Diabetes Diabetes and and FootCareFootCare

What is Diabetes?

Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem.

Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.

Diabetes

“Mild Disease” Serious consequences

Diabetes Mellitus A Serious Disease

Leading cause of newcases of blindness 25 times more prone to eye problems

6 times higher risk forParalysis (stroke)

5 times more prone toKidney failure 20 times more prone to

lower limb amputationNerve damage causes loss of sensation

2-3 times higher risk forheart attack

Diabetes and FeetWhy people with diabetes require good care of their feet?

There are several reasons Loss of sensation with increased risk of injury Poor circulation causing delayed healing Higher likelihood of developing infections that go unnoticed and spread widely

leading to gangrene

Diabetes foot ulcers are the most common cause for prolonged hospitalizations

Diabetes is the most important cause of non traumatic foot amputations

Learn to take good care of your feet Practice what you learn every day Foot problems must be detected and treated properly Take help of a Foot Care specialist or your Diabetes Care

Team

Prevention Is Better Than Cure

Daily Foot Care You can prevent major foot problems, if you

Learn to recognize signs of early foot problems Inspect your feet daily Keep your feet clean and dry Trim your toenails carefully Protect you feet with appropriate footwear Have your doctor or nurse examine your feet regularly

(especially if you have any loss of sensation in your feet or toes or have a poor eyesight)

Recognize the Symptoms of Foot Problems

Pay attention to peculiar sensations such as Tingling, like a feeling of “ants crawling” or “pins and needles” Numbness and heaviness “feeling of walking on cotton”, or feeling of

“wearing tight socks” even when the feet are bare Reduced ability to sense heat and cold Stabbing or burning pain A persistent “restlessness” in the feet and legs

(These are tell tale signs of impending serious foot problems)

Inspect Your Feet Daily Examine feet in good light after bath

Check for in-grown nails, corns and calluses, swelling of the leg and feet, dry skin or areas that are irritated.

Check to see that the nails are well trimmed. Use a mirror to see the bottom of the feet. Look and feel carefully for possible injuries, for breaks in the skin, cuts,

scratches, bruises, blisters, sores, and discolouration especially between the toes.

Using Mirror

Learn to recognize the early signs of Infection Unusual warmth over the injured area Redness Swelling Pain (if you still have good sensation) Drainage of pus from an opening in the skin

(If you find any of these immediately take Doctor’s advice or ask your Diabetes Care team)

Fungal infection between the toesBlister on the foot

Inspect Your Feet Daily

Keep your feet clean and dry Wash feet daily as you wash your hands, using soap and

lukewarm water Dry feet carefully with a soft towel after bathing, especially

between the toes where moisture can lead to a fungal infection

Apply a moisturising cream to keep skin over the feet smooth and soft

Take Care of Your Toenails Helps avoid ingrown toenails, which lead to infection Trim and cut toenails with a nail cutter after a bath, when

soft and pliable Cut your toenails straight across the top and not too far

back on the sides Do not use a sharp instrument to clean under the nail, or in

the grooves If your toe nails are too thick to cut, you can have them cut

by the foot specialist in your Diabetes Care team

Protect Your Feet With Appropriate Footwear

Many foot problems can be avoided if you are careful to protect your feet at all times

Don’t walk barefoot even at home especially when there is loss of sensation

Choose proper footwear of the correct shape and size Always shop for shoes in the evening when the feet are the largest Check the size of the shoes wearing the thickest socks Choose cotton or woolen socks Socks should be free of wrinkles and holes, elastic should not be

tight

Proper Footwear Shoe should be comfortable and should fit well

Never wear Shoes which are too short or too narrow

Rounded toes give more space to the feet

Always choose flat shoes with thick, sturdy soles to protect the feet from sharp objects

Proper Footwear Leather shoes let the foot breathe freely

Do not wear chappals without back support especially when there is loss of sensation

When buying a pair of shoe, take in to account any bunions or other irregularities. These will require wider and deeper shoe to avoid pressure points

Proper Footwear

Ill-fitting shoes

Take a paper cut of the foot shape Place the paper inside the shoe Paper must fit without folds

Pressure Sores or Ulcers It starts with a callus, which is a sign of continuous

pressure or friction on a particular part of feet It is always advisable to treat the callus before an ulcer

occurs. See your Doctor or Diabetes Care Team immediately

If not treated properly, such ulcers can lead to serious foot problems like gangrene

Gangrene often leads to the removal of a toe or foot (Amputation)

Red marks on the foot Inflammed toe

Black discolorationEarly sign of gangrene

Ulcer

Cramped toes

Callus

Blister

Ingrown toenails

Feet At High Risk

Cuts and Injuries Keep the affected area or injury clean and apply a sterile

bandage If you have decreased sensation in your feet, you have to be

more careful to avoid injuries such as minor accidents, burns etc

In absence of pain (alarm system), these minor injuries may become serious and can lead to amputation or removal of that part of the foot

Blisters and Cracks Never squeeze or puncture a blister Proper dressing and careful inspection is most important If the blisters appears to contain blood or becomes

inflamed see your doctor or Diabetes care team Cracks are difficult to heal and infections occur easily Daily use of foot cream to soften the skin as well as a

shock absorbing insole is recommended

Often caused by improper nail trimming or poorly fitted shoes

The problem can be solved by correcting the footwear. Ask you Diabetes Care Team for assistance

As with all foot problems, prevention is the best cure for ingrown nails

Ingrown Nails

Corns and Calluses Usually Corns and calluses result from poorly fitted

footwear that puts pressure on a certain area of the foot A deep ulcer or crack can result if the callus is left

untreated Do not apply corn caps or self treat Consult your doctor or Diabetes Care Team for further

treatment of corns and calluses

Callused skin

Bunion

Corn

Foot At High Risk

Nerve Problems Lead to Foot Deformity

Nerve damage in your feet may lead to loss of sensations and muscle weakness

It affects the way you walk, and increases pressure on certain parts of the feet leading to fractures and bony deformities that occur without any apparent accident or reason

It decreases your ability to sweat and impairs blood flow to your feet

Who Is at Risk of Foot Ulcers? Some People with Diabetes have a greater risk of developing

foot ulcers than others The factors which may play a role are:

Long standing poorly controlled diabetes Loss of sensation in the feet Poor blood circulation Bunions or other foot deformities Impaired Vision Smokers

Poor Vision Poor vision puts your feet at risk, because you may not be

able to see the minor sores and other foot problems at the bottom of the feet

Ask your diabetes care team for complete inspection of the feet

Smoking Do not smoke as nicotine causes blood vessels to shrink and

slows down the blood flow to the foot Impaired blood circulation can increase the foot problems

Examination of Your Feet Insist that your doctor examines your feet from time to time

to Assess the general condition of your skin and nails Check for signs of poor circulation

- Cold extremities, absent or weak pulsations Check for signs of decreased sensation Look for the deformities such as bunions Note any pressure points that lead to calluses Check for signs of infection, injury and ulcers Watch the way you walk and note any changes

Insist that your doctor examines your feet from time to time to

Test for the loss of protective sensation Check your ability to feel vibration Test light touch with a monofilament Check for impaired blood circulation Check for foot pulses Test toe blood pressure Perform an angiogram of arteries if needed

Examination of Your Feet

Blood Sugar Control Poor blood sugar control is a risk factor for the

development of foot ulcers Good control can prevent the development and

progression of nerve problems (loss of sensations) Good control ensures continued good blood supply Good control prevents minor injuries getting infected The better your blood sugar control, the better your body

can take care for itself. Take Insulin, if advised

ConclusionAchieve good blood sugar control - save your feet.

Take Insulin, if advised.