Foot problems in people with diabetes most commonly result from the loss of circulation and/or the loss of feeling in the feet because of nerve damage. A person with diabetes should follow guidelines for good foot care to prevent unnecessary complications.
A person with diabetes often has damage to the blood vessels of the legs and feet because of high blood sugar. This results in decreased circulation to the legs and feet, and thus, in turn, to poor healing of any cuts, scratches, or burns that the foot may sustain.
The person may also have diabetic neuropathy, in which nerve damage from diabetes causes decreased sensation in the legs and feet. The person can develop an open area from pressure or from a cut, and not even feel the sore. Untreated, the damaged area can develop a diabetic foot ulcer.
The following factors increase a person's chance of developing a foot ulcer: diabetic neuropathy, with damage to the nerves supplying the feetperipheral vascular disease, with decreased blood flow to the feeta history of 10 years or more of diabetesmale genderblood sugar levels that are not under controldiabetic retinopathy, or damage to the retina of the eye caused by diabetescardiovascular problems caused by diabeteskidney problems caused by diabetes, including chronic renal failurea history of skin ulcers or amputation of a limbconditions caused by increased pressure on the feet, such as corns and callusesfoot bones that are deformed or have limited movement, such as bunionsthick toenails
Guidelines for preventing foot ulcers from diabetes Inspect the feet daily for blisters, cuts, scratches, scalings, discolorations, and unusual swelling of the feet or toes. Pay particular attention to the area between the toes. If vision is poor or if reaching the feet is difficult, a member of the family should assist.Clean and soak both feet in tepid water for 15 minutes before trimming toenails.Trim toenails so they are even with the end of the toe, and file sharp edges smooth. Corners should never be cut or dug out.See a healthcare professional if the nails grow into the flesh or if they are difficult to cut.Wash feet daily with warm water and mild soap. Dry feet completely, especially between the toes.Gently massage a bland lubricating cream into the feet after drying them, especially around the toenails and heels. Do not put creams or ointments between the toes. Dust a non-medicated powder between the toes.Never use strong antiseptics, especially tincture of iodine, disinfectants, or bleaching agents, on the feet.If a cut is present, wash the area with an antibacterial soap. After drying the area, apply an antibiotic ointment and cover it with a sterile dressing.Avoid extremes of temperature. Protect feet from sunburn and frostbite.Wear clean cotton or wool socks to bed if feet are cold. Hot water bottles or heating pads should not be used.Change socks and stockings daily. Circular garters or stockings with elastic at the top should not be worn. They may cause a tourniquet effect that will lead to swelling of the lower leg.Wear properly fitted shoes with soft uppers and flexible soles, preferably with adjustable straps or laces. Avoid walking barefoot or wearing open-toed or open-heeled shoes.Break new shoes in gradually, by wearing them for a short time each day. Check inside shoes daily for foreign objects, nail points, and torn linings. If the linings are torn or crumpled, the shoe should be discarded.Corns or calluses should be treated by a healthcare professional. Never cut them with a razor blade or use chemicals to remove them.
Monitoring by the healthcare professional On each visit, the healthcare professional should specifically ask about any foot problems or leg or foot pain when the person is sitting, standing, or walking.The healthcare professional should check the pulse in the groin, behind the knees, behind the anklebones, and on top of the feet. The healthcare professional should test the person's ability to feel sharp and dull sensations, vibrations, and light touches to the feet and toes.The healthcare professional should look for corns, calluses, deformities, cuts, bruises, bunions, diabetic foot ulcers, and infections.
Approximately 50% to 70% of foot amputations among people with diabetes could be prevented if foot problems could be identified early and properly treated.
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