Over time, diabetes can cause you to lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. Diabetes also can lower the amount of blood flow in your feet. Numbness and less blood flow in the feet can lead to foot problems.
Foot care is very important for all people with diabetes, but even more so if you have:
pain or loss of feeling in your feet (numbness, tingling)
changes in the shape of your feet or toes
sores, cuts, or ulcers on your feet that do not heal
If you take care of your feet every day, you can lower your chances of losing a toe, foot, or leg. Managing your blood sugar can also help keep your feet healthy.
1.Check your feet
Check your feet for cuts, sores, red spots, swelling, and infected toenails. You may have foot problems, but feel no pain in your feet.
Check your feet each evening when you take off your shoes.
If you have trouble bending over to see your feet, use a mirror to help. You can also ask a family member or caregiver to help you.
2. Wash your feet every day
Wash your feet in warm, not hot, water. Do not soak your feet because your skin will get dry.
Before bathing or showering, test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow to test the water.
Use talcum powder to keep the skin between your toes dry to prevent infection.
3. Keep the skin soft and smooth
Rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet.
Do not put lotion or cream between your toes because this might cause an infection.
4. Smooth corns and calluses gently
Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, check with your foot doctor about the best way to care for them.
If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.
Do not cut corns and calluses.
Do not use razor blades, corn plasters, or liquid corn and callus removers – they can damage your skin and cause an infection.
5. If you can see, reach, and feel your feet, trim your toenails regularly
Trim your toenails with nail clippers after you wash and dry your feet.
Trim your toenails straight across and smooth the corners with an emery board or nail file. This prevents the nails from growing into the skin. Do not cut into the corners of the toenail.
6. Wear shoes and socks at all times
Wear shoes and socks at all times. Do not walk barefoot when indoors or outside. It is easy to step on something and hurt your feet. You may not feel any pain and not know that you hurt yourself.
Make sure you wear socks, stockings, or nylons with your shoes to keep from getting blisters and sores.
Choose clean, lightly padded socks that fit well. Socks that have no seams are best.
Check inside your shoes before you put them on. Make sure the lining is smooth and that there are no objects in your shoes.
Wear shoes that fit well and protect your feet.
7. Protect your feet from hot and cold
Wear shoes at the beach and on hot pavement. You may burn your feet and may not know it.
Put sunscreen on the top of your feet to prevent sunburn.
Keep your feet away from heaters and open fires.
Do not put hot water bottles or heating pads on your feet.
Wear socks at night if your feet get cold.
Wear lined boots in the winter to keep your feet warm.
8. Keep the blood flowing to your feet
Put your feet up when you are sitting.
Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to help blood flow in your feet and legs.
Do not cross your legs for long periods of time.
Do not wear tight socks, elastic, or rubber bands around your legs.
Do not smoke. Smoking can lower the amount of blood flow to your feet. Ask for help to stop smoking.
9. Be more active
Being active improves blood flow to the feet. Ask your health care team for safe ways to be more active each day. Move more by walking, dancing, swimming, or going bike riding.
If you are not very active, start slowly.
Find safe places to be active.
Wear athletic shoes that give support and are made for your activity.
10. Be sure to ask your health care team to:
check your feet at every visit
check the sense of feeling and pulses in your feet at least once a year
show you how to care for your feet
refer you to a foot doctor if needed
tell you if special shoes would help protect your feet
11. Take care of your diabetes
Work with your health care team to make a plan to manage your diabetes.
Ask your health care team to help you set and reach goals for managing your blood sugar, blood pressure, and cholesterol.
Ask your team to help you choose safe ways to be more active each day and choose healthy foods to eat.
12.Tips for Choosing the Right Footwear
Wearing the right type of shoes is important for keeping your feet healthy. Walking shoes and athletic shoes are good for daily wear. They support your feet and allow them to “breathe.”
Never wear vinyl or plastic shoes, because they do not stretch or “breathe.”
When buying shoes, make sure they feel good and have enough room for your toes.
Do not wear shoes with pointed toes or high heels often. They put too much pressure on your toes.
Buy shoes at the end of the day when your feet are the largest so that you can find the best fit.
People with diabetes can develop many different foot problems. Even ordinary problems can get worse and lead to serious complications.
Foot problems most often happen when there is nerve damage, also called neuropathy. This can cause tingling, pain (burning or stinging), or weakness in the foot. It can also cause loss of feeling in the foot, so you can injure it and not know it. Poor blood flow or changes in the shape of your feet or toes may also cause problems.
Although it can hurt, diabetic nerve damage can also lessen your ability to feel pain, heat, and cold. Loss of feeling often means you may not feel a foot injury. You could have a tack or stone in your shoe and walk on it all day without knowing. You could get a blister and not feel it. You might not notice a foot injury until the skin breaks down and becomes infected.
Nerve damage can also lead to changes in the shape of your feet and toes. Ask your health care provider about special therapeutic shoes, rather than forcing deformed feet and toes into regular shoes.
Diabetes can cause changes in the skin of your foot. At times your foot may become very dry. The skin may peel and crack. The problem is that the nerves that control the oil and moisture in your foot no longer work.
After bathing, dry your feet and seal in the remaining moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or other such products.
Do not put oils or creams between your toes. The extra moisture can lead to infection. Also, don’t soak your feet — that can dry your skin.
Calluses occur more often and build up faster on the feet of people with diabetes. This is because there are high-pressure areas under the foot. Too much calluses may mean that you will need therapeutic shoes and inserts.
Calluses, if not trimmed, get very thick, break down, and turn into ulcers (open sores). Never try to cut calluses or corns yourself – this can lead to ulcers and infection. Let your health care provider cut your calluses. Also, do not try to remove calluses and corns with chemical agents. These products can burn your skin.
Using a pumice stone every day will help keep calluses under control. It is best to use the pumice stone on wet skin. Put on lotion right after you use the pumice stone.
Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.
What your health care provider will do varies with your ulcer. Your health care provider may take x-rays of your foot to make sure the bone is not infected. The health care provider may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider may culture the wound to find out what type of infection you have, and which antibiotic will work best.
Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special shoe, brace, or cast on your foot to protect it.
If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon. Good diabetes control is important. High blood glucose levels make it hard to fight infection.
After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning.
Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden. You can control some of the things that cause poor blood flow. Don’t smoke; smoking makes arteries harden faster. Also, follow your health care provider’s advice for keeping your blood pressure and cholesterol under control.
If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.
Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. Stopping to rest for a few moments should end the pain. If you have these symptoms, you must stop smoking. Work with your health care provider to get started on a walking program. Some people can be helped with medication to improve circulation.
Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes, but don’t walk when you have open sores.
People with diabetes are far more likely to have a foot or leg amputated than other people. Many people with diabetes have peripheral arterial disease (PAD), which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.
For these reasons, take good care of your feet and see your health care provider right away about foot problems. Ask about prescription shoes that are covered by insurance. Always follow your health care provider’s advice when caring for ulcers or other foot problems.
One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers.
14.Diabetic Peripheral Neuropathy
Between 60 and 70 percent of people with diabetes have some form of neuropathy.Diabetic peripheral neuropathy is a condition caused by nerve damage. Patients sometimes report painful symptoms and other times minor or no symptoms at all.
(14a)What Causes Nerve Damage?
Nerve damage is the result of high levels of glucose and/or low levels of insulin in the blood. It isn’t entirely clear why high glucose levels damage nerves, but researchers suspect that elevated glucose hurts the interplay between nerve fibers and the blood vessels that provide nutrients to nerves.
(14b)Symptoms of Diabetic Peripheral Neuropathy
A common symptom of diabetic peripheral neuropathy is numbness. Sometimes you may be unable to feel your feet while walking. Other times, your hands and/or feet will tingle or burn. It may feel like you’re wearing a sock or glove when you’re not.
Sometimes pain will feel sudden and sharp, like an electrical current. Other times, you may feel cramping.
Often, walking with a wobbly motion, or even losing your balance can be the result of diabetic peripheral neuropathy. Wearing orthopedic shoes often helps with this.
If you begin to see sores or blisters on your feet that you can’t explain, it could be that you hurt yourself and didn’t feel it. Sometimes the brain doesn’t send a pain signal because of the nerve damage.Also, your hands or feet may feel hot or cold for no reason.
Diabetic peripheral neuropathy often worsens at night. This can make it difficult to fall asleep or sleep through the night.
(14c)Diabetic Peripheral Neuropathy Treatment
Avoid alcohol and tobacco if you have diabetic peripheral neuropathy, as these substances may worsen symptoms. Good nutrition is important, as vitamin deficiencies can exacerbate the condition. Diabetic neuropathy may be managed with medication.
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