The need for proper foot care in diabetes

Foot problems are a common complication in people with diabetes. Fortunately, most of these complications can be prevented with careful foot care. If complications do occur, daily attention will ensure that they are detected before they become serious.

It may take time and effort to build good foot care habits, but self-care is essential. In fact, when it comes to foot care, the patient is the main member of the medical team.

Diabetes can lead to many different types of foot complications, including athlete’s foot (a fungal infection), foot deformities, or wounds that can range from a surface wound to complicated deep infections.

Longstanding high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor blood flow can weaken the skin, contributing to the formation of wounds and impairing wound healing. Some bacteria and fungi thrive well on high levels of sugar in the bloodstream, and these can break down the skin and lead to development of complicated foot wounds.

More serious complications include deep skin and bone infections. Gangrene (death and decay of tissue) is a very serious complication that can result from such infections. Widespread gangrene may require foot amputation.

Approximately five per cent of men and women with diabetes eventually require amputation of a toe or foot. This tragic consequence can be prevented in most patients by managing blood sugar levels well and doing proper daily foot care.

Elevated blood glucose levels over time can damage the nerves of the foot, decreasing a person’s ability to notice pain and pressure. Without these sensations, it is easy to unconsciously accidentally injure the skin and other tissues leading to development of wounds, which owing to the poor healing in diabetes, can become complicated wounds that might end up with an amputation.

Patients who have had a previous foot wound are more likely to have future foot complications. Nerve damage, poor circulation, and chronically high blood sugar levels also increase the likelihood of foot complications.

Care for the feet is very essential in all diabetics as diabetes associated nerve damage may not present any bothersome symptoms initially until one notices a wound injury coincidentally.

It is recommended that people with diabetes should have a comprehensive foot examination once per year, and a visual examination of the feet at each hospital visit (usually every three to four months).

Some activities increase the risk of foot injury and are not recommended, including walking barefoot, stepping into the bathtub before testing the temperature with the hand. One needs to use extra care when trimming the nails.

Diabetics need to wash and inspect their feet daily. Use lukewarm water and mild soap to clean the feet. Gently pat feet dry and apply a moisturising cream or lotion. Check the entire surface of both feet for skin breaks, blisters, swelling, or redness, including between and underneath the toes where damage may be hidden. Using a mirror or asking a family member or caregiver to help if it is difficult to see the entire foot may help.

Select cotton socks that fit loosely, and change the socks every day. Wear shoes that fit correctly and that are not tight. There are special shoes for diabetics are cushioned well to reduce the risk of blistering and injury to the feet and these can be used.

Controlling blood sugar levels can reduce the blood vessel and nerve damage that often lead to diabetic foot complications. If a foot wound or ulcer does occur, blood sugar control reduces the risk of complicating into an amputation.

Smoking can worsen heart and vascular problems and reduce circulation to the feet, worsening foot complications in diabetes; hence, smoking cessation is very important in prevention of these food complications in diabetes.
                              
Dr Ian Shyaka,
Resident in Plastic Surgery, Rwanda Military Hospital

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