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Diabetes and Foot Complications

Foot Complications
Foot complications can affect anyone who has diabetes. People with diabetes need to take special care of their feet.

Why do I need to take care of my feet?
Diabetes may cause poor circulation and reduced feeling in the feet leading to damage. This might lead to infection, ulcers and even amputation. Whether your feet are normal or not, you should take full care of them to avoid any problems.

What are the risks?
You might take risks with your feet without thinking about it e.g. walking barefoot. Ill fitting shoes can cause damage by rubbing. Your feet may be misshapen and prone to bunions or corns.

Over and above these things that can affect anyone, other problems can develop. Nerve damage (neuropathy) causes loss of feeling. This tends to make the foot warm, dry and numb to feeling. You may not be aware of any pinching or small cuts. You might not feel a stone in your shoe. If these injuries go unnoticed they may become infected and an ulcer can form. The circulation to your feet may also be affected (ischaemia) and the foot tends to be cold and sometimes painful and any damage will not heal so well. The problems of nerve damage and poor circulation can occur together.

If you injure your foot or an ulcer develops, this can be difficult to heal sometimes needing several months of treatment and so it's best to prevent problems happening.

How can I help myself?
The risk of ulceration is decreased by the following do's and dont's of diabetic foot care/

  • Do not ignore even the slightest injury to your feet.

  • Examine feet daily.

  • Use a mirror if necessary.

  • You may not be aware of any foot injuries.

  • Report sores, swelling, skin damage or change in colour to your doctor or podiatrist.

  • Keep your feet clean.

  • Use a moisturising cream on dry skin.

  • Be sure to treat any Athlete's Foot problems that are causing moist skin or cracks between the toes.

  • Avoid extremes of temperature such as very hot baths, sitting close to fires / radiators, or using hot water bottles.

  • Never use surgical blades or corn pairing knives on your feet.

  • Avoid using corn plasters; they contain acid which may cause problems.

  • Always check inside your shoes / slippers for any objects before you put them on.

  • Always be careful when buying new shoes to ensure that they are a proper fit and break them in gradually.

  • Know how to cut your toenails properly.

Seeking advice and what care to expect
Everyone with diabetes should have full education about their foot care at the start and whenever they wish to seek advice. You should know exactly how to look after your feet. If you are dependant on others for foot care - they should be trained too. If you ever have concern about your feet talk to your medical team who will advise you.

At the very least, you must have an annual foot examination by your medical team.

According to this foot examination and whether it reveals any risk, you may need to be under podiatry care regularly or under the specialist diabetes foot team.

You must report urgently to your team if there are any foot problems.

Choosing Footwear
Foot problems can affect anyone who has diabetes, especially if there is a lack of circulation, poor feeling in the feet or if the feet are misshapen. Any injury to the foot can break the skin, let infection in and lead to an ulcer. Poorly chosen shoes are a common cause of such injury, leading to these serious problems even including amputation.

Footwear can damage feet
Your choice of footwear is so important. Good foot care must include choosing the correct footwear. The right shoes and stockings / tights / socks will help keep your feet healthy. Having diabetes should not, in itself, cause you difficulties in finding suitable shoes.

Shoes that do not fit well can cause corns, calluses, ingrowing toenails, blisters and ulcers. Remember, because there might be a problem with numb sensation in your feet, don't be fooled into thinking your shoes and socks are safe just because they are comfortable. Maybe you simply can't feel that they are tight. If you have neuropathy (poor feeling) or poor circulation in your feet, continued rubbing or pinching by unsuitable shoes can cause serious damage without causing you any pain.

How can I help myself?
To ensure the shoes you buy are suitable for you, you should have your feet measured for size and width when you buy a new pair of shoes. Buy shoes which are broad fitting, have a deep and rounded toe area, are flat or low heel, are fastened by lace or buckle to keep the heel in the back of the shoe - this prevents the foot from being able to slide forward and crush your toes. Always examine the inside of your shoes for sharp objects or stones before putting them on and replace damaged inner sole linings. Avoid socks, stockings or tights with prominent seams. Stockings or socks with over tight elastic tops should also be avoided as they can restrict circulation. Never wear socks with darned areas or holes
which can also cause rubbing and damage.

Seeking advice and what care to expect
You should have a full education about foot care. Your feet should be examined every year. If you have misshapen feet or poor circulation and lost feeling then you should have specialist care. All of this includes clear advice about footwear. If your feet are at high risk, you should be assessed formally for special footwear. If you are unsure of which fit or style is suitable for you, ask your diabetes team for advice or ask to see a diabetes specialist chiropodist. You must report urgently to your diabetes team if there are any foot problems.