This article was originally posted on April 27, 2012.
Bright reds, yellows, aquas with ankle straps and pretty buckles or maybe a sensible Birkenstock in neutral tan: it’s getting to be sandal season again. There’s nothing finer than feeling a gently warm breeze between your toes on a glorious spring day.
Which makes it once again time to discuss foot problems and review the basics of foot care.
Two of the complications of diabetes caused by hyperglycemia are neuropathy and vascular dysfunction. Both of these can wreak havoc with your feet, increasing their susceptibility to both infections and deformities.
Vascular disease remains the leading cause for limb amputation. The poor blood circulation of vasculitis deprives the tissues of needed nutrients and oxygen. Slow to heal, minor cuts and abrasions may develop into major infections.
With neuropathy you may have pain or tingling in the feet or you may lose sensation completely. Patients will often complain of dry itchy feet as a result of damage to the nerves that control oil secretion. In addition, it is easy to develop unnoticed sores and ulcers when there is diminished sensation in the feet.
Peripheral neuropathy can also induce muscle weakness and bone fractures which can precipitate hammer toe (the tip of the toe bends downward and the middle of the toe points upward resembling a hammer) and Charcot’s foot (a foot deformity caused by damage to the bones that destroys the joints. The foot becomes misaligned to the point where even walking is difficult.)
Other common foot problems which occur in the general public but are more problematic in people with diabetes include–
- Calluses and corns–they’re layers of hard skin, usually on the bottom of the foot in the case of calluses and near a bony area for corns. Using a pumice stone while the feet are wet can help keep these under control. But self-treating with over the counter medications is not recommended for people with diabetes. Corns and calluses that do not resolve or worsen should be care for by a podiatrist.
- Blisters are small pockets of fluid that form under the skin usually as a result of rubbing or friction, often from poorly fitting shoes. Keep the blister protected by covering it with an antibiotic cream and soft bandages.
- Foot ulcers are sores that vary in severity from those involving just the surface skin all the way to deep wound infections in the bone. Fifteen to twenty percent of people with diabetes will have one sometime during their lives.For many people with neuropathy, foot ulcers can be painless because the nerves are deadened to the point where they can’t feel pain. This is one reason people may not pay attention to them. Treatment varies depending on the size and severity of the ulcer. It is important to notify your health care provider of any slow-to-heal ulcers.
If your feet are in good shape, keep them there by engaging in regular preventive maintenance.
- Follow these guidelines to keep your feet healthy:
- Check all aspects of the foot including between the toes, daily (use a mirror if necessary). Look for signs of infection such as redness, pain, increased warmth, swelling, discharge and poor healing. Inspect for dryness, cracks, breaks in the skin, swelling, infection, redness, change in color or temperature.
- Cleanse the feet using warm water and mild soap
- Use products to moisturize the skin, preferably without alcohol or cream
- Avoid putting foot powder or creams between the toes
- Check the inside of shoes for any foreign objects, wrinkles in the lining or cracks in the soles
- Do not apply heat directly to skin
- Do not go barefoot
- Trim nails by filing (no cutting or clipping); shape nails straight across and following the contour of toe, curve borders
- Consult podiatrist for nails that are long, thick or split or have fungal infections and for ingrown toenails
- Make sure your physician examine your feet at every check up.
- Wear proper footwear
- Break in new shoes gradually by wearing only part of the day
- Avoid hose or stockings that constrict
- Wear socks made of fabric that “wicks” moisture away from the skin if your feet sweat a lot
- Never wear shoes that don’t fit properly
If you do find you have a cut or scrape:
- Wash with tepid water and soap
- Apply a mild antiseptic
- Avoid: iodine, hydrogen peroxide, Epsom salts
- Cover with dry sterile bandage
- Check area at least twice a day
- Keep off your foot as much as possible
- Call your health care provider if redness, swelling or pus is present or if not healed within 48 hours
- Athlete’s foot:
- Wash thoroughly and keep dry
- Use fungicide recommended by healthcare provider
At risk patients – including those with a history of foot ulcer, smoking, vascular insufficiency, neuropathy, structural foot deformities, foot infections, skin or toenail abnormalities, diabetic retinopathy, nephropathy, prior amputation, patients on anticoagulation therapy and patients who cannot see, feel or reach their feet – should have regular comprehensive foot care and evaluation by a podiatrist or vascular surgeon.
People with neuropathy or vascular disease should choose shoes with good structural support and avoid sandals and clogs.
And remember, the best way to have a fantastic foot summer is to quit smoking (if you do smoke) and keep your blood glucose and cholesterol in control.
For more information or to make an appointment, visit Joslin’s Foot Clinic.