Discover essential foot care practices for diabetic patients. Learn how to prevent complications and maintain healthy feet. Meri Sehat offers expert advice and resources for diabetic foot care

The Foot Care Guide For Diabetic Patients

PNS SHIFA

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Syed Intisar Hussain

Introduction

<a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes </a>foot problems are quite common as, according to the American Diabetes Association, 1 in 5 people with diabetes seek hospital care for it<a href="#accordion">[1]</a>. However, that doesn&#39;t mean everyone with diabetes has diabetic feet.

You won&#39;t succumb to diabetic feet if you give your feet all the attention they deserve. It&rsquo;s all the more imperative if your blood sugar levels are continually out of range.&nbsp;In short, you need to be proactive while taking care of your feet to avoid diabetic foot or any other complications. 
&nbsp;

Understanding Foot Care For Diabetic Patients

To understand the correlation between diabetes and foot problems, you first need to have a clear idea about what diabetes really is.&nbsp;

&nbsp;

<h5>Understanding Diabetes&nbsp;</h5>

Diabetes mellitus, or diabetes for short, is a metabolic disorder that causes high blood sugar levels, which is referred to as hyperglycemia.&nbsp;

The reason for diabetes is either absolute or relative deficiency of insulin or insulin resistance. Insulin is the hormone released by the pancreas that helps to maintain a normal level of blood glucose levels by ensuring glucose uptake in the liver and muscles after a meal.&nbsp;

&nbsp;

There are 3 different types of diabetes<a href="#accordion">[2]</a>:

<ul>
	<li>Type 1 Diabetes Mellitus: This type of diabetes has an autoimmune basis, which means that the body&#39;s own immune cells start attacking the pancreas resulting in an absolute deficiency of insulin. The reason behind this autoimmune destruction of cells in the pancreas that produce insulin remains unclear. This type of diabetes affects both children and young adults.</li>
	<li>Type 2 Diabetes Mellitus: Almost 90-95% of individuals with diabetes have this type of diabetes. It occurs when cells in the body become unresponsive to insulin and the sugar levels peak in the blood resulting in hyperglycemia.</li>
	<li><a href="https://merisehat.pk/disease/diabetes-gestational">Gestational Diabetes</a>: Some women experience this type of diabetes during pregnancy. Their placenta makes hormones that block insulin from functioning.&nbsp;</li>
</ul>

&nbsp;

Note: If left untreated, all three types of diabetes result in blood sugar levels beyond the normal range, which ultimately damages multiple sites in the body like the kidneys, eyes, nerves, and other organs.&nbsp; 
&nbsp;

Some common symptoms of diabetes include<a href="#accordion">[2]</a><a href="#accordion">[3]</a>:

<ul>
	<li>Increase in thirst&nbsp;</li>
	<li>Increase in hunger&nbsp;</li>
	<li>Increase in frequency of urination&nbsp;</li>
	<li>Weight loss (individuals with gestational diabetes would have increased weight gain during pregnancy)</li>
	<li>Blurry vision&nbsp;</li>
	<li>Sores that heal slowly or do not heal&nbsp;</li>
	<li>Fatigue&nbsp;</li>
	<li>Numbness or tingling in hand or feet&nbsp;</li>
	<li>Dry or itchy skin&nbsp; 
	&nbsp;</li>
</ul>

Now back to the initial question: how can diabetes cause foot problems? So, diabetes damages the nerves, a condition called diabetic neuropathy. As a result, you may experience pain, tingling, and burning sensations in your affected foot. If the nerve damage is extensive, you may feel nothing at all.&nbsp;

While the idea of having an area of skin being pain-free may sound great, not being able to have any sensation in any region of your body is far from great. The dangers associated with not being able to sense anything are so serious that it can even cost you losing the affected part through amputation, that is, surgically removing the affected limb.

As an individual with diabetic neuropathy, you may not feel a stone or pebble underneath your sole; you won&rsquo;t even feel a blister or if your foot&rsquo;s sore. When these lesions are not treated early on, they can either become the portal of entry for bacteria and other microorganisms causing infection or they can result in ulcer formation due to delayed healing of the skin<a href="#accordion">[4]</a>.

Slow healing in diabetic individuals is because the blood vessels supplying the periphery become very narrow which reduces the amount of blood flowing in the leg and foot. This impedes the healing process and infections of the feet often take too long to heal or at times may not heal at all. When an infection doesn&#39;t resolve, it progresses to gangrene (death of body tissue due to inadequate blood perfusion or due to serious bacterial infection).&nbsp; 
&nbsp;

Once gangrene or ulcers form in the foot, treatment options include removing the dead tissue and treating existing infections. In extreme cases, amputation of the involved part, such as the toe, foot, or part of the leg is the only option.

Therefore, in order to prevent the loss of a part of your limb, precautions should be taken and foot care needs to be maximized. Controlling blood sugar levels is the only way to prevent diabetic foot. In case a foot problem develops, a foot specialist or a podiatrist needs to be consulted immediately<a href="#accordion">[4]</a>. 
&nbsp;

Nerve damage eventually leads to diabetic foot if not treated. The following risk factors increase the risk of developing diabetic neuropathy<a href="#accordion">[3]</a>:

<ul>
	<li>High blood sugar levels that are difficult to manage&nbsp;</li>
	<li>Having a long history of diabetes with blood sugar levels beyond normal ranges&nbsp;</li>
	<li>Being overweight&nbsp;</li>
	<li>Having hypertension (increased blood pressure)&nbsp;</li>
	<li>Having high levels of cholesterol&nbsp;</li>
	<li>Being more than 40 years of age&nbsp;</li>
</ul>

&nbsp;

There are some measures that you can take to prevent nerve damage:&nbsp;

<ul>
	<li>Maintain healthy blood sugar levels&nbsp;</li>
	<li>Quit smoking since smoking reduces blood perfusion to the feet</li>
	<li>Use medications as prescribed by the doctor&nbsp;</li>
	<li>Become physically active&nbsp; 
	&nbsp;</li>
</ul>

You need to be consistent with your foot care regimen as it is the only way to prevent foot problems in diabetes. There&#39;s no denying that managing diabetes can get quite overwhelming with trying to maintain your blood sugar levels, going for doctor&#39;s appointments, taking medications, staying active along with eating healthy; and there is a chance that your feet get neglected in the process.&nbsp;However, incorporating foot care into your daily routine will help reduce the risk of developing diabetic feet. Remember, persistence is the key!&nbsp;

&nbsp;

Here&#39;s a list of tips that you can follow to ensure that your feet stay healthy<a href="#accordion">[3]</a>:

&nbsp;

<ul>
	<li>Inspect Your Feet Daily</li>
</ul>

You need to regularly check your feet for any signs of bruises, scar marks, blisters, swelling, sores, calluses, or any change in the color of the skin or nails. You can use a mirror to inspect the part of your feet that isn&#39;t visible to you or, if you don&#39;t find it convenient, ask a family member to help you or consult a doctor. The earlier you detect any sore or blister, the easier it is to treat and vice versa.&nbsp;

&nbsp;

<ul>
	<li>Don&#39;t Walk Barefoot&nbsp;</li>
</ul>

Always wear slippers at home and shoes outdoors and never walk barefoot even in your house. This is to prevent injuries to the feet. Moreover, make sure that your shoes have no pebbles or any other object that can cause any injury to your feet.&nbsp;

&nbsp;

<ul>
	<li>Wash Your Feet Daily With Warm Water&nbsp;</li>
</ul>

Do not use hot water to wash your feet as it will cause skin dryness; instead, use warm water. Also, don&#39;t soak your feet. Just wash them properly and dry them right after.&nbsp;

&nbsp;

<ul>
	<li>Moisturize Your Feet</li>
</ul>

Diabetic individuals, especially those who have dry feet, are no strangers to cracks on their feet. The trick is to keep your feet moistened. However, make sure not to apply lotion or moisturizing cream between the toes as it can result in infection, and keep the application limited to the heel of the foot.&nbsp;

&nbsp;

<ul>
	<li>Choose The Right Shoes&nbsp;</li>
</ul>

Wear shoes that are the right size, not too tight or too loose. It would not only be difficult to walk but would also increase the chances of developing foot problems. Most importantly, make it a habit to wear socks with your shoes.

&nbsp;

<ul>
	<li>Properly Trim Toenails</li>
</ul>

Try to cut your nails gently straight across and smooth them with a nail file. Avoid cutting your nails too deep as it may cause a break in the skin and become a space for an infection to set in.&nbsp;

&nbsp;

<ul>
	<li>Keep The Blood Flowing&nbsp;</li>
</ul>

To maintain perfusion in the feet, put your feet up while sitting. Also, don&#39;t stand or hang your legs for too long. This is also for women with gestational diabetes as they need proper perfusion in their lower limbs (leg area). Wiggle your toes multiple times a day to maintain perfusion.

&nbsp;

<ul>
	<li>Do Not Miss Your Doctor&#39;s Visit&nbsp;</li>
</ul>

Visit your doctor every year or as scheduled for your diabetes. Get your feet properly examined by a feet specialist, more so if your healthcare provider is suspecting diabetic neuropathy. 
&nbsp;

Stay vigilant and if you notice any of the symptoms listed below, consult a healthcare provider immediately to either treat or prevent diabetic foot<a href="#accordion">[3]</a>:

<ul>
	<li>Pain in the legs and cramping in the thighs and calves during physical activity&nbsp;</li>
	<li>Inability to sense temperature, pain, or touch over the skin of your foot&nbsp;</li>
	<li>Tingling, painful, and burning sensation in your feet&nbsp;</li>
	<li>Dry skin with cracks</li>
	<li>Thick, yellow toenails</li>
	<li>Signs of fungal infection, such as athlete&#39;s foot&nbsp;</li>
	<li>Any sign of sore, blister, or ulcer anywhere on the foot 
	&nbsp;</li>
</ul>

Conclusion

Diabetes is a very common metabolic disorder and it is associated with a constellation of signs and symptoms. Moreover, the damage caused by diabetes is also widespread as it involves many organs of the body. Diabetic neuropathy affecting the foot is another dreaded complication of diabetes that can cause the diabetic individual to lose sensation over the affected area. It can progress to diabetic foot, which can result in amputation and loss of limb. Optimization of feet care and maintenance of healthy blood sugar levels can prevent the development of this condition.&nbsp;

Key Points

<ul>
	<li>Diabetic foot is one of the common complications of diabetes yet the most dreaded.</li>
	<li>Diabetes causes nerve damage in the peripheries and this is often due to high blood sugar levels that are not managed.</li>
	<li>Nerve damage causes the foot to lose sensation, and blisters, sores, or minor injuries go unnoticed; it&rsquo;s dangerous because these points can become the site of entry for bacteria and result in infection.&nbsp;</li>
	<li>Infection in diabetic foot is often difficult to treat which then progresses to gangrene and ulceration.</li>
	<li>Amputation remains the last resort to protect the infection from progressing throughout the body.</li>
	<li>Maintaining normal blood sugar levels and adopting a healthy foot care regimen are the only ways to prevent diabetic foot.&nbsp; 
	&nbsp;</li>
</ul>