contours of your foot shape and creates a pressure free environment. The toe box should be high and wide to handle the common toe deformities such as bunions and hammertoes without rubbing on the toes. Orthofeet, a leader in orthopedic shoes, specializes in designing styles for the sensitive diabetic and neuropathic foot. They offer a wide range of diabetic shoes for both men and women in extended sizing up to 6E.
Insoles should be worn with the shoes. Diabetic insoles often have a top cover of pink soft material that molds to the foot and offloads any bumps. The insole should have a mild arch for support. Orthofeet manufactures the Biofit Insole and the doctor prescribed Thermofit insole that are especially well made for diabetics. They feature a contoured arch support and deep heel cup to provide comfortable support to help stabilize the foot, reducing stress on feet, ankles and knees. Their soft cushioning foam dynamically shapes to the contours of the foot providing excellent shock absorption and alleviating pressure on the bottom of the foot.
- 10. Wear proper socks. You might think that all socks are good and would work for the diabetic foot since they are soft, but that is not the case. Avoid cotton socks as they hold moisture against the feet and stay wet. Synthetic fibers like polypropylene or natural wool are superior. Orthofeet manufactures specially designed bamboo type socks, BioSoft, for diabetics that are soft and wick moisture away from the feet. In addition, socks should not have tight tops that grip the leg and cause constriction around the lower leg leaving marks. Diabetic socks should be stretchable around the leg but not tight. Orthofeet’s diabetic socks are also uniquely designed with a white sole which is very important for diabetics. This can alert the wearer of new ulcers, blisters or wounds that have formed they might not have felt due to neuropathy.
Finally, diabetes is a lifetime issue for most. It can be managed. In 31 years of practice I have not had a single diabetic patient I treated lose a foot. As a podiatrist I work with patients to help them through education as well as medical care to protect their feet. The 10 diabetic foot care tips above all help.