Diabetes - foot care

Diabetes and feet

Foot care is particularly important if you have diabetes.

Foot problems are a common complication of this condition.

Your feet can be affected in 2 ways. Blood supply may be affected, resulting in slower healing. You may also lose some feeling in your feet due to nerve damage. A person whose nerves are damaged by diabetes may not realise they have minor cuts or blisters, which can lead to ulcers.

Foot problems can be avoided if you take care of your feet and act quickly when you have a problem. Get your feet checked at least once a year by a doctor or podiatrist to detect problems early and help prevent complications.

Circulation in people with diabetes

Poor blood circulation can affect the blood supply to your feet. When this is reduced, cuts and sores may not heal. An early sign of poor circulation to the feet may be pain or cramps in the backs of your legs when walking.

Circulation problems can be caused by hardening or narrowing of arteries as they become clogged up. Common causes include:

• smoking
• high blood fats
• raised blood glucose levels.

How to improve circulation for people with diabetes

Suggestions to improve your blood circulation include:

• Control your blood fat levels.
• Keep blood glucose levels as close to normal as possible.
• Don’t smoke. Smoking causes spasm and narrowing of blood vessels. Smokers have more heart attacks, strokes and circulation problems than non-smokers.
• Exercise daily. A brisk walk will help keep the blood flowing around your body.

Foot care for people with diabetes

All people with diabetes should have their feet checked at least once a year by a doctor or podiatrist.

This is important to detect problems early and to prevent ulcers and other complications.

You may have heard it said that diabetes causes gangrene (dead, black tissue). Most cases of gangrene result from delayed treatment of foot injuries.

Daily foot care

Suggestions to help prevent foot problems in people with diabetes who suffer from neuropathy or vascular disease include:

• Check your feet daily for signs of swelling, redness or heat – these may be signs of infection.
• Wash your feet daily and dry well between the toes.
• Use methylated spirits if there is a lot of moisture between your toes.
• Moisturise dry skin, especially cracked heels (for example, with sorbolene cream) but not between the toes.

Buying new shoes

Suggestions include:

• Don’t be rushed into buying shoes that you aren’t completely happy with.
• Avoid open-toed shoes and narrow toes.
• Have your feet measured and try on the shoes to check they are long enough, wide enough and deep enough.

Nerve supply to the feet

Nerves are the ‘wiring’ of the body. They carry messages (feelings) to your brain from the rest of your body. The nerves to your feet are the most likely to be affected by diabetes.

Damaged nerves (neuropathy) can cause painful, numb or insensitive feet. Minor cuts, blisters or burns may not be felt and ulcers can develop, which you may not be aware of.

Some people with neuropathy experience uncomfortable sensations such as burning, tingling and pain. This is often worse at night.

It is important to remember that many people with nerve damage have no symptoms and are unaware of the problem. Nevertheless, they are still at risk of developing ulcers.

How to avoid injury to feet with damaged nerves

Suggestions include:

• Never go barefoot.
• Wear appropriate shoes to protect your feet.
• Avoid injury by wearing well-fitting, protective shoes – do not wear open-toed shoes.
• Keep toenails trimmed. Cut toenails along the shape of the toe and file rough edges.
• Have corns or calluses treated by a podiatrist.
• Check the temperature of your bath water with your elbow before stepping into the bath.
• Be careful not to put your feet too close to radiant heaters.
• Every 6 months, check for signs and symptoms that may indicate you have a problem. These may include reduced circulation or sensations, abnormal foot structure or poor hygiene.

See a podiatrist

Podiatrists are experts in looking after feet and lower limbs.

They are highly trained health professionals who deal with the prevention, diagnosis and management of foot problems.

You don’t need a referral to seek advice or treatment from a podiatrist, however, a referral from your doctor under a team care arrangement can assist in covering the fee for this service.

If you have circulation problems or reduced feeling in your feet:

• See a podiatrist at least once each year.
• Do not attempt to treat corns and calluses yourself.

When to see your doctor

See your doctor if:

• you develop pain, throbbing, heat, swelling or discolouration in your feet
• a cut or injury becomes red or does not heal.

Where to get help

• Your GP (doctor)
• Podiatrist
• Diabetes specialist
• Diabetes educator
• National Diabetes Services Scheme (NDSS) Tel. 1800 637 700
• Diabetes Victoria Tel. 1300 437 386
• Baker Heart and Diabetes Institute Diabetes Clinic Tel. (03) 8532 1800
• Juvenile Diabetes Research Foundation Tel. 1300 363 126