Havana Nights Diabetic Foot Care
Ten to fifteen percent of diabetic patients develop foot ulcers at some point in their lives and foot related problems are responsible for up to 50% of diabetes related hospital admissions.
Prevention is by frequent chiropody review, good foot hygiene, diabetic socks and shoes, and avoiding injury. Foot-care education combined with increased surveillance can reduce the incidence of serious foot lesions.
What causes foot problems with diabetes?
In patients with diabetes, blood flow to the feet may be impaired. This means that the foot is less able to fight infection or heal itself. Nerve damage (neuropathy) may be present, causing a lack of sensation in the feet. Pain may not be felt even with injury, predisposing you to foot ulcers and infection. The skin may also become dry, cracking and peeling easily, since neuropathy may cause sweating to be impaired.
The following guidelines by Sheridan Waldrop will help you protect the feet and should be done daily.
1. Good Blood Sugar Control
Keeping your blood sugar under control can help prevent or delay foot complications as well as other diabetes related problems. This will mean self-management of blood sugars with diet, exercise, medication, monitoring blood glucoses, and education in other techniques of controlling blood sugar.
2. Inspect Feet Daily
Visually checking feet is important, since residents may not feel injuries if they have neuropathy. Look for cuts, sores, red spots, infection, swelling or unusual appearing areas. Set a time daily (such as after bath or shower) to perform this check.
3. Wash and Moisturize Feet Daily
Warm (about 90-95 degrees) water is best, instead of hot. Use a thermometer to assess the temperature. Dry feet afterwards, with special attention between the toes (to prevent athlete’s feet). Rub a thin layer of a good moisturizer or lotion that does not contain alcohol (which can be drying), avoiding the area between the toes. Moisturizing will help prevent skin from drying and cracking, which can lead to infection. Also, do not soak the feet, since this will also dry out the skin.
4. Smooth Corns and Calluses
After bathing, when the skin is soft, use a pumice stone to gently rub in one direction, smoothing off corns or calluses. Avoid tearing the skin, and never cut corns or calluses. Never use liquid corn and callus removers, since they can create a chemical burn. If the calluses become thick, refer to a podiatrist. They may indicate a pressure area, and the need for special shoes or inserts to relieve the pressure.
5. Trim Toenails Regularly
Once a week is usually enough. After washing and drying feet, trim toenails straight across, then smooth them with an emery board so there are no sharp edges. Do not rip off hangnails, and don’t cut into the corners, or trim into the quick. Consult a podiatrist if the nails are thickened and yellow.
6. Never Go Barefoot
Even going barefoot indoors can cause injury. Good fitting shoes and socks are one of the best protections. Choose socks made of cotton or wool, since they will “wick” moisture away from the skin, and make sure there are no seams or bumps. Be sure to check inside shoes before putting them on for objects, rough spots or exposed nails.
It is best to break in new shoes slowly (one hour a day the first week, increasing time gradually). Choose shoes made of canvas or leather that let the feet “breathe,” with good support at the ankles. Don’t buy pointed toes or high heels, which put pressure on the feet. Keep slippers with good soles by the bed if residents get up at night.
7. Avoid Thermal Injury
Never use hot water bottles or heating pads on feet, which cause tissue injury or burns. Wear socks at night if feet get cold. Apply sunscreen on the top of feet to prevent sun burn. In the winter, lined boots can help keep feet warm. Check for frostbite if exposed to the cold.
8. Don’t Constrict Circulation
Avoid crossing legs, or wearing tight socks, garters or constricting garments.
Exercise helps promote blood flow. Walking, swimming and bicycling can help blood flow and do not put pressure on the feet. Avoid high impact exercises such as running or jumping. Wear good fitting, supportive athletic shoes.
10. Have Feet Checked at Every Visit Doctor Visit
At minimum, a yearly foot check of pulses, sensation and visual inspection should be done by a health care professional. Those at higher risk should be checked more frequently. Every ulcer should be seen by a health care provider immediately, even if there is not pain.
Sheridan Waldrop, from rural North Texas, has more than 18 years of experience as a nurse both in critical care and more recently, diabetes education.