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Diabetic Foot Care

Podiatrists have an extremely important role to play in the prevention and management of complications of the foot in those with diabetes. The Podiatrist should communicate this risk status to other members of the health care team. Advice should be given on how to reduce the chance of damage happening, what to do to prevent it and what to do if something does go wrong.

Regular foot care from a Podiatrist is a key way to prevent problems from developing in those who are at risk.

When something does go wrong, see a Podiatrist immediately. Waiting a "few days to see what happens" before seeing someone may be the difference between a good and poor outcome. The sooner treatment is started the better.

According to the American Diabetes Association, there are 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease.

Major Types of Diabetes

Type 1 diabetes

Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.

Type 2 diabetes

Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

Gestational diabetes

Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases in the United States each year.

Pre-diabetes

Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 54 million Americans who have pre-diabetes, in addition to the 20.8 million with diabetes.

Complications in Diabetes

Nervous system disease

About 60% to 70% of people have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.

Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e. at least one area that lacks feeling).

Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. [see Charcot]

Amputations

More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.

In 2002, about 82, 000 nontraumatic lower-limb amputations were performed in people with diabetes.

Ulcers

Foot ulcers are a common complication of the "diabetic foot". They allow a portal for infection to occur. Ulcers are caused by too much pressure on an area and the skin just "breaks down". They can occur under corns and callus. Healing can take a while and it is imperative that pressure is removed from the area and good wound dressings are used.

The do's and don'ts of foot care if you have diabetes:

If you have diabetes, there are a lot of things you need to do to prevent the problems from developing in your foot:

  1. Wash your feet daily (use a mild soap and lukewarm water). Dry very carefully, especially between the toes. It often helps to use talcum powder to dust the foot to further reduce moisture, however be certain to remove all the powder after dusting, as it should not leave a residue between the toes. If the skin is dry, use a good emollient - BUT, not between the toes).
  2. Inspect your foot daily (check sores, cuts, bruises, changes to the toenails; use a mirror to look under the foot if you can not see it).
  3. Look after your health (loose weight; stop smoking; exercise; reduce your alcohol consumption)
  4. Look after your feet:
      • cut toenails straight across and never cut into the corners; use an emery board or file on sharp corners.
      • do not try to remove corns and callus yourself - see a Podiatrist for this; Never use commercial corn cures - this is so important in those with diabetes as it is so easy to damage the skin.
      • avoid going barefoot, even in your own home (this lessens the chance of some accidental damage)
  5. Fitting of footwear is very important. Poorly fitted shoes are a common cause of problems in the foot of those with diabetes. Some advice:
      • get your feet measured each time you buy new shoes (foot size and shape change over time).
      • make sure the shoe fitter is experienced.
      • new shoes should be comfortable when purchased and should not need a "break-in" period.
      • they should fit both the length and width of the foot, with plenty of room for the toes.
      • avoid shoes with high heels, pointed toes or tight around the toes (these put too much pressure on parts of the foot and can contribute to ulcers)
  6. See a Podiatrist, at least annually.

Diabetic Therapeutic Shoe Program

The Podiatric profession and the American Diabetes Association are involved in a joint effort to lower the amputation rate in the diabetic population. To achieve this goal, diabetic patients at risk are being identified and educated about proper footwear and care of their feet. In May of 1993, Medicare established a preventative footwear program for patients with diabetes.

For any item to be covered by Medicare, beneficiaries must (1) be eligible for a defined Medicare benefit category, (2) be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member, and (3) meet all other applicable Medicare statutory and regulatory requirements. Please check with your Primary Care Physician who is managing your systemic diabetic condition for eligibility and medical necessity.

Barry University Foot and Ankle Institutes provide a variety of diabetic shoe styles and colors. As well as a comprehensive diabetic patient education and shoe wear training. Please contact one of our clinics to make an appointment for additional information.

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