HEALTH MATTERS
FOOT CARE
for People with Diabetes By Julie Pierantoni, MSN, RN, CDCES Sentara RMH Medical Center
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ost of us probably take our feet for granted and rarely give them a second thought. For someone with diabetes, however, proper foot care is key to preventing complications, including the possible loss of toes or even the feet themselves. Sustained high blood glucose (over 150) can cause a condition known as neuropathy, which involves nerve and blood vessel damage, especially in the smaller nerves and blood vessels of the feet (and sometimes the hands). Early neuropathy may have no symptoms at all, but later symptoms can include burning, tingling, numbness, foot ulcers and increased sensitivity to touch. Getting an annual foot exam by your medical provider is essential. The provider will check for early nerve damage with a monofilament, which is essentially a stiff piece of fishing line. While you may still have feeling in your feet, the monofilament detects early loss of their protective sensation. For a couple of reasons, people with diabetes are at higher risk of infection, and even minor foot injuries can lead to serious problems. First, germs inside a wound feed on glucose, which tends to be elevated in diabetics. Second, a blood glucose level above 200 paralyzes the white blood cells that defend against infections. To help prevent infections, people with diabetes should keep blood glucose levels below 150 and examine their feet daily for cracks, wounds, redness or blisters. If possible, use a mirror to view the bottom of your feet, or ask a family member to help. As well, since foot callouses can often have hidden damage
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underneath, it’s important to see a podiatrist regularly to keep callouses trimmed. Here are some more tips to help with proper foot care: • Wear well-fitting shoes at all times—even indoors. Look inside and remove any debris before putting them on. • Avoid soaking feet in hot water. Prolonged soaking removes moisture from the skin, increasing the risk of cracks and allowing germs in. Instead, wash feet in warm water, then dry thoroughly. • Keep feet dry, especially between the toes. Avoid using creams between toes, which may cause moisture retention. • Cut toenails straight across. The best time to trim toenails is after a bath or shower, when they are softer. If toenails are thickened or challenging to reach, have a professional trim them. • Avoid “bathroom surgery” (using sharp instruments on toes or feet). Instead, see a podiatrist, who has special tools for care, to have corns, callouses and toenails trimmed. • Pedicures are not recommended for people whose glucose is elevated, or who have neuropathy or poor circulation. • Avoid smoking and excessive alcohol intake. Smoking constricts the blood vessels, which over time decreases blood flow and can lead to poor healing in case of a foot injury. Excessive alcohol intake causes nerve damage and can worsen neuropathy. Keeping your blood glucose at safe levels and talking with your healthcare team regularly—especially if you develop cracks, wounds or redness on your feet— will help prevent foot issues.
