Your feet

FootcareCaring for your feet
To protect your feet, you should always wear soft, well-fitted shoes that allow a little extra room since feet expand, or swell, later in the day and when warm. Shoes that are too tight can cause sores within just a few hours. Socks should be seamless.

Diabetes and your feet
People with diabetes have special reason to take good care of their feet. High blood glucose levels may make feet susceptible to injury and infection. This is because the protective sensation in the toes or feet – your “pain alarm system” ­may slowly disappear with long term high blood glucose levels.

Diabetes Ireland are opening Care Centres. Cork City & Dublin North are open. There are more to come. We offer rapid-access, affordable Podiatry (Foot Care) services from these centres to treat people with a low to moderate risk thereby preventing complications that require the higher risk HSE services in hospitals.

Diabetes Ireland Care CentreOur Podiatrists have extensive clinical experience. We stock a range of specialised Shoes, Socks and foot care products . During the sessions, we aim to teach you how to care for your feet. Visit our Care Centre page if you are located near to a centre.

Learning good foot care
Learning good foot care habits can prevent most foot problems. To ensure continuous foot care education tailored to your needs, it is important that you have a foot examination each year.

Advice about foot care
You may be advised about foot care soon after you get diabetes, even if you have no current foot problems. You may think this is unnecessary at first but many problems can be avoided, if you establish a daily foot care routine early.

Foot examinations every day
Examine your feet every day and report problems immediately. Look for cuts and for changes in skin and nails. Check your feet in good light. Use a mirror to see the entire foot.

Signs of infection
Learn to spot the first signs of infection. These are elevated skin temperature, red areas and swelling. Pain and tenderness suggest that your pain alarm system is intact. Foot infections require immediate treatment by your doctor or foot care team.

Reduced sensation
Be aware that your protective sensation may decrease or disappear due to neuropathy. Often there are no symptoms when this happens. Regular examinations by your diabetes team are important. Be alert to signs such as prickly pain in the feet, numbness and peculiar sensations, such as a feeling of walking on cotton or of wearing tight socks. Without a working pain alarm system, injuries and poor fitting shoes may go unnoticed.

Squeezing shoes 
Don’t wear shoes that squeeze your toes. These may contribute to problems with damp feet, fungal infections, ingrown nails and skin problems such as corns and calluses. Poor fitting shoes may deform your feet and cause ulcerations.

Protecting footwear
Many foot problems can be avoided by protecting your feet with proper footwear that fits well right away and does not need to be broken in. Wear appropriate shoes for your activity. Dress shoes should only be used for a few hours at a time.

Foot Hygiene
Wash your feet as you wash your hands. Bathe or shower but do not soak your feet. Soaking removes vital oils from the skin and causes cracking. Keep the skin smooth and soft with moisturising cream. Wear well fitting shoes to protect your feet from pressure and the development of hard, thickened skin. Never walk barefoot. Sweaty feet can be treated with absorbent foot powder.

Trimming your toenails
Trim your toenails carefully (check with diabetes care team, if you may do this yourself)
Trimming your toenails carefully is part of good foot care. It helps to avoid ingrown nails, which can become infected. Cut your nails straight across and not too short. They should be even with the ends of your toes. You can use an emery board to smooth sharp edges. Thick nails and ingrown nails may require the attention of your chiropodist.

Foot injuries may occur
Scratches, wounds, pressure sores, ingrown nails, blisters and cracked skin may occur, despite all efforts to protect your feet. The best treatment is to identify and correct the causes of foot injury. When this has been done by your diabetes team, most injuries will heal with proper care.

Why is there so much talk about feet and diabetes?
Most people with diabetes have no initial trouble with their feet, but progressive damage to the blood vessels and nerves can cause severe problems. Damage to the blood vessels can cause poor circulation in:
• the large blood vessels in the legs – Ischaemia
• the small blood vessels in the skin – Peripheral vascular disease
• Damage to the nerves can cause a loss of sensation in the feet – pain sensation can be lost so that the feet may not be protected against damage.

You can help yourself to prevent damage to the blood vessels and nerves in your feet by keeping good control your blood sugar level as set by your doctor, stop smoking and keep active.

Should I be putting cream on my feet every day?
Wash your feet daily and be careful to dry them well – especially between the toes.
If your skin is dry use a moisturising cream on your skin daily on your feet. Avoid using it between your toes that can make the skin too moist.

Frequently asked questions

Can I still cut my own nails now that I have diabetes?
You may continue to look after your own feet if you have no visual problems of foot damage. If you have ‘high risk feet (your doctor or nurse will examine your feet and tell you if you have), you will need to attend a podiatrist for foot care. For most people with diabetes, they can cut their own nails. Cut your toenails straight across and not too short. File them if it is easier.

I have recently been given a foot spa and was very disappointed to read a caution on the side of the box that it was not suitable for people with diabetes. Is this true?
If you have neuropathy (nerve damage) you definitely should check with your diabetes team before using this product. If you do not have neuropathy make sure you check the temperature of the water carefully and don’t soak your feet for too long.

COMMON FOOT PROBLEMS

Athlete’s foot is contagious via skin to skin contact and indirectly if one uses the same towel as a person with the condition.

The symptoms of Athlete’s foot are:
• An itchy, red rash, which often starts in between the 4th and 5th toes, before spreading to the other toes.
• Scaling or cracking of the skin may occur.
• Blisters can occur. If these burst, they can cause pain & swelling.

To prevent Athlete’s foot:
• Wash your feet daily & ensure you dry them properly, paying particular attention to between the toes.
• After drying put anti-fungal powder on your feet.
• Wear socks made of adsorbent fibres such as cotton
• Change your socks daily or change them if they become damp.
• Wear waterproof sandals/socks in public showers and pools.
• Avoid wearing tight shoes, or shoes made of synthetic material, such as runners. If you do wear runners, always wear cotton socks with them.
• When the weather is hot and humid, give your feet plenty of ventilation by wearing perforated shoes or sandals.
• Air shoes at night and if possible don’t wear the same shoes every day.
• Remember feet are meant to be aired on a daily basis and especially at night.
• If somebody in your family has a foot ailment, do not share clothes or towels with them, and make sure possibly contaminated areas, such as the bathroom floor or the shower, are regularly washed in hot, soapy water.

Fungal nail infections
People with diabetes are more prone to fungal nails so it is important to recognise and known how to prevent the condition.
Most fungal nail infections are caused when fungi get under the nail following an injury such as dropping something heavy on your foot, stubbing your toe or trimming nails too closely.
Fungal nail infections are more common in toenails than finger nails because shoes and socks create warm moist environments that help fungi to grow. Wearing too tight fitting shoes can also weaken the nail and expose the nail bed to infection. Like athlete’s foot, fungal nail infections are contagious, something as simple as an emery board can spread the infection.

The symptoms of fungal nail infections:
• Discolouration – nail may become yellowish/greyish in colour.
• Loss of shine
• Thickening
• Distortion of nail shape
• Crumbling of the nails
• Debris being trapped under the nail
• Sore, tender nails
• Lack of growth
• Loosing (detaching) of the nail

To prevent fungal nail infections:
Follow the points to prevent athlete’s foot as well as:
• Don’t share shoes, nail clippers or emery boards
• Use sterile manicure and pedicure instruments
• Don’t apply polish to nails that may be infected
• Wash and dry hands thoroughly after contact with any fungal infection to prevent spreading the infection

Warts (Verrucae)
Warts are caused by the human papillomavirus (HPV) and are referred to as verrucae when they appear on the foot. They can appear anywhere on the foot but are usually found on the soles where they can be very painful.

Recognising a verruca:
• The verruca usually starts as a small pink area that can be speckled with black dots (unlike a callus).
• As the verruca ages it may turn a brownish colour with a rough crumbly surface which can sometimes be covered with hard skin.
• Verrucae can spread and form groups of growths on the same foot, each with its own centre.

Over the counter remedies to treat verrucae should not be used by people with diabetes, it is best to see a state registered podiatrist.

To prevent verrucae:
Again follow the points to prevent athlete’s foot paying particular attention to:
• Wear waterproof sandals/socks in public showers and pools.
• If somebody in your family has a foot ailment, do not share clothes or towels with them, and make sure possibly contaminated areas, such as the bathroom floor or the shower, are regularly washed in hot, soapy water.

What is gangrene?

Gangrene (gang”green) is the name given to the gradual destruction of living tissue, a common result of inadequate blood and oxygen supply, usually due to arterial obstruction. Gangrene usually follows a disorder that cuts off the blood supply to an area of the body.

The most common category of gangrene is “dry” gangrene. This kind of gangrene, caused by a gradual reduction in the blood supply to the tissues, is almost exclusively limited to the extremities – especially feet and toes.

In early stages, dry gangrene causes some dull, aching pain – the affected area is extremely painful to palpate (touch). Then, it becomes cold, dry and wrinkled. The skin changes in colour to dark brown, then a dark purplish-blue, then completely black.

“Wet” gangrene is usually the result of infection and the process is accelerated. However, this form is relatively rare.

Gangrene is often treated by an operation to remove the dead tissue. If it’s an area of tissue that can be removed, the operation is called debridement – the surgical removal of lacerated, devitalized, or contaminated tissue.

If it’s an arm, leg, hand, foot, finger, or toe that has to be removed, the operation is called an amputation – the surgical removal of an affected part of the body.

Other standard medical treatments include:
• antibiotics (usually intravenously, through a needle in a vein)
• pain killers
• blood thinners (to make sure that blood clots don’t form)
• extra oxygen – either by a mask or nasal prongs, or in a hyperbaric
• oxygen chamber (very high pressures of pure oxygen are used to treat the gangrenous area).

Neuropathy

After many years of living with high blood sugar levels, some people develop a nerve disease known as diabetic neuropathy. This disease affects peripheral nerves, which serve the muscles, skin and inner organs.

What is ‘neuropathy’?
You may hear the term ‘neuropathy’. This is another potential complication of poorly controlled diabetes. ‘Neuropathy’ simply means disease of the nerves.

Which nerves are affected?
Nerves need blood to survive, so damage to small blood vessels that supply the nerves leaves them with too little blood. Any nerve in the body can be affected, but there are some typical symptoms that you might notice. These are described below.

Symptoms of neuropathy
Often the first sign that nerves are affected is a patch of numbness or tingling in the toes or feet. The skin may be tender. Some people experience pain, whereas others find themselves unable to feel pain or temperature. This can be extremely dangerous, since pain and temperature act as alarm bells to warn us of potential danger. Some people say that numbness in the feet makes it feel like they are walking on cotton wool. If you have longstanding diabetes, you might notice muscle weakness.

Effects on specific organs
Widespread damage to nerves can affect the intestinal system, causing diarrhoea. Some people experience a full feeling in the stomach, or nausea. You may notice dizziness if you stand up quickly, and it is best to get up slowly, and with assistance. Damage to nerves in the pelvis can lead to bladder problems and men may have difficulty getting an erection. Because your ability to detect pain is reduced, your feet need special attention. Foot problems are very common in people with diabetes, so this topic is covered in detail in the section on ‘Your Feet’.

Preventing neuropathy
Good control of your blood sugar and diabetic treatment will slow down or prevent neuropathy, and hence reduce the likelihood of you suffering the symptoms. This has been proven in many large research studies.

Treatment of symptoms
If you are in pain, trying a painkiller suggested by your doctor is a good start. However, neuropathic pain can be difficult to treat with common painkillers. We now know that drugs normally used to combat depression can be excellent painkillers. For some people the antidepressant effect is also a bonus, as learning to deal with the problems associated with diabetes can make you feel low at times. The specific organ complications need addressing on an individual basis. As these can be difficult to treat, your GP may refer you to a neurologist – the specialist who deals with nerve problems.