Foot Care In Diabetes Mellitus
Foot problems are a common complication in people with diabetes. Most of these complications can be prevented with careful foot care.
Diabetes and Foot Complications
Diabetes can lead to many different types of foot complications, like athlete’s foot (a fungal infection), calluses, bunions and other foot deformities, or ulcers that can range from a skin lesion to a deep infection.
Longstanding high blood sugar can damage blood vessels and cause thickening of all the blood vessel walls which decreases the blood flow to the feet. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. This is due to the growth of bacteria and fungi, which multiply and thrive on high blood sugar levels in the bloodstream. More serious complications include deep skin and bone infections. Gangrene (death and decay of tissue) is a very serious complication. If widespread, gangrene may require foot amputation. This tragic consequence can be prevented in most patients by managing blood sugar levels and daily foot care.
Clues: Some simple clues can point to circulatory problems. Poor pulse, cold feet, thin or blue skin, and lack of hair indicate
that the feet are not getting enough blood.
Nerve damage (Neuropathy)
High blood glucose levels over time can damage the nerves of the feet and decrease a person’s ability to notice/ feel pain and pressure. Without these sensations, it is easy to develop callused pressure spots and accidentally injure the skin and soft tissues. Infections take place in the injured soft tissues and this infection can spread into the bones and joints, resulting in life threatening foot complications like gangrene. Over time, bone and joint damage can dramatically alter the shape of the foot and can also
weaken certain foot muscles, further contributing to foot deformities.
1. Nerve damage may cause no symptoms as the foot and leg slowly lose sensation and become numb. This can be very dangerous because the person may be unaware that they have improperly fitted shoes or any foreign bodies in the shoes that could cause injury.
2. Skin changes in which excessive skin dryness, scaling, and cracking may indicate that circulation to the skin is compromised. Other skin changes may include healed or new ulcers, calluses, and broken skin between the toes.
3. Deformities wherein nerve damage can lead to joint and other foot deformities.
The toes may have a peculiar “claw toe” appearance, and the foot arch and other bones may appear collapsed. This destruction of the bones and joints is called Charcot arthropathy (bag of bones). Loss of sensation and poor blood circulation initiates and perpetuates diabetic foot complications.
What are the general foot problems in diabetes?
It is not that diabetics are prone to foot problems. Instead, the fact is that the common foot ailments like calluses, corns, blisters which trouble everybody are more difficult to heal in diabetics. The reason is the enormous amount of blood glucose and the same leading to infections if not discovered and treated well in time.
Corns and Calluses
A corn is the result of formation of thick hard skin along the bony part of a toe or, at times, between the toes. Corns may arise
due to the abrasion of the shoes against the toes or the toes rubbing with each other. A callus which is the build-up of hard skin is formed on the bottom of the forefoot or heel due to uneven weight distribution or ill-fitting shoes. Using a pumice stone, carefully remove the dead skin along the toes or the hard build-up preferably after a shower. Your doctor can tell you how to soften the callus. Any attempts of cutting or taking out the corn are a strict NO-NO. Cushion pads and insoles in shoes can lend a great degree of comfort.
Ingrown toenails arise when the nail edges start growing into the skin. This piercing of the nails into the skin causes pain, swelling, redness and finally an infection. Ingrown toenails occur due to pressure exerted by ill fitting or tight shoes, inappropriately cut nails, continuous suffering of the feet because of strenuous walking and running, etc. Surgery is required to remove the infected toenail along with the growth plat in severe cases.
Blisters are formed when inappropriately fitting shoes repeatedly rub against the
same spot. Wearing socks is helpful. In case the blisters become infected, do not try to pierce through the blisters, and use an antibacterial ointment to avert infection.
Bunions arise when your big toe starts skewing towards the smaller toe and the spot at the base of your big toe (where the big toe is joined to the foot) turns red, develops a callus and becomes sore. In diabetics, the chances of bunions becoming infected are very high. Bunions leading to deformity can form on one or both feet and can be corrected with surgery for realigning the toes. Apart from being hereditary, bunions can be caused by high heeled pointed shoes, exerting pressure on the big toe while pushing it to the second toe. Toes can be separated with specially designed devises and padding can prevent further irritation to the bunion.
Athlete’s foot is again a fungal infection wherein the symptoms include redness, itching, and cracking of the skin. Germs can make their way through these cracks in the skin and cause an infection which soon starts spreading to the toenails, making them yellow, thick and hard to cut. Athlete’s foot is treated with anti-fungal medicines and ointments as prescribed by
Plantar warts are caused by a virus and are formed on the soles of the feet.
Hammer toes are the toes that bend due to a weak foot muscle often caused by the diabetic nerve damage. The muscle so weakened, makes the tendons, connecting bone to muscles in the foot shorter, making the toes to curl under the feet. Hammertoes can also cause blisters, sores and calluses in addition to causing problems while walking. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes
that fit well. Hammertoes can be genetic in addition to be being caused by shoes which are too small. These can be treated with surgery, splinting and corrective footwear.
Dry skin on becoming cracked, permit the germs to enter and result in an infection. If your blood glucose is high, it promotes the
growth of germs and makes the infection worse. Keep your sin hydrated with moisturizing soaps and lotions.
Fungal infection of nails
Nails after being infected with a fungus become discoloured (yellowish-brown or opaque), thick and brittle, and at times slowly get disengaged from the rest of the toe. This nail may subsequently crumble. The reason for such a fungal infection can be an injury to the nail, or humid socks and shoes. Often difficult to treat, fungal nail infections require regular removal of the infected nail tissue, oral and local medications.
A foot ulcer is a deep sore which has a high probability of becoming infected in diabetics. Scrapes, slow healing cuts and uncomfortable shoes can lead to foot ulcers requiring immediate medical treatment.