Foot problems are common in almost all adults.  Not surprising, considering that the foot and ankle contains 29 different joints, with 42 different muscles, along with 26 different bones.  In an average lifetime, the average human will walk four and one half times around the world!

Because diabetes mellitus particularly affects the nerves and blood vessels to the legs and foot, it would not be surprising to learn that diabetics have particularly high incidence of foot problems and extra care must be taken to prevent this from occurring.

What Causes Foot Problems in Diabetics?

Diabetics have increased risk of both nerve and blood vessel damage.  Most of the diabetic foot problems occur because of nerve damage and the resulting lack of sensation or numbness.  This lack of sensitivity allows the diabetic foot to sustain trauma or infections or irritations that a normal person would sense much earlier.

What is worse is that when a problem does occur, poor circulation causes delayed healing, sometimes serious infection which exacerbates the poor blood flow.  In some circumstances, even the most minor injuries or neglect can lead to serious infections and even loss of part of the limb.

Prevention of Foot Problems

Obviously, prevention of foot problems is important in all adults, but particularly in diabetics whose diabetes makes them susceptible to foot problems.  The following is a list of suggestions and recommendations that one should follow to help prevent and of course treat any problems that do arise

• Keep your feet clean.  The feet should be washed daily with a very mild soap in moderate temperature water.  The toes and feet should be dried carefully, particularly between the toes where the moisture can cause an increase in yeast infections and other problems.  A soft towel should be used.  The drying of the area between the toes is most important for removing dead skin and preventing skin breakdown.

• Keep your feet as dry as possible.  Wearing socks and shoes and being active creates moisture and sweat.  The chronic moisture can cause breakdown of the skin.  One should use a good foot powder sparingly between the toes daily, and in some cases, even small wads of cotton between the toes which can absorb moisture.  If the feet become very dry, a small amount of skin cream may be used.  You should be careful, however, not to put any moisturizers between the toes for the reasons mentioned above.

• Careful inspection of the feet daily.  Diabetics must be very careful to check for blisters, scratches, cuts or bruising.  Because of the nerve damage and lack of sensitivity, it is possible to have a fairly severe injury to the foot an not know about it.  It is necessary, therefore, that your feet be inspected on a regular basis.  This includes inspecting the entire foot, top and bottom, and in between the toes.  You may need to wear your glasses, us a magnifying glass, or in some circumstances, if you vision is significantly impaired, consider having a family member inspect it for you.

• Toenail care.  The toenails should be kept relatively short and the toenails should be cut straight across.

• Use fresh socks on a daily basis.  Obviously, keeping the feet dry along with proper hygiene as mentioned above, is important.  The socks should be well fitting and seamless without ridges or areas that might cause blisters or sores.

What Factors Contribute to Feet Problems in Diabetics?

• Smoking

• Alcohol

• Walking bare footed

• Chronic moisture

• Wearing shoes without socks

• Applying heat to feet such as hot water bottles or heating pads.

• Infections from improper care of corns of calluses or the use of chemical agents or corn plasters for the treatment of corns, crossing one's legs while sitting or crossing the ankles while sleeping causing restriction of blood flow.

How Important are Shoes?

A properly fitting shoe is very important.  In some circumstances, we may have to recommend that you have a specially made shoe.

Again, prevention is the key word.  You should inspect the inside of your shoes every day for stones or foreign objects or torn linings.  Remembering that diabetics do not have normal sensation, a stone could possibly cause an ulcerous sore which could become infected if not felt.

Shoes should be made in such a way that there is no excessive pressure points or areas of compression, particularly around the toes.

What Else Can I Do?

Anything that improves blood supply to the feet can be helpful in preventing disease and keeping the foot healthy.  Walking, which exercises the legs without causing severe physical stress to the feet, is an excellent way to do this.

Summary

In summary, diabetes is a serious disease which can cause a variety of problems.  The foot is unfortunately taken for granted in many patients and can be a source of great distress if a complication occurs.  Please ask your doctor if you have any questions about foot care.