Islets of Hope  care tips for persons with diabetes

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Article disclaimer

Article compiled and edit by Lahle Wolfe.

Sources

NIH Publication No. 06–4282; March 2006

NIH Publication (.pdf)
Take Care of Your Feet for a Lifetime


Foot care involves taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. They will also heal less well than others. However, foot care is needed and applies to all individuals with foot problems, not only to those with diabetes.


Links

Medline Plus offers a free, online interactive tutorial to help you with foot care.

Diabetic Foot.com

American Academy of Podiatric Sports Medicine

American Podiatric Medical Association

The Italian Diabetic Foot WebSite

Medicare Therapeutic Shoe Program – A program under Medicare offering free foot-care for diabetics.  The coverage  includes a specialized shoe program to help prevent complications for people with diabetes and those with foot problems.  Under the program patients are entitled to (annually) one pair of customized shoes, two sets of inserts, and a fitting by a podiatrist or shoe specialist.  Patients can order molded or a depth shoe.

Visit our Health Insurance page to find out what your state laws require health insurance to cover for diabetes care.


Organizations

Lower Extremity Amputation Prevention (LEAP) Program, DPSP, BPHC

National Diabetes Information Clearinghouse, NIDDK, NIH, HHS

National Institute of Diabetes and Digestive and Kidney Diseases, NIH, HHS

American Academy of Orthotists and Prosthetists

American Diabetes Association

Amputee Coalition of America

National Amputation Foundation

 

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Diabetes Care Tips
Preventing Problems with Your Feet


Mini Site Index
Taking Care of Your Feet
How Problems Can Occur
Preventive Care for Diabetes-Related Complications
How to Have Happy Feet
Depression
Resources and Information about Foot Care and Preventing Amputation

Taking Care of Your Feet

Everyone with diabetes needs to pay careful, daily, attention to their feet.  Certain diabetes complications can cause the loss of sensation (neuropathy) and circulation throughout the body, including the feet.  Diminished sensation can interfere with the body’s injury warning system:  pain.  Small cuts and abrasions may go unnoticed and become infected due to poor circulation. Diabetics in general, have a tendency towards easier infection, and are slower and harder to overcome infections – especially when blood glucose is not under tight control.

Infections can ulcerate, fail to respond to treatment, and eventually all, or a portion of the foot, may need to be surgically removed (amputated).  If the infection persists even after amputation, it may even be necessary to remove part of the leg from below the knee in order to halt the deadly progression, which unattended, can lead to death.

Diabetes Care (Diabetes Care, November 2004;27:2636-2641) reported alarming statistics for the rate of amputation among the diabetic population in Barbados.  However, from the data, we are reminded that an ounce of prevention is worth a pound of cure.  For example, not wearing shoes tripled the risk of diabetes-related, lower-extremity amputation among Barbados residents and risk of amputation was quadrupled in the same population for those wearing “fashion” footwear, as well as for female walkers wearing sneakers into town.  It would seem obvious that  good footwear is of relative significance to preventing foot ulcerations which can lead to further complications including amputation.

Other risk factors for amputation (indicated in the report) include the following:

  • Single persons and men,
  • Length of diabetes, those on insulin, those with an elevated HbA1c,
  • Higher resting pulse rates and lower systolic blood pressure,
  • Previous history of foot ulcerations or infections,
  • Sensorimotor neuropathy,
  • Clinical signs of peripheral arterial disease (PAD),
  • Inadequate footwear.

For those who examined their feet daily, a remarkable 80% risk reduction was reported.  

    

How Problems Can Occur

Chronic high blood sugars restricts blood flow and impedes circulation to the lower limbs, especially the feet.  The problem can be worse for older persons and how long someone has had diabetes (either type 1 or type 2), with poorly managed blood glucose levels also increases the risk of foot problems.

Poor circulation makes it harder to treat infections and ulcers.  And when blood glucose levels are high a person with diabetes may not respond effectively to treatment.  Since neuropathy (damage to nerves) makes it hard to detect problems, it is absolutely crucial for all persons with diabetes to carefully inspect their feet every single day.

Persons with neuropathy can lose all feeling in an area and suffer severe damage to tissue and never even feel it.  (One physician stated “neuropathy can leave feet and lower legs so numb patients could walk around with a nail under their foot for a day and not realize it."  But early detection and treatment can help avoid amputation. 

    

Preventive Care for Diabetes Foot-Related Complications

Since most problems for diabetics begin with small sores on the skin like scrapes and blisters it is important to visually inspect your feet every single day.  Other steps you can take to ensure healthy feet include:

  • Quit smoking, which can cause or aggravate circulatory problems,
  • Check blood glucose often, and keep it in range as much as possible,
  • Eat a healthy, balanced diet
  • Exercise regularly (exercise increases blood flow and insulin sensitivity)
  • Maintain a healthy body weight,
  • Check your feet DAILY and immediately care for small cuts or blisters,
  • Have your doctor inspect your feet and hands at every visit,
  • See your doctor at the FIRST sign of any foot problems,
  • Be aware that heating pads or electric blankets can burn skin, especially when neuropathy is present.

The most frequent reason for hospitalization in persons with diabetes is due to problems with their feet.  But many of these problems, including amputation and hospitalization, could be prevented through simple preventive foot care.  

    

How to Have Happy Feet

  • Wearing comfortable shoes that fit goes a long way to preventing diabetes related foot problems.  If you require customized shoes, in may cases, your insurance should cover most of the cost.  (See a list of insurance laws for your state on our Legal Page, and Insurance options available to persons with diabetes.)

  • Cracks, and dried feet can lead to infections.  Apply lotion daily to cracked and calloused feet.  It is not necessary to spend a fortune on fancy foot creams (although they are nice), you can apply petroleum jelly liberally at night to the entire foot and simply wear a sock to bed.
     
  • Keep toenails trimmed,  Ingrown toenails can cause pain and infection.  Clip toenails so that the ends are rounded, not sharp or angled.  If you do get an ingrown toenail and it becomes red, puffy, or pussy, soak it in Epson salts until you can see your doctor and wear loose-fitting shoes, or open-toed sandals to avoid putting more pressure on the toe.
     
  • If you hold water in your feet or legs, try elevating your legs and feet above your head for 15-30 minutes.
     
  • Watch your blood glucose levels -- keeping in range as often as possible will dramatically reduce your risk of developing serious complications from diabetes.
     
  • If you are the parent of a child with diabetes, inspect their feet daily.  They don't have to know it is out of concern and inspection for potential problems; make it a game and give them a "tickle test."  If your child cannot feel your fingers on any part of the foot (top, bottom, sides, toes) call your doctor immediately.
     
  • If you get a blister, call your doctor for advice on how best to treat it.
     
  • Eat a health, well-balanced diet, drink plenty of water each day, and exercise regularly.  Staying fit and healthy will contribute to your overall diabetes control.
     
  • Limit caffeine, which can constrict blood vessels and may contribute to circulation problems.
     
  • Keep your blood pressure under control.  If you have high blood pressure, be sure to follow your doctor's instructions.  High blood pressure can cause circulatory problems in the feet.

Depression

The rate of depression among diabetics with ulcerations parallels that of those who have already undergone amputation.  Part of the reason may be that ulceration often is an impending sign of the need for amputation.  Counseling for both those with ulcerations showing signs of depression, and for those having undergone amputation is often advised.  

    

Resources and Information about Amputation

Diabetic Neuropathies: The Nerve Damage of Diabetes – Information about the causes, symptoms, and significant types of neuropathy. Includes information about diagnosis and treatment, and the findings of the Diabetic Control and Complication Trial (DCCT) in relation to neuropathy.

Feet Can Last a Lifetime - A Health Care Provider's Guide to Preventing Diabetes Foot Problems - This comprehensive kit for health care providers contains ready-to-use foot exam forms, Medicare certification forms for therapeutic footwear, a sample disposable sensory testing monofilament, reproducible patient education materials, and current resource and reference materials.

Take Care of Your Feet For a Lifetime - A Guide for People with Diabetes – Discussions complications of diabetes including loss of feeling, changes in foot shape, ulcerations of the feet, and wounds that don’t heal.

Financial Assistance for Prostheses and Other Assistive Devices (Copyright © ACA/NLLIC) – Information about who might be eligible for financial assistance and a list of organizations that can provide assistance with prosthetic devices.

Limb Loss FAQ's (Copyright © ACA/NLLIC) - Contains information about caring for, and reducing the risk of, amputations.  Also list of commonly used terms when discussing amputation.

For more information also, see:

    

 

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Page Updated 04/27/2006