Diabetes & your Feet

Diabetes is has been diagnosed in about 2 – 3% of the UK population but there is estimated to be another 2 % of the population who have diabetes that has not been diagnosed. About 85 – 95% of all diabetics are type 2. Type 2 diabetics make insulin but often not enough and the insulin often it does not work properly. Type 1 diabetics are unable to produce enough insulin.

1 How does diabetes affect circulation?
Diabetes can cause narrowing of arteries, decreasing the circulation in the leg. But neuropathy not circulation is the main cause of diabetic foot problems.

2 What can be done to improve circulation?
Vascular surgeons an sometimes improve the circulation to the foot and leg which can help ulcers and sores to heal.

1 What is neuropathy?
Neuropathy is the gradual loss of nerve function due to diabetes. The most common and significant change is loss of feeling, or touch sensation in the feet and legs. With neuropathy you may not feel touch or pain. Occasionally patients may present with symptoms and signs of neuropathy and investigation show that they are diabetic. The most dangerous thing about neuropathy is the absence of feeling, because this allows any injury to go unrecognised.

2 How do I know if I have neuropathy?
Neuropathy comes on slowly. It is sometimes hard to be aware of something you cannot feel. A clinical examination by your orthopaedic foot and ankle surgeon will be able to quantify and neuropathy. This is usually done using a special filament called a Semmes Weinstein filament, which is pressed against the skin to see if you can feel it. Occasionally other investigations may be initiated.

3 If neuropathy causes loss of feeling, why do my feet sometimes hurt or tingle?
Neuropathy can cause the nerves to “go haywire”, or transmit impulses that you experience as numbness, tingling, shooting pains, burning sensations, pins and needles, electric shock sensations or any combination of the above. In other words the nerves are all messed up.

4 Do all diabetics get neuropathy?
The likelihood of getting neuropathy increases with age and the longer you have diabetes, the increased chance you have of developing neuropathy. The severity of any neuropathy does not necessarily correspond to the severity of the diabetes. So even if you have very mild diabetes that you think is well controlled you are not immune from developing a neuropathy.

5 What can happen to my feet if I have neuropathy?
You can injure your feet without knowing it. So, for example you may let a cut or a sore of the foot get out of hand because you are unable to feel it and may not appreciate the extent of it or even recognise that you have it in the first place. A severe infection could then develop which could be limb threatening in the worst case scenario.

6 What other ways can neuropathy hurt my feet?
If you wear a pair of poorly fitting shoes, blisters or open sores (ulcers) can develop. At first these can cause small problems but they can progress to become much more severe. Walking barefoot is dangerous with decreased foot sensation.

7 Does this mean that I should seek medical attention if I have a small foot injury or minor infection?
Yes you should be checked out. A small area of swelling or redness may seem very minor and may not hurt at all because of the neuropathy. It can however represent a significant problem or injury that requires treatment to prevent a serious complication developing.

1 Why do infections cause foot probems?
Infections may spead quickly in the foot, giving little warning. Minor injuries can become ulcers which can then develop into deep infections. A severe tissue or bone infection may require surgery in addition to antibiotics.

2 What should I watch for?
Several warning signs should lead you to suspect infection. Unexplained temperature rise or fevers coupled with open sores or blisters on your feet may signal an infection. Another warning sign may be blood sugar that is difficult to control and requires a higher insulin dosage.

3 Can antibiotics treat infections?
Yes, antibiotics are important. But if you have poor circulation, antibitics may not reach the infection.

1 How do I prevent foot problems?

Good care requires daily vigilance. Close visual inspection must substitute for the feeling you have lost in your feet. Look for reddened skin, sores, blisters, inflamed nails, bony prominences, and change in the shape of your foot.

2 How do I do this when I find it hard to get in a position to see the bottom of my foot?

You can place a mirror aginst a wall near a chair in the bedroom or bath to inspect your feet. If you have poor vision, you may find a magnifying glass helpful. A better technique is to get a member of your family or a friend to inspect your feet regularly.

3 What daily care should I do?
Use gentle cleaning routines. Wash your feet (do not soak them) in lukewarm water, never hot. Since you cannot rely on your feet to warn you that the water is too hot. Test the water with your elbow or better still is to use a thermometer. Wash your feet with a soft cloth and mild soap.

4 What else can I do?
Dry thouroughly but gently between the toes. Use a moisturizing lotion for any dry skin, but do not put it between the toes. Keep the dry skin soft and pliable.

5 How should I trim my nails?
If you have good vision and can reach them easily, trim nails straight across with a nail clipper. Do not round the corners. However, it is safest to file the nails down frequently with a simple nail file or emery board. If you have difficulty or are uncertain, you should have your nails trimmed professionally by a chiropodist.

6 Are corns a problem?
Yes, corns are hard calluses that form on the top of the foot, especially on the toes, almost always due to pressure of shoes. Corns indicate that your shoes are too tight and you need to be professionally fitted.

7 How should I treat calluses on the bottom of my feet?
Thickened skin or calluses also occur in these areas due to pressure. They can cause problems if they become excessively thick and/or dry, causing splits in the underlying skin that can lead to an infection.

8 How should I trim calluses?
Calluses can be reduced with gentle daily rubbing with a foot file or pumice stone. Rub in one direction to avoid tearing the skin. If you uncertain or unable to trim consult your doctor or chiropodist. Never trim with a sharp razor blade or apply liquid corn or callus removers.

9 What kind of footwear should I choose?
Choosing good footwear that allows plenty of room can help prevent foot injuries. Shoes should have cushioned soles with uppers made of soft, breathable materials such as leather, not plastic. Professional shoe fitting is advised and sometimes this requires referral to an appliance department or orthotist.

10 What about sandals?
These can concentrate pressure between the toes. The loose fit can also allow the foot to shift and slide leading to abrasions and ulcers.

11 What kind of socks should I wear?
Cotton or natural fiber socks provide the best padding. Avoid synthetic materials. Avoid holes, wrinkles and lumpy stitching. Do not use socks or stockings with garters or elastic tops that can cut off your circulation giving little warning. Minor injuries can become ulcers and then develop into deep infections. A severe tissue or bone infection may require surgery in addition to antibiotics.

12 Should I check my shoes every time I put them on ?
Yes, always look inside the shoes for foreign objects. Make sure the shoe is in good repair and free of loose seems, loose heels and nails. Break in new shoes gradually. Wear them one or two hours at a time before you check your feet in the mirror for reddened areas.
13 What kind of shoes should I wear if I have neuropathy ?
The best shoes for neuropathy are in depth shoes with custom moulded insoles (Orthoses or arch supports)

14 Should I wear arch supports ?
Patients with neuropathy should use custom moulded insoles to help cushion the foot. These are shaped to the foot. Patients with neuropathy should avoid over the counter rigid and hard plastic insoles.