Preventing and Controlling Diabetic Foot Problems
by Joan Hultgren, RD, LDN, CDE
What types of foot problems are more likely seen with diabetes?
Neuropathy (Nerve damage)
Neuropathy is one of the most common foot problems associated with diabetes.
Symptoms can include tingling, pain, burning, stinging and foot weakness. Over time, the nerve damage can lower the ability to feel temperature changes and pain. Without knowing it, burns, cuts or broken skin can occur. Items on the ground can get lodged in the foot and lead to complications.
Additionally the nerve damage can change the shape of the foot. Special shoes designed with wider and higher toe boxes can allow deformed feet from being further damaged.
Foot callouses can occur more often and build up faster with diabetes. Callouses, if not trimmed, thicken and turn into open sores (foot ulcers). To avoid burns and infections from doing home foot “surgery” and using over the counter remedies, it is best to have callouses safely removed by a podiatrist.
Dry, peeling and cracked skin may occur because the nerves that control the oil and moisture in the foot are no longer working. Healthy skin is one of the ways the body is able to fight infection. Keep feet clean and use lotion.
Diabetes causes the blood vessels of the feet and legs to narrow and harden making it difficult to fight infection and heal adequately. Feeling may be compromised, leading to difficulty in determining hot and cold sensations.
Ulcers can form from poorly fitting shoes. They most often occur on the ball of the foot or on the bottom of the big toe. They may or may not hurt. It is extremely important that the ulcer is examined by a health care provider. X-rays may be needed to determine if the infection has reached the bone. Keeping pressure off the foot is key to healing. The foot needs to be cared for long after the ulcer heals.
Rates are higher with diabetes due to nerve damage and peripheral artery disease, both of which reduce blood flow. Complications requiring amputation can be greatly reduced by controlling blood glucose and blood pressure, and by not smoking.
What can be done to prevent any problems?
- Work with your doctors and certified diabetes educators to keep blood glucose levels and blood pressure under control.
- Additional medications, weight loss and exercise will all help.
- Check feet daily for blisters, redness and cracked skin. Call your healthcare provider immediately if the area looks red, is swollen or worse than the day before.
- Moisturize the feet with lotion, but limit the amount of lotion in between toes to avoid infection.
- Wash feet daily, but avoid soaking as this can further dry the feet.
- Avoid walking barefoot!
- Walk to improve circulation.
- Find ways to stop smoking! This will greatly improve circulation.
- Make an appointment with a podiatrist for foot inspections, nail care, foot appliances and shoes to help limit complications.
Written by : Joan Hultgren RD LDN CDE (Certified Diabetes Educator)
Program Coordinator Pentucket Medical Associates