Take Proper Care of Your Feet to Avoid a Diabetic Foot Ulcer
It sounds a bit odd when you first learn that as a diabetic you need to practice regular diabetic foot care. How on earth can the amount of sugar in your blood relate to what goes on with your feet?
It's all down to blood circulation issues and nerve damage (neuropathy) that can affect diabetic patients, especially if their blood glucose (sugar) control is poor.
Your feet are of course classed as extremities and if your circulation is less than perfect they may not be supplied with as much blood as someone without diabetes. This might make your feet less sensitive and mean you don't notice small cuts or grazes, especially if you have any degree of nerve damage in your feet too.
Imagine - you are enjoying a romantic barefoot walk along a beach with your other half. The waves are lapping around your toes. You step on a sharp shell, but because of your poor circulation and neuropathy you don't notice.
Or, you are determined to wear those killer heels that involve squishing five toes into a space really suitable for three. Some people end up with sore feet and maybe a blister. Diabetics can end up with an ulcer.
And that annoying pebble in your shoe? Anyone who has walked with children wearing sandals knows how irritating it can be when every 100 feet they ask you to get stones out of their shoe. But a diabetic with neuropathy may well not notice the pebble - and that too can cause an ulcer.
Any form of abnormality in the bones or muscles of the feet like severe arthritis can also lead to ulceration which, if left unnoticed – maybe because of poor eyesight or a physical inability to check feet thoroughly – can get infected.
What Is an Ulcer?
So what if you get an ulcer? Firstly we need to understand what an ulcer actually is. Put down your lunch now – this is a bit gruesome!
An ulcer is basically an open sore, a shallow crater on the surface of the skin. If not caught quickly and treated they can go quite deep, through the full thickness of the skin and into tendons and bones.
Complications include:
- An abscess – a lovely pocket of pus
- Cellulitis – a spreading infection of the skin and the fat underneath
- Osteomylitis – a painful bone infection
- Gangrene
You may have heard that some unfortunate diabetics have to have toes, feet or even legs amputated. Sadly most of these people's outcomes were cause by an untreated foot ulcer.
The Importance of Checking Your Feet
Many deaths in diabetics are caused by cardiovascular problems like heart attack or stroke, which are more prevalent in people with ulcers. Diabetics with ulcers or sores are much more likely to have high blood pressure, too, which can lead to other cardiovascular conditions.
Some hospitals have a "foot first" policy of checking all diabetic patients’ feet, but leaving it until you have an admission might be too late!
If you are diabetic you should either regularly check your feet yourself of get someone to do it for you – this could be a brave friend or family member or ideally, someone more formally qualified to check like a caregiver, nurse or doctor.
If you have a relative or friend with diabetes, especially someone with mobility or vision issues, do them a huge favour and volunteer to check their feet for them or arrange for their feet to be looked at regularly.
What to Look For
So what are you looking for?
Most ulcers start on the bottom of the foot (so some contortion might be involved looking for them if you are checking your own feet) although some might appear on the side of your foot or on the top or tip of a toe.
It will look like a red crater on the skin, which might be surrounded by thicker or calloused skin. In severe cases socks might have discharge seeping into them and there might also be a nasty smell. Your foot may be red or swollen.
In some cases even rubbed areas, corns or calluses can lead to ulcers so if you find them, make an appointment with your doctor, nurse or foot specialist making sure they know about the diabetes aspect of the patient's medical history.
If you spot or even suspect an ulcer it is vital that you seek expert medical help as soon as possible - this is not one of those cases where soaking in salt water or dabbing on antiseptic cream is going to help.
Preventing Foot Damage
To prevent foot damage in the first place it is important to wear good quality, properly fitting shoes and soft absorbent socks. Check inside shoes to make sure no foreign objects are inside and if you must wear sandals, flip-flops or tight fitting fashion shoes occasionally check your feet for damage carefully afterwards. Avoid walking bare footed, even in the house.
Trim toenails straight across with sharp clippers or an emery board. Make sure feet are always clean, even between the toes, and moisturise them. Think of it as a spa treatment which can save your legs or your life and it becomes less of a chore.
Ulcers can be treated by trimming away affected tissue and protecting the foot in a cast or cushioned footwear until the area heals. More serious cases might need more drastic surgery so it is well worth spending time on checking and caring for your feet rather than losing them altogether.