Beware: Your Diabetic Feet

March 24, 2009

Amy Tenderich of DiabetesMine.com

I think most of us have a vague idea that we ought to take special care of our feet with diabetes, yet in truth, we’d rather not know the details. Am I right? Who wants to bother with special shoes and socks and daily inspections, and even consider the possibility of foot amputation? Especially when we have so much else to worry about with our diabetes?

But knowledge is indeed power, and the truth is that prevention is the key to keeping our feet safe and healthy. Although I’ve heard from patients from all walks of life suffering with foot pain, swollen feet, tingling and numbness, severe dry skin, deep cracks in the skin, fungal toenails, and yes – even amputation – the doctors and medical experts assure me that there are some very simple steps we can all take to avoid these ailments.

The vagueness and misconceptions about diabetes and feet often starts with the notion: “If anything were really wrong with my foot, it would hurt...”

Or the other side of the coin, equally dangerous, is: “Funny, my foot has been really hurting lately. I wonder if that has anything to do with my diabetes?”

The first thing you should know is that diabetes itself doesn’t necessarily lead to amputation, but unnoticed injuries do! The culprit is the LOSS OF FEELING in your feet that can be caused by diabetes.

A 58-year-old San Diego man with Type 2 diabetes recently told me this disturbing but all-too-common story:

“I once dropped whole wad of car keys into my shoe and was walking around on them all day, and I didn’t feel anything! They were cutting into my foot, so that at the end of the day all I noticed was blood on my sock.”

He later experienced a staff infection in that foot, which required partial amputation.

So diabetic foot care is all about being aware of this loss of sensation as it occurs, and checking, checking, checking those feet every day for small cuts or injuries that you likely won’t feel. The goal is to catch them and treat them BEFORE they become infected, which is where the real trouble begins.

Why Damage Occurs
Many people assume that foot complications stem from impaired circulation caused by atherosclerosis (or narrowing of the arteries), just as atherosclerosis in the heart and head can lead to heart attacks and strokes. This isn’t actually true. While circulation changes certainly contribute, a larger factor is neuropathy, which means injury to the nerves—in this case to the small sensory nerves in the feet. This injury is more likely to occur if your A1c (average blood glucose level) remains high over time. The numbness it can cause in your feet often goes unnoticed by you. The most sensitive indicator of this numbness is a decreased sense of vibration in your feet—something you are also unlikely to notice, but that your medical provider can easily check by testing your feet with a tuning fork (128 Hz or low C, for the musically inclined).

With decreased sensory input, your feet are more at risk for injury, partly because they are not constantly making the small micro-corrections that you need to keep your balance, and to move the pressure points on your feet around. With this background of neuropathy, any decreases in blood flow to large or small vessels increases the chance of damage to your feet.

If you have already experienced noticeable pain or discomfort in your feet, it’s imperative that you see an endocrinologist (diabetes doctor) or podiatrist (foot doctor) right away, because intervention can likely slow or halt any damage that may have already been done.

Tips & Resources
Here are some things you should know about diabetes and foot care:

To ward off foot ailments, it’s vital to keep the muscles in your feet and legs strong. Simple walking is one of the easiest and most effective ways to do this, experts say.

Especially if your feet feel numb, it’s very important to look at them every day to check for blisters, bunions, cuts, or anything unusual, and seek help right away if there are abnormalities. You should also inspect the tip of your big toe, the base of the little toes, between your toes, your heel, the outside edge of your foot, and across the ball of your foot every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, and nail problems.
In case you’re not very flexible and have trouble twisting around to see the bottoms of your feet, check out the Insight Foot Care Scale at www.focusonyourfeet.com. It’s a new bathroom scale with an integrated “illuminated and magnified mirroring system” that gives you a good look at the bottoms of your feet without all the contortions usually required.
Diabetes may cause you to sweat less, which can lead to cracked, dry skin. So when you trim your toenails, take care not to injure the surrounding skin. If you have poor blood circulation in your legs or aren't able to see well enough to trim your nails, have your podiatrist (foot doctor) do it for you.
If you have neuropathy, avoid walking around barefoot, even if the weather is fine and the ground seems smooth and “safe.” It’s just too easy to injure your feet this way, or pick up tiny splinters that you don’t notice until they cause real problems.
If you have neuropathy, doctors suggest wearing moisture-resistant socks and well-fitting shoes with flexible soles made from crepe or foam rubber and soft leather tops that allow your feet to breathe. To prevent pressure sores on your feet, make sure your socks don't bunch or wrinkle inside your shoes.
If you’re travelling and doing a lot of walking, it’s a good idea to simply change your shoes often, so the support and pressure points on your feet are rotated. If you bought new shoes for your trip, try wearing them for a while before you leave in order to “break them in.”
Stop smoking! Even if you’re not worried about the other side effects of smoking—lung cancer, emphysema, strokes and heart attacks—please be kind to your feet, and keep trying ways to stop smoking cigarettes.
If you have a little money to invest, you can learn more about caring for diabetic foot problems in a quality video called If You Have Diabetes™, produced by Alpyn Health Education, which you can order online for $35 at this site: www.alpyn.com.

From	Comment
Auberginecow	July 14, 2009 2:53 PM I am guilty of walking around barefoot and almost never wearing socks. I am trying to be better about it, especially after I burned my feet in the shower - didn't realize a bunch of VERY hot water had accumulated in the tub and was standing in it for a few minutes before it registered how hot it was!
biochemstudent	May 12, 2009 11:51 PM I was just diagnosed with diabetes but my mother was diagnosed with it about 31 years ago and she has neuropathy of her feet really bad. In the summer of 2007, she walked out barefoot on the hot sand of Barstow California and suffered 3rd degree burns on her feet. We were able to save her feet but she required multiple surgeries, home IV treatments skin grafts, it was horrible the suffering my mother went through that year now my mother has a deformed toe on her right foot. She was a lucky woman. Please be careful out there and the longer you have diabetes, the more you have to watch your feet because of the neuropathy. I have the diabetic shoes on and I wear them all day and I am a 30 year old. I love my shoes and I know I should take more care of my feet and watch them as well as I watch my sugar. :-)
thomas kosky	May 12, 2009 10:18 PM i've had type2 since 6/08.i don't diet 100% but i try.i do take my meds and test etc.the one thing i do take care of is my feet.i go to a foot doctor every 9 weeks.i have my nails clipped and my feet inspected.i wear comfortable shoes and diabetic socks.and i rub eucerin on my feet almost every day.i consider footcare very important and it doesn't take long at all.