Diabetes Foot Care

If you have diabetes, it's vital to take special care of your feet. This is because common complications of the disease, particularly impaired blood circulation to the extremities and nerve damage (neuropathy), can cause problems ranging from calluses and fungal infections to ulcers (open sores) and tissue death. In some cases, the damage can be so severe amputation is necessary.

Serious as these problems can be, preventing them is not complicated: Being vigilant and prioritizing care for your feet is the key.

How Diabetes Can Affect Feet

Poor blood circulation and nerve damage can cause a multitude of problems in the feet. Many are relatively mild and easily treated, such as:

• Calluses and corns
• Athlete's foot and other fungal infections
• Bunions
• Hammertoes (bent toes)
• Cracked heels
• Ingrown toenails

While these issues are common even in people who don't have diabetes, other foot problems associated with diabetes can be far more serious.

Neuropathy

Diabetic neuropathy occurs when diabetes is poorly controlled, allowing for a build-up of glucose in the blood that can cause blood vessels to break down and impair communication between nerves. This, in turn, can affect sensation in the extremities experienced as tingling, numbness, pain, and the inability to feel temperature extremes or other sensations.

Loss of feeling from neuropathy may prevent a person from noticing a minor foot injury, allowing it to go untreated and become infected. Neuropathy also is associated with muscle weakness and wasting.

Ulcers

Diabetes increases the risk of peripheral artery disease (PAD), a narrowing (occlusion) of arteries that impedes blood flow and oxygen to the toes and fingers. This depletion of oxygen may contribute to the formation of ulcers—open sores that are difficult to heal and can extend deep into the skin.

For people with diabetes, untreated ulcers may form on the bottom of the foot or underneath the big toe, or on the sides of the feet due to shoe friction.

Decreased oxygen may lead to ulcer formation.

MRSA

People with diabetes are at increased risk of contracting methicillin-resistant Staphylococcus aureus (MRSA), a type of staph infection that is resistant to multiple antibiotics that can enter breaks in the skin.

A MRSA infection can appear as a reddish rash, a small boil, or an abscess. There are two major categories of MRSA: nosocomial infection, meaning that it's an infection that is transmitted mostly in healthcare settings, or community-acquired MRSA. This strain of MRSA is transmitted by contact. It can live on surfaces and is also spread by skin-to-skin contact. It has become a major concern because the number of people contracting it has recently increased. There are a few antibiotics and topical antibiotic treatments that are successful in treating MRSA, but re-occurrence can still be a problem for many people.

Prevention

Good hygiene and watchfulness are key to lowering the risk of sores and infections, including MRSA. Keeping blood sugar under control can also help by lowering the risk of all foot complications including sores, ulcers, and neuropathy.

Blood Sugar Management

To best manage your blood sugar, use a glucometer to test your blood sugar levels several times per day. This will allow you to identify any patterns in fluctuation and help you make wise decisions about your daily treatment.

Additionally, you should have regular checkups as well as regular hemoglobin A1C tests, which provide a picture of average blood glucose control over three months.

How often you have an A1C test depends on the how well your blood sugar is controlled. The American Diabetes Association (ADA) recommends A1C testing at least twice a year for people whose blood sugar is well-controlled and other goals of treatment are being met. For those who aren't meeting glycemic controls or who have recently changed their treatment, the ADA advises having an A1C test quarterly or more often if necessary.

Good Hygiene Practices

To limit your exposure to infection and disease, follow these tips:

• Washing your hands frequently with soap and water or alcohol-based hand sanitizer.
• Never share towels, razors, or other personal items.
• Never share insulin pens or needles with another person.
• If you use equipment that is regularly used by others, such as at the gym, on airplanes, or on the subway, make sure that the surfaces are wiped down to the best of your ability with an antibacterial wipe or spray before you use it, or use hand sanitizer after you're finished using the equipment.

Regular Foot Care

Being proactive about foot care is key to avoiding complications.

• Inspect your feet every day for sores and open areas.
• Do not go barefoot. Keep your feet covered with dry, clean socks and well-fitting shoes.
• Wear white socks, so you can visibly notice if there's any blood or pus forming.
• Try compression socks that work to promote good circulation.
• Get regular checkups at the podiatrist (a doctor who specializes in feet) and be sure to get any open sores quickly treated. Keep the sore covered with a clean, dry bandage.
• Trim toenails carefully by clipping straight across the edge, then filing down sharp corners with an emery board.
• Avoid pedicures at nail salons, as these could potentially open you up to the risk of infection.

What to Do If Foot Issues Arise

If you notice a new blister, sore, or another foot issue, your best course of action is to get it immediately treated by a professional. This could be a podiatrist or your general practitioner. Because circulation and nerves may be affected by diabetes, the healing process could take longer than normal, so be sure to monitor your feet daily to be sure healing is taking place. If things start to worsen, reach out to your care provider again immediately.