January 13, 2008 by Kavit Haria
How diabetes affects your feet - and what you can do about it!
By Afni Shah, the footcare expert.
A common question asked by my patients is how diabetes mellitus affects the feet. This article will explain why and how Type I and II diabetes mellitus affects the feet.Diabetes may not affect your feet initially but there are three mains way in which it could. These ways can exist together or separately.
Reduced circulation can occur. This is called ischaemia.
This occurs when large blood vessels or arteries have their inner walls covered by a fatty substance called an artheroma. This means that there is less room for the blood to flow down to the foot. There also may be changes to smaller blood vessels such as the ones in the foot. In severe cases a blockage can occur in the vessel. Diabetes can also cause hardening of the arteries as calcium becomes deposited in the vessel wall, thus causing the blood not to be pumped efficiently around the body.
Smoking can make the problem much worse. It is important to maintain a good supply as it is essential in helping to maintain healthy skin and tissues and heal any open wounds. Regular blood supply checks can be carried out easily by feeling for pulses in the foot and performing blood pressure checks on the foot. This should be carried out routinely by a Podiatrist or other Health care professional. It is recommended that diabetic patients have a foot health check at least once a year.
Impaired sensation known as neuropathy.
This is where the nerves in the foot and sometimes the lower leg have been damaged by diabetes. You may be unable to distinguish the difference between hot and cold, or feel sharp objects. Sensory loss can occur at any time. The skin can often appear dry due the loss of nerves stimulating sweating which help keep the foot hydrated. A podiatrist can routinely perform a simple test that will identify any problems. They will test your protective senses through using a 10mg monofilament test and using a tuning fork.
Changes in foot shape
This is likely to occur in association with reduced sensation. The nerves controlling the muscles do not work properly and this can cause clawing of the toes. The balls of the feet can become more prominent. This can cause a change in way you walk or stand which can cause abnormal pressure areas and calluses.
How to prevent foot problems - General measures
Ensure that you do everything you can to maintain good control of your blood sugar level and it is very important not to smoke as it increases the chances of problems occurring. Also performing gentle exercise regularly will help improve the blood flow.
Daily foot checks
You may not be aware of injury to your feet, therefore it is important to incorporate checking your feet as part of your daily routine. If you have poor eyesight please ask a friend or relative to help you. If you can not reach your feet use a well-positioned mirror to see parts of the foot that can not normally be seen. It is also important to check in between the toes.
General nail cutting
It is advised that diabetics should not cut their nails because if you cut the nails yourself you could be at a higher risk of developing an infection. It is advised to file your nail using an emery board every few days. If your nails are thickened, a podiatrist can use a nail drill to reduce the thickness of the nail and cut them too.
Treating hard skin
A foot file can be used for light hard skin and then gently rub cream over the thickened skin. This will help maintain the elasticity of the skin. For corns and very hard skin, it is best to see a podiatrist to treat the areas. Corns may feel like you are constantly walking on a pebble. Do not use a blade, razor or scalpel yourself as you cannot see how much skin you are taking off and this may cause an open wound and scarring. Also if a cut is created, it could lead to severe infection. For corns do not use corn plasters as the ointment in the plaster is too potent on the skin and can cause an infection.
Bathing
Wash your feet with warm water and soap. Make sure you dry your feet carefully especially in between your toes, this will prevent the skin cracking. Also it is important to check the temperature of the bath water before you put your foot in, as you may lose temperature sensation in your feet and not realise it. This could result in you scalding your feet.
Socks and hosiery
Natural fibres such as cotton or wool are preferable. Change socks every day.
Footwear
Always ensure that your shoes have a round, wide, deep toe box and compare the shape of your toes with that of the shoe. Laces are best for fastening shoes, but buckles or Velcro straps are just as effective if you have difficulty with laces. A ¼ inch of space between the end of your longest toe and the end of the shoe is ideal. If your feet swell, take care not to lace, buckle or fasten too tightly. The height of the heel should not be more than one inch and leather uppers are preferred. If possible have your feet measured before buying shoes. The best time to have your feet measured is at the end of the day as feet generally swell slight throughout the day.
Heat
Your feet may not be able to distinguish between hot and cold. Don’t use hot water bottles or sit in front of a fire to warm up your feet. Burns can occur which may not heal easily.
Do not do the following things:
Ignore any problems with feet that you are unsure about. If there is a distinct colour change, any swelling, pain, heat or other abnormalities, please seek professional help immediately. Do not use razor blades or sharp implements to remove hard skin as this could lead to an infection. Do not use corn plasters as these may contain acid which is harmful to your skin. Do not wear badly fitting shoes or walk barefoot. Do not wash your feet in strong disinfectants.
In the event of an emergency
First aid: If a minor injury occurs on your foot, cleanse with warm salt water, dry the foot carefully with a soft clean towel without touching the actual wound. Cover with a dry dressing.If for any reason, there are problems in contacting your podiatrist, please telephone your GP immediately.Most importantly make sure that your Podiatrist is registered with the Health Professions Council (HPC).
This article was written by Afni Shah, B.S.c (Hons), M.S.c, M.Ch. S, S.R.Ch, our footcare expert. Afni runs Tip Toe Footcare, a podiatry/chiropractic clinic in London.
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