FOOT CARE IN DIABETES

Medical importance of the foot

The heart is situated in the chest and has to pump blood all over the body, and also maintain a pressure of about 28 mm of Hg at the beginning of the capillary (tiniest blood vessel that actually supplies blood to cells). The further a body part is from the heart, the lower the tendency of blood to maintain the required pressure (same as water pressure in a house close to the pump/water tower is much higher as compared to a house at the end of the line).

To compensate for this, the further a body part is from the heart, the greater the arterial wall tension, to squeeze the blood flow to augment the pressure. Thus, the foot has the highest arterial tension, and a lower blood flow. Any further compromise in the lumen of the artery by clogging by fats (atherosclerosis), and the foot has it:- no blood or too poor a blood supply.

In diabetes, three problems occur to affect the foot :

  • The blood of a diabetic usually has a higher than normal level of fats and oils (hyperlipidemia), which stick to arterial walls to clog it. This compromises blood flow especially in the periphery, i.e. foot.
  • The nerves that control peripheral blood flow, are a part of the artery wall. They also have arteries and capillaries of their own that get clogged and close partially. Hence the nerves degenerate and fail to respond to tissue oxygenation needs. As a result, the peripheral blood vessels do not open up as needed to maintain blood flow to tissues as required. This happens all over the body and is called autonomic (= involuntary nerve control) neuro-(=nerve) pathy (damaged structure and function of that body part).
  • The foot is used for walking and is therefore is very prone to infections. Any infection here is almost always due to multiple bacteria, that are resistant to many usual antibiotics.

The combination of these three factors makes the foot the most vulnerable part of the body as far as compromised blood flow and recurrent and non-healing infections is concerned. In other words, the foot can be said to mirror the state of the body in a diabetic, and to provide a valuable advance warning system about what is happening elsewhere.

Importance of foot care in diabetes

Infections anywhere in the body lead to stress hormones building up, that further increase the blood sugar, that further helps the infection to spread, that ……. thus the vicious cycle goes on. The foot is the most vulnerable to infections (due to trauma while walking, playing or from ill fitting shoes), and the factors mentioned above. Hence, if we take care of the foot, a lot of things fall into place in the management of diabetes.

Some tips you should follow for proper foot care :

General Tips

  • Never cut the corners of your nails.
  • File the nails straight across never file them shorter than the underlying soft tissues of the toe.
  • Never sit with the legs crossed as it may disturb the normal supply of blood to the feet.
  • Do not apply heat in the form of hot water, hot water bottles or heating pads without your doctors consent.

Wear Comfortable shoes

  • Tight fitting shoes not only cause direct trauma when walking, but also compress peripheral blood vessels to further reduce blood supply. This can lead to localized tissue death, infection and even gangrene of toes or foot.
  • Use fancy shoes or high heeled shoes only on very special occasions, and that too for the bare minimum time necessary.
  • Have not one but two comfortable shoes. All shoes press at different points. Two shoes would press at two sets of different places, hence changing shoes would also enable the foot to revive from constant pressure at any one point.

Always wear Comfortable socks

  • Wear comfortable socks that “breathe”, i.e. cotton or pure woolen ones.
  • Wear soft socks with a padding to protect your feet at pressure points.

Keep a First aid kit handy

  • Maintain a First Aid Kit that must include antiseptic lotions and cotton packs, Antibacterial cream, gauze pads, hypoallergenic or paper tape or bandages, syringes and sugar testing equipment, prepackaged cleansing towelette and adequate supplies of your drugs including glucose packets or tablets to use for low blood sugar attacks.

Pre-holiday / Pre-tour preparations

  • Talk to your doctor and follow his guidelines on your personal foot-care needs.
  • Make a medical card for your wallet that contains your doctor’s name and contact numbers, or medical diagnosis, a copy of your last prescription, and what a lay person should do to revive you if you develop low blood sugar and faint.

Preparing to go to cold places

  • Choose well fitting comfortable and proper shoes that will protect your foot from cold and wet weather.
  • Wear boots or shoes that will keep your feet dry.
  • Wear warm socks to protect circulation in legs
  • Warm socks are often thick. Make sure that the shoes chosen are still comfortable when used along with thick woolen socks.
  • Find time to go indoors periodically and warm your foot to restore circulation and thus avoid frostbite.

Preparing to go to warm / hot places

  • Do not risk barefoot walking as it increases chances of foot trauma and also increases chances of picking up infection. Even bare toe sandals are risky since the exposed toes are the most vulnerable to knocking on something and getting hurt.
  • When going to the beach, use shoes meant for walking there.

Preventive maintenance

  • Daily check the foot for the presence of any blisters, cuts, scratches, sores, redness, increased warmth, ingrown toenails, corns and calluses.
  • Daily wash both feet with mild soap and lukewarm water and gently dry it completely.
  • Use lotion on your feet to prevent cracking. Do not apply lotion between your toes.
  • Maintain correct toe nail length. Cut them soon after bath when they are still soft.
  • Corns and calluses on foot spell trouble. Do not try self medication but see a doctor.
  • When in any doubt about a foot problem, do not hesitate to see a doctor at once.

First aid guidelines for your feet :

For a small cut or minor skin irritations

  • Gently wash the area with mild soap and warm water (never use hot water), or the antiseptic lotion (avoid using strong antiseptic lotions such as tincture of iodine), and apply the antibacterial cream. Cover the cut with a gauze pad. Secure the gauze in place with hypoallergenic or paper tape.
  • Change the dressing daily.

For blisters or minor burns

  • Blisters are bubbles full of sterile fluid till you puncture it.
  • Gently wash the area with a mild soap and warm water or antiseptic lotion, apply antibacterial cream and cover with gauze. Secure the gauze in place with hypoallergenic or paper tape.
  • Change the dressing at least once a day.
  • Wear other shoes until the blister heals.

For frostbite

  • Use warm water to warm the skin (98 degrees Fahrenheit to 104 degrees Fahrenheit).
  • Call for medical help immediately.
  • Don’t rub the area or apply creams.
  • Don’t try to walk on the affected foot.