Diabetes (or more correctly, diabetes mellitus) is a chronic disease
that affects up to 6% of the population (higher in the older age
groups). Insulin is a hormone that helps the body deal with sugar
(glucose) in the diet. When diabetes is present, either the body
produces less or no insulin (Type 1) or the body tissues are
resistant to the effects of diabetes (Type 2). This results in
higher levels of glucose in the blood, which can damage a whole
range of body tissues and organs.
Why the foot is so important to those with diabetes:
The foot is especially affected by diabetes because:
diabetes damages the nerves (damage can occur to the foot and not be
detected) - this is called peripheral neuropathy.
diabetes also affect the circulation. Poor circulation can affect
the ability of the body to heal when damage occurs.
those with diabetes are more prone to infection - the body's
processes that normally fight infection respond slower and often
have trouble getting to infections due to the poor circulation.
diabetes can also affect the joints, making them stiffer
other diabetes complications that can also affect the foot, for
example, kidney disease (affects proteins that are involved in wound
healing) and eye disease (can't see the foot to check for damage).
As a consequence of these factors a number of things can go wrong:
the foot may get damaged and you do not know about (for example,
your shoe rubs a sore onto a toe that gets infected - you can not
feel it because of the peripheral neuropathy - you can not heal very
well due to the infection and poor circulation).
foot ulcer are common (see below)
infections can spread
the ultimate of this process is an amputation. Diabetes is the main
cause of amputations.
Charcot's joints is another complication of diabetes in the foot,
especially if peripheral neuropathy is present - the neuropathy
cause a numbness (imagine spraining your ankle and not knowing you
have done this. You will continue to walk on it - imagine the damage
that this would do. This is what happens in a Charcot foot)
Foot ulcers in those with diabetes:
Foot ulcers are a common complication of the "diabetic foot". They
allow a portal for infection to occur. Ulcers are caused by too much
pressure on an area and the skin just "breaks down". They can occur
under corns and callus. Healing can take a while and its is
imperative that pressure is removed from the area and good wound
dressings are used.
The do's and don'ts of foot care if you have diabetes:
If you have diabetes, there are a lot of things you need to do to
prevent the problems from developing in your foot:
1) Wash your feet daily (use a mild soap and lukewarm water). Dry
very carefully, especially between the toes. It often helps to use
talcum powder to dust the foot to further reduce moisture, however
be certain to remove all the powder after dusting, as it should not
leave a residue between the toes. If the skin is dry, use a good
emollient - BUT, not between the toes).
2) Inspect your foot daily (check sores, cuts, bruises, changes to
the toenails; use a mirror to look under the foot if you can not see
it).
3) Look after your health (loose weight; stop smoking; exercise;
reduce your alcohol consumption)
4) Look after your feet:
cut toenails straight across and never cut into the corners; use an
emery board or file on sharp corners.
do not try to remove corns and callus yourself - see a Podiatrist
for this; NEVER use commercial corn cures - this is so important in
those with diabetes as it is so easy to damage the skin.
avoid going barefoot, even in your own home (this lessens the chance
of some accidental damage)
5) Fitting of footwear is very important. Poorly fitted shoes are a
common cause of problems in the foot of those with diabetes. Some
advice:
get your feet measured each time you buy new shoes (foot size and
shape change over time).
make sure the shoe fitter is experienced.
new shoes should be comfortable when purchased and should not need
a "break-in" period.
they should fit both the length and width of the foot, with plenty
of room for the toes.
avoid shoes with high heels, pointed toes or tight around the toes
(these put too much pressure on parts of the foot and can contribute
to ulcers)
6) See a Podiatrist, at least annually.
These two books are highly recommended for those with diabetes:
101 Foot Care Tips for those with Diabetes
Numb Toes and Aching Soles - Coping with Peripheral Neuropathy
Podiatric treatment of the foot in those with diabetes:
Podiatrists have an extremely important role to play in the
prevention and management of complications of the foot in those with
diabetes. All those who are at risk for a problem should have that
risk status assessed at least annually (more if the risk is
greater). The Podiatrist should communicate this risk status to
other members of the health care team. Advice should be given on how
to reduce the chance of damage happening, what to do to prevent it
and what to do if something does go wrong.
Regular foot care from a Podiatrist is a key way to prevent problems
from developing in those who are at risk.
When something does go wrong, see a Podiatrist immediately. Waiting
a "few days to see what happens" before seeing someone may be the
difference between a good and poor outcome. The sooner treatment is
started the better.
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