Foot Care for People with Diabetes

If proper foot care is not maintained, it can result in serious negative consequences.
Photo credits: RHN Team Picture Bank

Foot care should be taken very seriously for all people, but especially for people with diabetes. If proper foot care is not maintained, it can result in serious negative consequences.

Neuropathy and Diabetes

Neuropathy is the result of nerve damage in any part of the body. This needs to be taken very seriously because it can cause individuals not to be able to sense pain or pressure in these regions.

One common complication of diabetes is neuropathy. Specifically, neuropathy of the lower limbs and feet is an issue for people with diabetes. Individuals with diabetes are more likely to develop neuropathy because high blood glucose levels can damage nerve endings. If a person with diabetes has neuropathy, which affects feeling in their feet or hands, it can very quickly become a serious issue. These individuals would be more likely to notice if they get a cut or scrape on their hands than their feet because they are closer to your line of sight and looked at more often. Therefore, it is critical to provide close care and pay attention to your feet daily.

As a result of neuropathy, minor cuts and scrapes have the potential to develop into more serious infections. If an individual with neuropathy in their feet gets a cut in between their toes, they will most likely not be aware of the open wound because they cannot feel it. This open wound is now exposed to germs and other harmful bacteria in the environment. If you do not know you have a cut on your toe(s) or feet, then you will have no way to know that you need to treat it. Untreated, minor cuts and scrapes can turn into more serious problems.

Types of Infections

Untreated wounds can develop into foot ulcers, a big concern for people with diabetic neuropathy. Foot ulcers can develop as a result of untreated foot wounds. They can be treated with antibiotics if caught early. However, if untreated, they can develop into infections that take longer to heal.

Infections are categorized into three main groups:

• Superficial and local infections
  • Presence of wounds on the skin’s surface
  • Can be treated with antibiotics
  • Can spread and develop to become more serious if not cared for immediately
• Soft tissue and spreading infections
  • Presence of inflammation and decreased blood flow to the foot
  • Deeper than superficial and local infections and, therefore, more serious
  • Can develop into inflammation of the bone (osteomyelitis), if not treated
• Osteomyelitis
  • Presence of infections that have spread so deeply into the body’s tissues that they are now infecting bones
  • Can result in an amputation of the foot or even part of the leg

If untreated, any of these types of infection can spread and be very harmful to the body. People with diabetes should be educated on the importance of foot care and how to practice proper foot care to prevent these more serious health concerns.

Steps to Proper Footcare

Knowledge regarding the daily precautions and practices for people with diabetes is imperative so that they can prevent medical issues from developing.

Proper Footwear: Individuals diagnosed with diabetes should wear seamless cotton socks and comfortable, supportive shoes when possible. The cotton material of these socks is breathable and will help prevent feet from sweating. Sweating causes skin to become soft and less resistant to injury, making it easily torn and damaged. Wearing socks with seams can cause less blood flow to your feet, and seamless socks will help maintain proper blood flow to the feet. Wearing a shoe creates an additional barrier to anything that could potentially harm the feet. Shoes should be comfortable to wear and not too tight to make sure circulation is not cut off.

Proper Foot Hygiene: Both feet should also be washed and dried daily. Feet are on the ground and collecting bacteria constantly. Dirty feet can become infected easier, so it is important to take good care when washing them. Feet should be thoroughly washed with soap and warm water, remembering to scrub between the toes and toenails where bacteria can be hiding. It is also crucial to dry the feet, including in between the toes, to get rid of any moisture. Moisture can promote the growth of infections.

Individuals with diabetes should regularly clip their toenails straight across, making sure there are no edges or sharp portions of the nail left behind. Sharp nails can easily and unintentionally cut other parts of your body, especially the other foot. This cut can then become infected if it goes unnoticed. Cutting toenails on a regular basis can prevent this from occurring.

Frequent Foot Exams: People with diabetes should examine their feet fully each day. Keep a lookout for any cuts, scrapes, punctures, or blisters. It is possible that an injury to your foot has occurred without you being aware due to neuropathy. By examining both feet completely every day, any wound can be treated before it gets infected and becomes a major health concern.

Neuropathy can impact balance, which can make examining feet a difficult task. It can be helpful to keep a mirror on the floor. Using a mirror allows individuals not to have to bend over to check their feet. It allows people to examine the bottoms and sides of the feet quickly and with more comfort. Placing a mirror on the floor and using a chair for support and balance can help prevent individuals from having to lean over and could potentially save them from falling and injuring themselves. In addition to using a mirror, individuals can ask their support systems for help with examining their feet. Friends and family can be very helpful when doing foot checks if they feel comfortable doing so.

You should also make sure your doctor is conducting foot exams at every visit. To help remind them of this, take off your shoes and socks before the doctor begins your appointment. You may also ask them to check your feet during the visit if they have forgotten to do so.

Checking feet and proper foot hygiene can help people with diabetes prevent medical issues. If medical problems with feet do arise, it is important to be aware of the signs and symptoms so you will know when you should visit your doctor.

Signs and Symptoms of Foot Issues that Require Attention

Even if an individual with diabetes is practicing proper foot care, wounds can still occur and may go unnoticed. It is important to be aware of signs and symptoms so one can begin treatment as soon as possible. Pain is usually one of the first symptoms associated with any foot problem. However, neuropathy can impair one’s ability to notice this symptom of injury. This means by the time symptoms are noticeable, the foot issue may have worsened and could cause permanent damage. If one cannot feel pain due to neuropathy of the feet, there are other signs and symptoms of complications. These include swelling, redness, skin warm to the touch around the infected area, feeling fatigued, and fever and flu-like symptoms. Particularly if you are experiencing fever and flu-like symptoms, it is recommended you contact your doctor.

Knowing the signs and symptoms can help with recovery when a foot injury occurs. People with diabetes, especially those who suffer from neuropathy, should be sure to practice proper foot care by maintaining foot hygiene, wearing appropriate shoes and socks, and doing daily foot exams. The only way to tell if something has changed with your feet is by checking them daily. If there is a noticeable change in your feet, be sure to contact your doctor as soon as possible.

References:

1. Diabetes and Your Feet (2019). Center for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/healthy-feet.html
2. Bohorquez Robles, R., Compeán Ortiz, L. G., González Quirarte, N. H., Berry, D. C., Aguilera Pérez, P., & Piñones Martínez, S. (2017). Knowledge and Practices of Diabetes Foot Care and Risk of Developing Foot Ulcers in México May Have Implications for Patients of Méxican Heritage Living in the US. The Diabetes Educator, 43(3), 297–303. https://doi.org/10.1177/0145721717706417
3. Sumpio, B. E. (2000). Foot Ulcers. The New England Journal of Medicine, 343:787-793. https://doi.org/10.1056/NEJM200009143431107
4. Osteomyelitis (2020). Mayo Clinic, Mayo Foundation for Medical Education and Research. www.mayoclinic.org/diseases-conditions/osteomyelitis/symptoms-causes/syc-20375913.
5. Edmonds, M., Foster, A., & Thompson, S. (2014). Managing the diabetic foot (3rd ed.). Wiley Blackwell.
6. Edwards, M. (2008). Risk reduction and care for the diabetic foot: this article considers the importance of foot care in diabetes management, and offers guidance on the prevention and/or identification of problems that may require referral. Practice Nurse : the Journal for Nurses in General Practice, 36(4), 21–.
7. Matricciani, L., & Jones, S. (2015). Who Cares About Foot Care? Barriers and Enablers of Foot Self-care Practices Among Non-Institutionalized Older Adults Diagnosed With Diabetes: An Integrative Review. The Diabetes Educator, 41(1), 106–117. https://doi.org/10.1177/0145721714560441
8. Abbott, C., Carrington, A., Ashe, H., Bath, S., Every, L., Griffiths, J., Hann, A., Hussein, A., Jackson, N., Johnson, K., Ryder, C., Torkington, R., Van Ross, E., Whalley, A., Widdows, P., Williamson, S., & Boulton, A. (2002). The North‐West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community‐based patient cohort. Diabetic Medicine, 19(5), 377–384. https://doi.org/10.1046/j.1464-5491.2002.00698.x
9. Mayo Clinic Staff (2020). Diabetic neuropathy. Mayo Clinic, Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580#:~:text=Researchers%20think%20that%20over%20time,nerves%20with%20oxygen%20and%20nutrients.

Originally published 05/21