Why is Diabetic Foot Care important?

People with Diabetes are at increased risk of peripheral arterial disease and diabetic neuropathy, as well as having risk of developing infections and decreased ability to clear infections.

Because of sensory deficits, there are no protective symptoms guarding against pressure and heat and so trauma can initiate the development of a leg ulcer. Absence of pain contributes to the development of Charcot foot, which further impairs the ability to sustain pressure. Motor fibre abnormalities lead to undue physical stress and to the development of further impairs the ability to sustain pressure. 

Foot complications are common in people with diabetes. Diabetes is the most common cause of non-traumatic limb amputation, with diabetic foot ulcers preceding more than 80% of amputations in people with diabetes. After a first amputation, people with diabetes are twice as likely to have a subsequent amputation as people without diabetes. 

Diabetic foot ulcers are usually painless, punched-out ulcers in areas of thick callus, pus, oedema and malodour.

• Neuro-ischaemic ulcers tends to occur on the margins of the foot. Neuro-ischaemic foot tends to be cool and pink with atrophic skin and absent pulses, the foot may be painful and there is little callus.
• Neuropathic ulcers tends to occur on the plantar surface of the foot. Neuropathic foot tends to be warm with dry skin, bounding pulses, distended veins, reduced sensation and callus around the ulcer.

The 10 Golden rules for Diabetic feet:

1. Check the feet daily, possibly with a mirror. Watch for skin lesions and discolorations.
2. Wear wool socks or stockings.
3. Do not walk barefoot to avoid wounds.
4. Do not walk for too long to avoid skin damage and blisters.
5. Walk with small strides (less gait less load on the forefoot and heel).
6. Check the shoe before putting the foot in for bumps and stones.
7. Take a lukewarm foot bath, check the bath water and use foot crème or oil.
8. Never use a warm water bottle in bed to heat your feet, this causes numbness.
9. Cut the nails straight and not too short. Do not remove corns or calluses by yourself.
10. If in doubt, please contact your doctor or medical pedicurist.

Foot ulcers in people with diabetes have a high risk of necessitating amputation. Ulcer recurrence rates are high: however, appropriate education, regular surveillance, the provision of post-healing footwear and regular foot care can reduce rates of re-ulceration. Early detection and effective management of diabetic foot ulcers can reduce complications, including preventable amputations and possible mortality. Even when healed, diabetic feet should be regarded as a lifelong condition and treat accordingly to prevent recurrence. 

Taking care of your feet in Diabetes!