Have you examined your feet lately? All diabetics have been told about amputations and how often they occur in people with diabetes so should we be concerned?
Diabetes Canada states that approximately 70% of amputations performed in hospitals is due to diabetes. Adults with diabetes are 20 times more likely to undergo non-traumatic lower-limb amputations as compared to the general population.The majority of these amputations start with a foot ulcer that becomes infected. Diabetes foot ulcerations can result from nerve damage (often referred to as neuropathy) and poor blood flow or circulation to the legs and feet (also known as peripheral arterial disease). If you have either of these complications you would be less likely to feel a foot injury such as a cut or blister. Diabetes can impair your ability to heal these type of sores (wounds) especially if the diabetes is uncontrolled and the sore goes unnoticed for a period of time. Diabetes foot complications place a tremendous emotional and financial burden on the individuals suffering from these complications, their families and the health care system.(1) Foot care is of extreme importance in managing your diabetes.
There are many factors that contribute to foot problems such as:
o Foot ulcers (may be called sores or wounds)- if the skin is broken then bacteria and fungus can enter that area. If a break in the skin does not heal properly then it can become a chronic wound referred to as an ulcer. At the first sign of any wound, broken skin, redness or soreness on your foot, don’t hesitate to see your doctor. The quicker it is treated the better the outcome. Also if you blood sugars have been out of control, then gaining better control will definitely make a difference in the healing process.
o If you have cracked or peeling skin on your feet then ask your pharmacist or health-care team for a good cream/lotion to hydrate the skin. Avoid bathing in hot water which will dry the skin even more. Do not put cream between the toes.
o Dry between your toes well to prevent an infections such as athlete’s foot which loves moist environments. If your feet sweat a lot then changing socks throughout the day may help or wear socks that wick away the moisture.
o Wash and check your feet every day. This includes the sole of the foot, the top of the foot, between the toes and sides of the feet. If you have the nerve damage mentioned above, then you may not feel anything on the foot or if your shoe was rubbing to cause friction. A good foot rub down is inexpensive and just takes a bit of energy and dedication. If this is difficult for you or there is no one to help you, then use a mirror to examine the foot. Check for corns and calluses and any bumps or lumps that might mean a bone injury. DO NOT cut your own corns/calluses. Let the professionals do this for you. Avoid over- the-counter remedies as these could be harmful.
o Toenail infections- the same fungus that causes athlete’s food can cause infection behind the toenail. A warning sign of this type of infection could be the nail appears dark, thick and cracked. There are prescriptions available to treat this infection but it may take several months and the infection could come back.
o Nail clipping- toenails should be trimmed/cut straight across and any sharp edges should be filed. Don’t cut the nails too short. Use toenail clippers for thick nails.
o Shoes- should be well fitted. Diabetes Canada has an excellent website that I strongly recommend not only for us with diabetes but for the general population. Always protect your feet. Do NOT go barefoot. Wearing flip-flops as in the picture should not be worn.
o Be sure your physician/health care providers to do foot care screening and if this is not part of their normal routine then don’t be shy to ask.
o Keep your feet safe outdoors meaning cover up the feet, don’t forget sunscreen on the feet and toes and reapply often. Check your feet for any cuts or scrapes after coming out of the water and consider wearing water shoes.
We depend on our feet all day long to get us to work, exercise, clean the house, drive the car and so many other events. We want to keep them forever so daily examining of the feet does not take long and helps at preventing issues.
Long term blood glucose control is one of the key factors to prevent the complications of nerve damage and poor circulation to the feet and legs. Other factors that will benefit you include:
· Not smoking- smoking makes the arteries harden faster. It decreases blood flow to the feet and makes wounds heal slowly. Ask your health care providers of what programs are available in your area to help you quit.
· Keep your blood pressure and cholesterol under control. High fat intake can cause fat to build up in the blood vessels and decrease blood flow.
· Never use a hot water bottle or heating pad since these could cause burning on your feet especially if you cannot feel pain.
· Exercise- this stimulates blood flow to the feet and legs.
There are many excellent resources from Diabetes Canada and The American Diabetes Association for your review if you want more information.
I have feared an amputation since my diagnosis 47 years ago. I see these bad ulcers and amputations in my work place and I think how terrible it is for the patient. Today we have many devices to help us control our disease as compared to years ago, unfortunately, these devices come at a cost and not everyone is able to afford these items. We still have a journey ahead of us to overcome this financial burden to patients with diabetes.
Thank you for your time today and I hope this has been beneficial. Feel free to subscribe to my blog and I welcome feedback.
References:
1. Can J Diabetes 42 (2018) S222-S227- Foot Care Diabetes Clinical Practice Guidelines
3. Google images accessed August 9th,2020
4. https://beyondtype1.org/give-yourself-a-foot-exam-to-prevent-diabetes-related-complications/ accessed on August 1st,2020
5. https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-32#panel-tab_FullText-accessed August 9th,2020
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