Diabetic Foot

If you have diabetes, your blood sugar levels are too high. Over time, this can damage your nerves or blood vessels. Nerve damage from diabetes can cause you to lose feeling in your feet. You may not feel a cut, a blister or a sore. Foot injuries such as these can cause ulcers and infections. Serious cases may even lead to amputation. Damage to the blood vessels can also mean that your feet do not get enough blood and oxygen. It is harder for your foot to heal, if you do get a sore or infection.

You can help avoid foot problems. First, control your blood sugar levels. Good foot hygiene is also crucial.

Diabetic Foot Ulcers

lf you have diabetes, you may have an increased risk for developing foot ulcers, or sores. Foot ulcers are the most common reason for hospital stays for people with diabetes. It may take weeks or even several months for your foot ulcers to heal. Diabetic ulcers are often painless.

Debridement

Debridement is the process to remove dead skin and tissue. Your doctor or nurse will need to do this to be able to see your foot ulcer. There are many ways to do this.

One way is to use a scalpel and special scissors.

• The skin surrounding the wound is cleaned and disinfected.
  
• The wound is probed with a metal instrument to determine how deep it is and to see if there is any foreign material or object in the ulcer.
  
• The doctor cuts away the dead tissue, then washes out any unattached tissue.
  
• Your sore may seem bigger and deeper after the doctor or nurse debrides it. The ulcer should be red or pink in color and look like fresh meat.

Taking Pressure off of Your Foot Ulcer

Foot ulcers are partly caused by increased pressure on your foot. Be sure to wear shoes that do not put a lot of pressure on your foot, especially where the ulcer is.

Your doctor may ask you to wear special shoes, or a brace or a special cast. You may need to use a wheelchair or crutches for awhile. These devices will reduce the pressure and irritation to the ulcer area, and that will help speed up the healing process.

The type of shoes you wear when you have diabetes is important:

Wear shoes made out of canvas, leather, or suede. Do not wear shoes made out of plastic, or other material that does not breathe. Wear shoes you can adjust easily. They should have laces, Velcro, or buckles. Wear shoes that fit properly and have plenty of room in them. You may need a special shoe made to fit your foot. Do not wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals.

Wound Care and Dressings

You will need to do these things to care for your wound:

• Keep your blood sugar levels under tight control. This can help you heal faster.
  
• Keep the ulcer clean and bandaged.
  
• Cleanse the wound daily, using a wound dressing or bandage.
  
• Try to take fewer steps around your house.
  
• Do not walk barefoot.

Your doctor or nurse may use different kinds of dressings to treat your ulcer.

Wet-to-dry dressings are often used first. This process involves applying a wet dressing to your wound. As the dressing dries, it absorbs wound material. When the dressing is removed, some of the tissue comes off with it.

• Your doctor or nurse will tell you how often you need to change the dressing.
  
• You may be able to change your own dressing, or family members may be able to help.
  
• A visiting nurse may also help you.

See also: Wet to dry dressing changes

Other types of dressings are:

• Dressing that contain calcium alginates or growth factors
  
• Skin substitutes

Keep your dressing and the skin around it dry. Try not to get healthy tissue around your wound too wet from your dressings. This can soften the healthy tissue and cause more foot problems.

Taking care of your feet

Diabetes can damage the nerves and blood vessels in your feet. This damage can cause numbness and reduce feeling in your feet. As a result, your feet may not heal well if they are injured. If you get a blister, you may not notice, and it may get worse.

Check your feet every day. Inspect the top, sides, soles, heels, and between the toes. Look for:

• Dry and cracked skin
  
• Blisters or sores
  
• Bruises or cuts
  
• Redness, warmth, or tenderness
  
• Firm or hard spots

If you cannot see well, ask someone else to check your feet.

Call your doctor right way about any foot problems. Do not try to treat them yourself first. Even small sores or blisters can become big problems if infection develops or they do not heal.

Wash your feet every day with lukewarm water and mild soap. Strong soaps may damage the skin.

• Check the temperature of the water with your hands or elbow first.
  
• Gently dry your feet, especially between the toes.
  
• Use lotion, petroleum jelly, lanolin, or oil on dry skin. Do NOT put lotion between your toes.

Ask your health care provider to show you how to trim your toenails.

• Soak your feet in lukewarm water to soften the nail before trimming.
  
• Cut the nail straight across, because curved nails are more likely to become ingrown.
  
• Your foot doctor (podiatrist) can trim your nails if you are unable to.

Most people with diabetes should have corns or calluses treated by a foot doctor. If your doctor has given you permission to treat corns or calluses on your own:

• Gently use a pumice stone to remove corns and calluses after a shower or bath, when your skin is soft.
  
• Do NOT use medicated pads or try to shave or cut them away at home.

If you smoke, stop. Smoking decreases blood flow to your feet. Talk with your doctor or nurse if you need help quitting.

Do not use a heating pad or hot water bottle on your feet. Do not walk barefoot, especially on hot pavement or hot sandy beaches. Remove your shoes and socks during visits to your health care provider so that they can check your feet.
Shoes and Socks

Wear shoes at all times to protect your feet from injury. Before you put them on, always check the inside of your shoes for stones, nails, or rough areas that may hurt your feet.

Wear shoes that are comfortable and fit well when you buy them. Never buy shoes that are tight, hoping they will stretch as you wear them. You may not feel pressure from shoes that do not fit well. Blisters and sores can develop when your foot presses against your shoe.

Ask your doctor about special shoes that can give your feet more room. When you get new shoes, break them in slowly. Wear them 1 or 2 hours a day for the first 1 or 2 weeks.

Change your broken-in shoes after 5 hours during the day to change the pressure points on your feet. Do not wear flip-flop sandals or stockings with seams. Both can cause pressure points.

Wear clean, dry socks or non-binding panty hose every day. They will help protect your feet.

You may want special socks with extra padding. Socks that move moisture away from your feet will keep your feet drier. In cold weather, wear warm socks, and do not stay out in the cold for very long. Wear clean, dry socks to bed if your feet are cold.

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