What is diabetes? Diabetes is a chronic (long term) illness that occurs when your body does not make enough insulin. Diabetes also occurs if your body does not use the insulin it makes properly. Insulin is a hormone that allows your cells to use the sugar in your blood for energy. Lack of working insulin leads to high blood sugar levels. Treatment for diabetes aims to keep your blood sugar levels normal. Chronic high blood sugar levels can damage the blood vessels and nerves in your legs and feet.
What conditions may I have with diabetes? Chronic high blood sugar levels may cause chemical changes in your nerve cells leading to decreased function. You may have any of the following:
Diabetic neuropathy: Diabetic neuropathy is nerve damage. Nerves carry information needed for you to feel sensations (touch), pressure, pain, and temperature. With diabetes, parts of your body such as your feet, may be numb (decreased feeling). You may not be able to feel when your footwear is too tight. You may also not be able to feel when you have a cut or sore on your foot.
Peripheral vascular disease: Peripheral vascular disease (PVD) occurs when your blood vessels become narrow or blocked. PVD causes decreased blood flow to your feet. Blood contains oxygen and cells that are needed for your body to heal when it is injured. Decreased blood flow to your feet may lead to an increased risk for infection. Poor blood flow will also slow your healing.
Poor vision: Diabetes may cause problems with your ability to see. Problems with your vision may make it hard for you to see problems with your feet.
What foot problems may I have with diabetes? With diabetes you are at high risk of getting foot ulcers (deep wounds). Your risk increases if you have had diabetes for 10 years or longer. Past foot ulcers also increases your risk for another foot ulcer. Even a small cut or scratch can become an ulcer. Diabetic foot ulcers do not heal well and are hard to treat. A foot ulcer may become infected and you may be at risk of needing your foot amputated (cut off). Any of the following may increase your risk for a foot ulcer:
Corns and calluses: Corns and calluses are thick areas of dead, dry skin on your feet.
Dry, cracked skin: Nerve damage and decreased blood flow to your feet may make your feet very dry. With dry feet, you may also have cracks in your skin.
Foot deformities: Diabetes may cause changes in the shape of your feet. Your toes may become crooked or curved under. You may also notice changes in the way that you walk. Foot changes may lead to increased pressure in your forefoot (middle of your foot to your toes). Foot changes may also cause your feet to rub against your shoes causing skin sores.
Inflammation: Inflammation which is redness and swelling may occur with decreased blood flow to your feet. With inflammation, your feet may feel warmer than they normally do increasing your risk for an ulcer.
Skin changes: The skin on your feet may look shiny or tight. Your skin may look dark red, brown, or blackish in color. Your feet may also feel cold and look pale (colorless). Any skin changes in your feet increases your risk for an ulcer.
Why is diabetic foot care important? Diabetic foot care is needed to prevent foot problems. Small problems with your feet, such as dry skin or small wounds, can become life-threatening if not treated right away. If you take good care of your feet, you may not have foot problems. You may also avoid foot problems if your blood sugar levels are controlled. You and your caregiver can work together to treat your diabetes and prevent injury to your feet.
What may caregivers do to decrease my risk for foot problems?
Foot exam: Your caregiver will look carefully at your feet for problems such as skin changes and wounds. He will check your feet for changes in their shape and problems with movement. Your caregiver will also look at the shoes you are wearing to see if they fit you well. If you have corns or calluses, your caregiver may remove them. A foot exam allows your caregiver to see if you need treatment for foot problems. You may need to see your caregiver at least once a year for a foot exam. Your caregiver may want to see you more often if you are at high risk for foot ulcers. Ask your caregiver how often you need to see him. Your caregiver may also do the following tests to check for problems that increase your risk for foot ulcers:
Monofilament test: Your caregiver will press a small wire against the bottoms of your feet until the wire bends. If you cannot feel the wire, you may have nerve damage. Ask your caregiver for more information about this and other tests he may use to check for nerve damage.
Ankle brachial index: Ankle brachial index (ABI) is a test to check how well your blood is flowing to your feet. During an ABI, your caregiver will measure the blood pressure in your ankles and arms. Differences in pressure between your ankles and arms may be a sign of blood vessel damage. Ask your caregiver for more information about this and other tests he may use to check your blood flow.
Offloading devices: Offloading devices are used to decrease the amount of weight and pressure on your feet. You may need any of the following:
Casting: Casting may be needed if you have a foot at high risk for an ulcer. The cast will protect your foot from injury. The cast may or may not be removable.
Foam bandages: Your caregiver may wrap one or both of your feet in a cushioned bandage. The bandage is used if your caregiver sees at risk areas on your feet that need protection.
Insoles: Insoles are pads or cushions that are put inside your shoes. Insoles may help protect your feet from injury.
Orthotics: Orthotics are foot braces that help decrease the pressure on your feet.
Rocker soles: Rocker soles help decrease the pressure on your forefoot.
Special footwear: Your caregiver may have special footwear made for you. The footwear may protect your feet if you have deformities.
Walking aids: Walking aids may be needed to decrease the weight and pressure on your feet. Walking aids include canes, crutches, walkers, and wheelchairs.
Surgery: You may need surgery if you are at high risk for foot ulcers. Surgery may be done to fix foot deformities, and to increase the blood flow to your feet. Ask your caregiver for more information about surgeries that may help protect your feet.
What can I do to prevent diabetic foot problems?
Check your blood sugar levels: Make sure you check your blood sugar levels as often as your caregiver tells you to. Your caregiver will tell you what your blood sugar level should be. Keeping your blood sugar normal decreases your risk for health problems, including foot ulcers. Keep a diary of your blood sugar levels with the date and time that you checked them. The diary will show how well you are managing your diabetes.
Take your medicine as directed by caregivers: Your caregiver may give you medicine to keep your blood sugar levels normal. You may also have medicine to help treat your nerve damage, or other health problems. Keep a written list of the medicines you take, the amounts, and why you take them. Do not stop taking your medicines unless you discuss it with your caregiver.
Diet: Eat a variety of healthy foods every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy.
You may need to change the way you eat to control your blood sugar. Choose foods lower in sugar, fat, and cholesterol. Your caregiver or dietitian will help you plan a diet.
It can take time getting used to a new diet. Special cookbooks may help the cook in the family find new recipes.
Quit smoking: It is never too late to quit smoking. Smoking increases your risk for blood vessel disease that can lead to foot ulcers. Smoking also harms your heart and lungs. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
Maintain a healthy weight: Weighing more than what your caregiver says is healthy can increase your risk for foot ulcers. Maintaining a healthy weight decreases the amount of force and pressure you put on your feet. Talk to your caregiver if you need help losing weight.
Take smaller steps: You can decrease the pressure on your feet by taking smaller steps when you walk. Walking slower may also help decrease pressure on your feet, and decrease your risk for a foot ulcer.
Wear proper fitting shoes: Wear shoes that do not rub against any area of your feet. Your shoes should be 1 to 2 centimeters longer than your feet. Your shoes should also have extra space around the widest part of your feet. Walking or athletic shoes with laces or straps that let you adjust their size are best. Ask your caregiver for help in choosing shoes that fit you best. If your caregiver orders you special shoes, make sure you wear them.
How should I care for my feet?
Check your feet daily for any skin tears, calluses, wounds, or blisters. Make sure you look at all areas of your feet including the bottoms, and between and under your toes. Use a mirror or ask someone for help if you cannot see all areas of your feet.
Wash your feet daily with soap and warm (not hot) water. Ask your caregiver what temperature the water should be. Dry your feet gently with a towel after washing. Make sure you also dry between your toes.
Use a lotion or moisturizer after washing and drying your feet. Ask your caregiver for more information about which lotions or moisturizers to use.
File or cut your toenails straight across. Use a soft brush to clean around your toenails. Ask someone for help if you cannot do this yourself. Using sharp objects to cut your toenails can cause wounds that may lead to ulcers. If your toenails are very thick, you may need to have a caregiver cut them. You may also need a caregiver to cut your toenails if you are at high risk for foot ulcers.
Do not walk barefoot or wear your shoes without socks. Before you put on your shoes, always check if there are rocks or other objects inside that can hurt your feet.
Wear socks made of cotton to help keep your feet dry. Wear socks without toe seams, or wear socks with the seams inside out. Change your socks daily. Do not wear socks that are dirty or damp (not dry).
Do not try to remove corns or calluses yourself. Talk to your caregiver if you have corns or calluses.
Do not warm your feet with foot spas or hot water bottles. Do not warm your feet close to a fire or on anything that makes heat. If you have decreased feeling in your feet, you are at a higher risk for burns.
Where can I go for support and more information? Learning as much as you can about diabetes is an important part of preventing problems with your feet. Ask your caregiver for more information about diabetes and diabetic foot problems. You may also contact the following:
American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 Phone: 1-800-342-2383 Web Address: http://www.diabetes.org
National Diabetes Information Clearinghouse 1 Information Way Bethesda, MD 20892-3560 Phone: 1-800-860-8747 Web Address: www.diabetes.niddk.nih.gov/
When should I call my caregiver? Call your caregiver if:
Your blood sugar is higher or lower than your caregiver recommends.
You see any blisters, cuts, scratches, or sores on your foot.
You see hard areas of skin on your foot.
Your feet feel weak or you have trouble moving them.
Your toenails become thick, curled, or look yellow.
You have questions or concerns about your condition, treatment, or care.
When should I seek immediate help? Seek care immediately or call 911 if:
Your feet become red, warm, and swollen.
You have pus draining from or redness around a toenail.
You have a wound on your foot that gets bigger, deeper, or does not heal.
You have a fever (high body temperature).
CARE AGREEMENT:
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
