Proper Foot Care when Managing Diabetes

Diabetic foot care is a serious concern for those with diabetes.  At Family Podiatry of Maryland, we encounter many diabetic patients on a daily basis. Unfortunately, we also witness the impact and effects this disease can have on our Patients. DIabetic Foot Care Patients are treated on a routine basis for palliative foot care and wound care.  Too often amputation of toes, due to infection, becomes necessary. We offer these Diabetic Foot Care tips in the hope of preventing infections that can results in the loss of toes or worse.

Clinical Effects of Uncontrolled Diabetes

Studies have shown uncontrolled diabetes has a long-standing effect on many systems in your body.   Hyperglycemia (high blood sugar) affects the lower extremities, particularly the foot and toes. Consequently, there are vascular and neurological complications.  A high glucose diet may not affect you immediately.  However, over time, it results in accumulative and irreversible damage to your body. Proper diet and glucose monitoring are cornerstones of good diabetic care.

The Pathogenesis of Diabetes

Glucose is metabolized in the bloodstream by insulin which is secreted by the pancreas.  In diabetes, hyperglycemia occurs when there is a malfunction of the pancreas leading to insulin deficiency as seen in type 1 diabetes.  Autoimmune process is known to be one of the causes of the disease process as well as genetic factors.  Obesity is often to blame for causing type 2 diabetes. Obesity causes insulin resistance.  Added weight also increases the risk of damage to the foot and ankle. Diabetic Foot Care Patients with Type 2 diabetes can reduce the damaging effects of hyperglycemia with a combination of proper nutrition and exercise.

How Diabetes Affects the Legs and the Feet

The high glucose level attaches to the lining of the blood vessels, hardening the lining of the vessels walls. This effect can lead to the narrowing of the lumen of the blood vessels as well or render them ineffective to pump blood efficiently. The toes, being they are the farthest away from the body, are the last place to receive blood supply. So, if there is peripheral arterial disease (PAD) from long-term hyperglycemia, the toes and the feet are the first places to show signs of ischemia (poor blood supply).
Your Podiatrist is often the first to discover PAD in the process of practicing good diabetic foot care. He can refer you to a vascular specialist when needed.

Diabetic Nerve Pain

The high sorbitol level from hyperglycemia has an irreversible effect on the peripheral nerves in your body.  Think of glucose as sugar in your system.  Like sugar, glucose sticks to things, e.g. nerves. Glucose adds layers of coating around the nerves and attaches to proteins that affect nerve function.  Symptoms of Diabetic Nerve pain include: numbness, tingling, sharp shooting pain, or burning sensation in the feet and legs. This is also known as neuropathy. Diabetics who have neuropathy may lose their protective mechanism to feel sharp objects. They may step on a sharp object, or burn their feet without feeling it. Left untreated,  what are minor injuries to most can turn into other serious ulcerations. Infections in the foot of a diabetic patient can lead to the possible loss of limb.

Prevention of Diabetic Foot Conditions

1. Eat Well. Ultimately, controlling your glucose will help prevent its deleterious effects on your body.Proper nutrition is learned and practiced. Ask your podiatrist (Foot Doctor). Just as we see the bad effects of poor foot care, we also witness the positive outcomes of those that take an active role in their nutrition. We can work with your primary care doctor and nutritionist to help you get on a plan to minimize the serious and lasting effects on your feet and overall health.
2. Exercise. When you exercise, your body needs energy. It will use the calories from the food that you digest; thus, reducing your glucose level.
3. Wear supportive shoes. Make sure they are properly sized shoes. The width of the shoes is just as important as the length.  From your longest toe, leave an extra 1/2 inch of room to the tip of the toe box. If you have swelling and deformity like hammertoes, buy extra-depth shoes to accommodate these factors. Ask your Podiatrist [Foot Doctor] for an Orthotic Evaluation. He can tell you if you would benefit from a custom fitted orthotic/inserts or orthopedics shoes. At Family Podiatry of Maryland, those simple inserts can make a huge difference.
4. Do not trim your calluses and corns yourself. And do not use over-the-counter pads with acid to treat this condition. You can be overzealous and cause more harm than good.
5. Wear slippers at home. Wearing socks alone does not protect your feet. Sharp objects go through socks too. Slippers for the home are a must.
6. Lotion your feet. Diabetics tend to have dry skin due to neuropathy, age or other causes. Use a good body lotion and moisturize them every day. Don’t use thick, oily cream and apply lightly. Good foot hygiene is also important in preventing infection and dry, cracked skin.
7. Have routine foot exams. If you are a low-risk diabetic, have at least an annual foot exam. If you are a high-risk diabetic and show sign of neuropathy, develop calluses, or have foot deformities, you need to be followed more often. Your foot and ankle specialist will advise you.
8. Ask your foot doctor for further workup if you have signs of calve pain with increased activities or rest pain. These symptoms are sometimes signs of peripheral arterial disease (PAD) or poor blood flow to your legs and feet. We have the PADnet system at our office to assess your circulation status.
9. Practice Diabetic Foot Care.  Finally, examine your feet.  Care for them.  Extra attention to your feet is necessary when managing diabetes. When you see signs of infection, e.g. cracks, drainage, swelling or redness, bring them to your podiatrist attention. This is one place where an ounce of prevention is truly worth a pound of cure!

Dr. Dang H. Vu is board certified by the American Board of the Foot and Ankle Surgery. He is a member of the Maryland Podiatric Medical Association and the American Podiatric Medical Association.  As a leading Podiatrist [Foot Doctor] and Foot and Ankle Surgeon in Baltimore, he is honored to be on staff at Northwest Hospital, the Surgcenter of Windsor Mill and the Surgcenter of White Marsh. Book an Appointment in either his Reisterstown or Towson office.