North Jefferson News, Gardendale, AL

June 17, 2009

Diabetics should take extra precautions when it comes to the foot


Health Watch By Robert Sikes

The North Jefferson News




Diabetes is a very manageable disease with proper drug therapy and lifestyle modifications.

Foot care should be an integral part of your care. As diabetes progresses, one can lose proper blood flow and feeling to the lower extremities if blood sugar is not sufficiently managed.

As blood sugar rises, blood flow to the extremities decreases and the loss of sensation to the feet may occur. This loss can lead to problems with wound healing, foot ulcers and infections.

Patients could step on a nail or tack and never realize that they have done so. Diabetic patients may also lose the ability to feel if a bath is too hot, which could lead to severe burns to the feet (have someone test the temperature for you or use your hand).

Foot care can be an easy task if taken seriously. The American Diabetes Association (ADA) recommends that people with diabetes have yearly foot exams performed by their doctor. The loss of feeling to the extremities is a condition called peripheral neuropathy. To test for this, the doctor may perform a monofilament test.

Along with annual exams, the patient should check their feet daily for cracks and sores. Many patients lose feeling in their feet and they may not notice or feel a cut, blister or sore on their feet. If left untreated/unnoticed, amputation of the foot or leg may be required.

Diabetes is the primary source of foot amputations according to the ADA. So what can be done to protect your feet?

First, always wear shoes. Summer is now here and we all want to walk around barefoot. The first thing is to NEVER walk barefoot. Shoes should always be worn, even at the beach.

It is also important to have shoes that fit properly. Special diabetic shoes should be fitted by a certified fitter of therapeutic shoes as they can provide a proper fitting shoe. Diabetic shoes can be found at your local pharmacy that employs a specialist. You may also want to ask your doctor or pharmacist for more information about diabetic shoes (sometimes insurance companies will cover the cost of shoes and inserts).

Calluses, bunions, warts and corns may form on the foot in places that are weight bearing or in places that rub a lot. By wearing shoes that fit properly, you can prevent these from occurring.

If you notice any of these on your feet after one of your daily exams, report it to your doctor. If left untreated, they can become thick, break down and lead to sores or ulcers on the foot.

Do not try to remove it yourself as you could cause a wound or infection to your foot. Your doctor may recommend a pumice stone to remove calluses. This should be done when your foot is wet, as this will cause less friction from the pumice stone. Caution – do not remove too much skin. Sores and infections could result if you remove too much. Proper technique should be to remove a little at a time.

Along with shoes, white socks should be worn. The reason for white socks is that it will alert the patient to any blood or injury that may be coming from the foot, as many patients will not be able to feel the injury. Patients should also consider seamless socks, as the seams could cause friction, which may result in blisters.

Secondly, patients should check their feet daily for any changes in the skin of the foot. This can simply be done with a mirror. Things such as cracks, dryness or sores should be reported.

Lotion should be applied to the tops and bottoms of the foot to prevent dryness, which could lead to cracking and ulcers of the foot. The lotion should NOT be applied between the toes. Apply the lotion to clean and dry feet. Products such as petroleum jelly or hand creams (unscented is best) may be used.

Cutting your toenails can sometimes be very difficult, but here are a few tips for proper clipping. Cut the nail straight across then file the edges round. These two steps can prevent ingrown toenails and future problems with the nail. If you cannot reach your feet to cut your toenails or are uncomfortable cutting them, you should contact your podiatrist to assist in trimming your toenails.

As mentioned before, prevention is the key. Loss of feeling in the feet may not be completely avoidable with diabetes, but control of your glucose levels and lifestyle modifications can slow the progression.

Simple care of the area can prevent future problems and reduce your healthcare costs.

Robert Sikes is a Pharm D candidate at Samford University’s McWhorter School of Pharmacy and an intern at The Pharmacy in Mt. Olive. The Pharmacy can be reached at 631-1201.