Diabetic Footcare Advice

Diabetes can cause significant foot problems. However, in many cases, particularly if blood sugar levels are well controlled and foot care advice is carefully followed, the risks of such changes occurring are reduced.

The changes in feet can occur whether patients are insulin dependent, tablet or diet controlled.

PodiatryThe following information explains some of the changes you may experience with your feet. As part of your ongoing care, your podiatrist will ascertain whether you are showing signs of the following conditions:

Poor circulation – this is reduced blood flow to your feet and legs. It can cause very cold feet, cramp like pains in the feet or legs, and tingling or burning sensations. Smoking is harmful to everyone. If you smoke and have diabetes the risk of developing circulatory problems is greatly increased.

Neuropathy – this is a reduced ability to feel pain, pressure and sensation. The feet often feel numb or tight. However, neuropathic feet may also feel painful with sharp shooting pains, particularly at night.

Infection – cuts and grazes are often slow to heal and can easily become infected.

Ulceration – an ulcer is a wound or break in the skin. They can occur as a result of pressure, friction or injury and often result from poorly fitting shoes. You are more at risk of developing an ulcer if you have poor circulation or neuropathy. In some instances diabetes can result in changes to the feet which alter foot shape, sometimes resulting in the need for specialist footwear.

Many people with diabetes are understandably concerned about gangrene. It is rare, however it remains a risk, particularly for neglected diabetic foot problems.

Tips to help keep your feet fit and healthy

Hygiene

  • Wash feet daily in warm water not hot water (40°c max). Remember your feet may not be able to gauge water temperature!
  • Do not use hot water bottles or toast your feet next to the fire or radiators.
  • Do not soak your feet for longer than 5 minutes.
  • Always dry feet well by rubbing gently with a soft towel and don’t forget in between your toes.
  • If the skin between your toes is too moist you can apply small quantities of surgical spirit on a cotton wool bud as long as there are no cuts to the area. If you are unsure ask your Podiatrist for further advice.
  • If you suffer from dry skin, apply moisturising cream daily – again your Podiatrist will be able to advise you. DO NOT put moisturising cream between your toes.
  • Inspect your feet daily for sores, redness or any areas of discharge. Ask family members to help or use a mirror if you can’t inspect your feet easily. Check inside your shoes with your hands for any foreign bodies.
  • Always cover any sores with a dry dressing and consult your Podiatrist or Doctor if healing takes longer or looks different to normal.

Footwear and hosiery

  • Try to ensure that your feet are measured when buying new shoes. Over the years your feet will naturally change shape and even size.
  • If you have been given insoles by the Podiatrists, always try new shoes with the insoles in place.
  • Don’t accept shoes that need “breaking in”. A correctly fitting shoe will feel right from the start.
  • Wear shoes for short periods initially and examine your feet carefully for any rubbing, redness or pressure points.
  • Shoes and slippers should have enough length, width and depth for your feet, particularly in the toe box of the shoes. Shoes need to be held in place by a lace, velcro or buckle fastening.
  • Always ensure that the shoe upper is made of soft material and is free from bulky seams or stitching.
  • Thick cushioning soles are best.
  • Fashion shoes should be kept strictly for special occasions and then only if your feet are not at particular risk.
  • Walking barefoot is hazardous.
  • Change socks/hosiery daily. Cotton or wool socks are preferable and should be the correct size and fit properly.
  • Do not wear socks with holes or darns. For sensitive feet, wear socks inside out so that seams do not irritate them.
  • Socks that are too small are as harmful as tight shoes!
  • Do not wear garters or socks/popsocks that constrict the circulation. Your Podiatrist can advise on comfort top socks to alleviate this problem.

General foot health advice

Many people who have diabetes do not have any foot problems. If that is the case, your podiatrist may advise you to continue your own normal foot care.

You should always have yearly checks to ensure you have not developed any problems, these should be arranged by your doctor.

  • Try to stay active. If your circulation is poor, still go for short walks unless advised otherwise.
  • If your feet swell by evening, treat yourself to an hour with your feet up at lunchtime.
  • If your podiatrist agrees, cut or file nails following the natural contour of your nail. Do not cut nails too short or cut down the sides of the nails. Thick nails benefit from regular filing.
  • Never poke down the sides of the nails.
  • Reduce any hard skin regularly with a file. Do not use any types of corn plasters or blades, they are potentially very dangerous.

Helpful holiday advice for diabetics with “at risk” feet

Before you go

  • Check that your travel insurance will cover any problems that arise.
  • When packing, carry your medication in your hand luggage, or better still, carry a supply in two different places.
  • If you are on insulin you will need to get a letter from your GP or the hospital to enable you to carry it in your hand luggage
  • It is advisable to always carry a full list of your current medication with you.
  • Bear in mind, there may be delays, carry extra medication and currency in case of emergency.
  • Pack a small first aid kit you can make your own or purchase ready-made kits.
  • Don’t take brand new shoes on holiday as they may rub.

The Journey

  • When flying, allow plenty of time at the airport.
  • Don’t carry heavy luggage: use a trolley.
  • Consider asking for a wheelchair if your feet are at risk.
  • Beware of trolleys pushed by other passengers in a hurry.
  • Wear shoes with adjustable fastenings to accommodate swelling.
  • Ask for an aisle seat and exercise/walk up and down to prevent swelling.
  • Do not get dehydrated – keep sipping water.
  • On a car or coach journey, have frequent stops to stretch your legs.

On arrival

  • Use sun block or very high factor sunscreen- and keep in the shade. Remember your feet can burn too!
  • Hot sand, shells, broken glass and debris can cause serious injuries. Wear closed style beach shoes on the beach or poolside and in the sea. Don’t go barefoot.
  • Your feet may be swollen after travelling or in hot climates, be aware of pressure from footwear.

Daily checklist

  • Wash your feet daily using mild soap, checking for any wounds or blisters as you do so. Ask a friend or use a mirror to check your feet if you cannot reach.
  • Apply moisturising cream to your feet daily avoiding in between your toes.
  • Check inside your footwear every time you put them on. Clean out any debris thoroughly and look for any damage to the inside of your shoes.