I have diabetes – what is my risk of foot problems?

Persons with diabetes, Type 1 or 2, are individuals who share a common disease that causes high blood sugars. The effects of the high blood sugars will vary from person to person. Likewise, diabetes will affect the feet of each diabetic individual in a different manner. Some persons with diabetes have a high risk for foot problems, while others do not.

What are the risk factors for diabetic related foot problems?

Health care providers examine four risk factors that can result in foot problems. These include:

• prior history of foot diabetes-related foot problems
• foot deformity
• loss of circulation
• loss of feeling (peripheral neuropathy)

The greater the number of risk factors, the greater the risk for foot problems.

What foot problems can be caused by diabetes?

Dry and cracked skin can be a serious problem for diabetics. A crack in the foot can result in infection since germs or bacteria can easily enter. In a foot with circulatory troubles, cracks may not heal and could potentially turn into gangrene.

Dry skin on the feet is typically treated with moisturizing creams. There is a variety of different moisturizing creams on the market, and there is not one single cream that works for everyone. Your foot health care provider should be able to prescribe a cream; sometimes it is a matter of trying several different creams in order to find one that works best for you.

Fungal infections and other skin disorders can also cause dry skin on the feet. Persons with diabetes should not try to self-diagnose or self-treat dry skin – professional foot health care is highly recommended.

Infections

An infection occurs when germs multiply and cause damage to tissue. In order for a foot infection to develop there has to be an opening for the germs or bacteria to enter the foot. In other words, there needs to be a break in the skin, an ulcer, or a wound. Not all wounds will get infected, but the longer a wound remains unhealed the greater the chance of developing an infection. People with diabetes are more prone to developing wound infections, especially those with poor blood sugar control.

Foot infections can have serious consequences especially if they are not recognized and treated in a timely manner. Infection can cause serious injury to the affected part and thus needs to be treated as early as possible. Sometimes antibiotics and wound care are all that are necessary for treatment. Surgery may be necessary in serious or advanced infections.

Persons with diabetes can decrease the risk for foot infection by adhering to good diabetic foot care, blood sugar control, and daily foot inspection.

By far the best method to treat an infection is to prevent from happening in the first place. However, an infection can be treated through the use of antibiotics. Some antibiotics actually kill the germs, whereas others slow down the growth of the germs. There are many different types of germs that can cause infection; there are also many different types of antibiotics. Sometimes more than one type of germ is involved in the infection, and several different antibiotics may be required to fight the infection.

Foot Ulcers

A foot ulcer is a skin sore or wound. Ulcers can occur on any part of the foot but they are more common on the sole. Once a crack occurs the foot is prone to invasion from harmful bacteria that can cause infection; the longer an ulcer remains open and untreated the greater the risk of infection.

Foot ulcers are caused by excessive pressure against the skin. It does not take much pressure to cause an ulcer. Persons with diabetes are prone to peripheral neuropathy or loss of feeling, and this pressure may go unnoticed until an ulcer has occurred.

It is important to treat foot ulcers as soon as possible because the longer an ulcer remains open the greater the chance of developing an infection. In severe cases infection can spread into the leg. Signs that an ulcer is infected include redness, swelling, increased drainage, sudden elevations in blood sugar, fever, chills, and fatigue.

Ulcer treatment begins with recognizing and eliminating the cause of the harmful pressure, sometimes referred to as pressure reduction or off-weighting. Pressure reduction may be as simple as switching shoes or it may be more involved and require orthotics, braces or casts. Antibiotics and possibly even surgery may be necessary for some ulcers. The majority of foot ulcers will respond to pressure reduction and dressings.

Calluses and Blisters

Calluses are thick skin that forms in response to repeated pressure over a course of time. Blisters are fluid-filled pockets that also result from increased pressure. However, blisters typically occur when the pressure is more intense and applied over a shorter period of time than that of a callus. In persons with diabetes, the body does not know how much callus to lay down and the callus is different – elevated blood sugars affect the skin and cause thicker and harder calluses.

Heavier calluses combined with peripheral neuropathy (or loss of feeling) can cause sores or an ulcer. The pressure that causes callus formation can also cause bleeding. Untreated calluses and blisters are dangerous because they can become infected and/or turn into non-healing wounds.

Calluses should be treated regularly by a professional. Persons with diabetes should not attempt to trim their own calluses.

What are the do’s and don’ts of diabetic foot care?

Do:

• have your shoes professionally fitted
• inspect your feet daily
• dry between your toes
• wash your feet daily
• have your feet checked regularly by a foot health care professional (frequency of visits will vary on an individual basis)
• use moisturizing creams if your feet are dry

Don’t:

• walk barefoot
• cut the corners of your nails
• cut your own corns or calluses
• soak your feet
• smoke