Diabetes and foot care: Why is it important?
By Dr Anirban Banerjee MS, MRCS (Consultant Surgeon)
Diabetes mellitus is a chronic disease that affects up to 6% of the population (higher in the older age groups). Insulin is a hormone that helps the body deal with sugar (glucose) in the diet. When diabetes is present, either the body produces less or no insulin (Type 1) or the body tissues are resistant to the effects of insulin (Type 2). This results in higher levels of glucose in the blood, which can damage a whole range of body tissues and organs.
Why is the foot so important to those with diabetes?
The foot is especially affected by diabetes because:
Diabetes damages the nerves (damage can occur to the foot and not be detected) – this is called peripheral neuropathy.
– Diabetes also affects the circulation. Poor circulation can affect the ability of the body to heal when damage occurs.
– Those with diabetes are more prone to infection – the body’s processes that normally fight infection respond slower and often have trouble getting to the site of infection due to the poor circulation.
– Diabetes can also affect the joints, making them stiffer.
Other diabetes complications can also affect the foot, for example, kidney disease (affects proteins that are involved in wound healing) and eye disease (can’t see the foot to check for damage).
As a consequence of these factors, a number of things can go wrong:
– The foot may get damaged and you do not know (for example, your shoe rubs a sore on your toe that gets infected; you cannot feel it because of the peripheral neuropathy; you cannot heal very well due to the infection and poor circulation).
– Foot ulcers are common
Foot ulcers are a common complication of the ‘diabetic foot.’ They allow a window for infection to occur. Ulcers are caused by too much pressure on an area and the skin just ‘breaks down.’ They can occur under corns and calluses. Healing can take a while and it is imperative that pressure is removed from the area and good wound dressings are used.
– Infections can spread.
The most dreaded end-point to this process is an amputation. Diabetes is the main cause of amputations.
– Charcot’s joints is another complication of diabetes in the foot, especially if peripheral neuropathy is present. The neuropathy causes a numbness (imagine spraining your ankle and not knowing you have done this. You will continue to walk on it, so imagine the damage that this would do. This is what happens in a Charcot foot).
The dos and don’ts of foot care if you have diabetes:
If you have diabetes, there are a lot of things you need to do to prevent the problems from developing in your foot:
1. Wash your feet daily (use a mild soap and lukewarm water). Dry very carefully, especially between the toes. It often helps to use talcum powder to dust the foot to further reduce moisture; however, be certain to remove all the powder after dusting, as it should not leave a residue between the toes. If the skin is dry, use a good emollient, but not between the toes).
2. Inspect your foot daily (check sores, cuts, bruises, changes to the toe-nails; use a mirror to look under the foot if you cannot see it).
3. Look after your health (lose weight, stop smoking, exercise, reduce your alcohol consumption).
4. Look after your feet
– Cut toenails straight across and never cut into the corners; use an emery board or file on sharp corners.
– Do not try to remove corns and calluses yourself. You can take the help of a doctor/health care personnel for this; never use commercial corn preparations. This is so important in those with diabetes, as it is so easy to damage the skin.
– Avoid going barefoot, even in your own home (this lessens the chance of some accidental damage).
5. The fitting of footwear is very important. Poor fitting shoes are a common cause of problems in the feet of those with diabetes. Some advice:
– Get your feet measured each time you buy new shoes (foot size and shape change over time).
– New shoes should be comfortable when purchased and should not need a ‘break-in’ period.
– They should fit both the length and width of the foot, with plenty of room for the toes.
– Avoid shoes with high heels, pointed toes or tight around the toes (these put too much pressure on parts of the foot and can contribute to ulcers).
Regular foot care is the key to prevent problems from developing in those at risk.
