How can I take care of my feet if I have diabetes?

What is diabetes?

Diabetes is a serious, complex, and chronic condition that is, unfortunately, becoming increasingly more common and affects the entire body. Poorly managed diabetes can have significant physical and mental health impacts and has a negative health effect on the feet in particular.

Diabetes mellitus is a condition that occurs when the body is not producing enough insulin from the pancreas. Insulin helps the body transport sugar from the blood into the cells. When there is not enough insulin it results in higher levels of glucose or sugar in the blood. Sugar comes from the food you eat and drink, it helps you do things like walking and running. It is ok to have a little bit of sugar in your blood; the ideal range is between 4-6mmol/L fasting. However, when you have diabetes the level of sugar needs help to stay in this range with diet, medication, and/or insulin. Those with diabetes have a higher risk of damage to nerves and blood vessels feet because there are higher levels of sugar in your blood which can cause damage.

The two main types of diabetes are known as Type 1 and Type 2. Type 1 diabetes often occurs in younger people and is insulin-dependent. While Type 2 diabetes often occurs more commonly as you age and is associated with obesity and hypertension. It is a non-insulin-dependent form of diabetes, however, some people with Type 2 diabetes require insulin injections.

According to Diabetes Australia:

• Is the leading cause of blindness in working-age adults

• Is a leading cause of kidney failure and dialysis

• Increases the risk of heart attacks and stroke by up to four times

• Is a major cause of limb amputations

• Affects mental health as well as physical health. Depression, anxiety, and distress occur in more than 30% of all people with diabetes

What effect can diabetes have on my feet?

Diabetes is often not managed properly or taken seriously enough. Those with diabetes may forget or neglect their foot health despite the risks of infection and in very serious cases amputation. If diabetes is properly managed with lifestyle, medications, assessments, foot checks, and maintenance, then the foot-related risks of diabetes can be reduced.

Diabetes increases your risk of foot complications, which is why it is recommended to have a diabetes foot assessment performed by a podiatrist and ongoing podiatry care if necessary. The podiatrist will conduct a neurological and vascular assessment as part of the diabetes foot assessment.

Long Term Lower Limb Complications of Diabetes:

• Loss of protective sensation

• Decreased blood supply to the feet

• Increased risk of infection

• Diabetic foot ulcers, amputations, and gangrene

 Your podiatrist will advise you on appropriate footwear, care instructions such as how to perform daily foot checks and what to look out for to manage and prevent ulceration, infection, and other complications.

People with diabetes are more likely to develop the following foot-related conditions:

• Neuropathy is the loss of feeling in your feet which can result in injuries occurring which you do not feel and hence can cause ulceration

• Vascular complications like Medial Calcification of the arteries can lead to reduced blood flow and poor healing

• Charcot neuroarthropathy is a condition that can lead to bone destruction and a rocker bottom shaped foot

• Ulceration is a break in the skin which can result in osteomyelitis which is an infection of the bone, which left untreated may result in amputation

Please see your podiatrist ensure you are having regular diabetes foot assessments, checking if your footwear is appropriate, and gaining advice on daily foot checks, etc.

How can I care for my feet?

• Check your feet daily for any breaks in the skin, blisters, infection, and changes in the appearance of the foot and nails. You can use a mirror, a camera, or have someone help you if you have trouble reaching your feet.

• If you notice any small cuts or blisters contact a podiatrist immediately or see your general practitioner

• Wash your feet regularly in warm soapy water (make sure you check the water temperature first)

• Dry your feet thoroughly afterward with a soft towel taking care to dry in-between your toes

• Apply moisturizing cream every day - do not put the cream between your toes

• Book an appointment with a podiatrist to cut your nails if you have diabetes with neuropathy (loss of sensation) or decreased blood supply, do not cut your toenails between appointments. If you notice any sharp/rough areas file the nails lightly.

• Change your socks daily. Make sure you always wear socks and shoes - even while at home.

• Look at the bottom of your shoes before putting them on to make sure nothing sharp has pierced the sole. Feel inside the shoe with your hand for any small objects.

• Do not use corn removal products

• Do not remove any hard skin or callous yourself