BDA


Diabetes and Your Feet


Diabetes can affect the health of your feet.  Consistent, good blood sugar control is your best defense to lessen the chances of these effects.

Foot complications include diabetic neuropathy, changes in the skin and poor circulation. 

Click here for a quick overview of "What Your Feet Say About Your Health"

Diabetic Neuropathy

Uncontrolled high blood sugar can damage the nerve fibres in your feet. Many people suffering with type II diabetes have some form of neuropathy.

This can affect the muscles of your lower limb and your feet, termed motor neuropathy. Some muscles may become weaker. Changes can occur in your toes leading to clawed or hammer toes. 

There are sweat glands in your feet responsible for keeping your skin moisturized.  These stop working leading to drier skin.  This is an effect of autonomic neuropathy.

Sensory neuropathy occurs when your ability to feel your feet is affected.   Your ability to feel pain, pressure, temperature and general awareness of your feet can diminish.

See your physician, diabetic nurse, or foot specialist to help determine whether you have diabetic neuropathy in your feet.

If you are diagnosed with neuropathy, it is very important to not cut your own toenails but to visit a podiatrist regularly to have toenails cared for.

Skin changes

Now that you have diabetes, treat your feet with care.  Here are some of the common problems that can occur in the skin:

Hyperkeratosis (corns and callus)

These areas of hard skin occur on sites of pressure and friction.

Calluses, if not trimmed, get very thick, break down and turn into ulcers (open sores). Never try to cut these yourself – this can lead to ulcers and infection. 

Over the counter callus/corn removers are not recommended because these may harm your skin. Wearing properly fitting footwear is also important.  In some cases, special offloading insoles called orthotics are needed. You should see your foot specialist regularly to treat these areas and help you select and properly fit your shoes.

Nail changes

These include in-growing toenails,

 thickened nails

 and fungal nails. 

 Diabetics with any of the above toenail conditions should consult with a podiatrist.

Foot Ulcers

Ulcers occur most often on the ball of the foot or on the bottom of the big toe.

 Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections which, in turn, can lead to loss of a limb.

What your health care provider will do varies with your ulcer. Your health care provider may take x-rays of your foot to make sure the bone is not infected. The health care provider may clean out any dead and infected tissue. You may need to go into the hospital for this. Also, the health care provider may culture the wound to find out what type of infection you have, and which antibiotic will work best. Good diabetes control is important. High blood glucose levels make it hard to fight infection.

Keeping off your feet is very important. Walking on an ulcer can make it get larger and force the infection deeper into your foot. Your health care provider may put a special shoe, brace or cast on your foot to protect it.

If your ulcer is not healing and your circulation is poor, your health care provider may need to refer you to a vascular surgeon.

After the foot ulcer heals, treat your foot carefully. Scar tissue under the healed wound will break down easily. You may need to wear special shoes after the ulcer is healed to protect this area and to prevent the ulcer from returning. 

Amputation

People with diabetes are far more likely to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet, making the foot at risk of ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.

One of the biggest threats to your feet is smoking. Smoking affects small blood vessels. It can cause decreased blood flow to the feet and make wounds heal slowly. A lot of people with diabetes who need amputations are smokers.

Poor Circulation

Poor circulation (blood flow) can make your foot less able to fight infection and to heal. Diabetes causes blood vessels of the foot and leg to narrow and harden.

You can control some of the things that cause poor blood flow. Don't smoke; smoking makes arteries harden faster. Also, follow your health care provider's advice for keeping your blood pressure and cholesterol under control.

If your feet are cold, you may be tempted to warm them. Unfortunately, if your feet cannot feel heat, it is easy for you to burn them with hot water, hot water bottles, or heating pads. The best way to help cold feet is to wear warm socks.

Some people feel pain in their calves when walking fast, up a hill, or on a hard surface. This condition is called intermittent claudication. Stopping to rest for a few moments should end the pain.  Work with your health care provider to get started on a walking program. Some people can be helped with medication to improve circulation.

Exercise is good for poor circulation. It stimulates blood flow in the legs and feet. Walk in sturdy, good-fitting, comfortable shoes, but don't walk when you have open sores.

Prevention

Your foot specialist should perform a complete foot exam at least annually - more often if you have foot problems.  The exam will look at the shape and function of your feet.  Your foot specialist will also test your ability to feel using a small painless filament called a monofilament.

Seek help if you have cuts or breaks in the skin, or have an ingrown nail. Also, seek help if your foot changes color, shape, or just feels different (for example, becomes less sensitive or hurts).

If you have corns or calluses, a foot specialist can trim them for you. Your foot specialist can also trim your toenails if you cannot do so safely.

Because people with diabetes are more prone to foot problems, a foot care specialist should be a part of your health care team.

Foot Care Tips

Inspect your feet every day, and seek care early if you do get a foot injury.

Make sure your health care providers check your feet at least once a year - more often if you have foot problems.

Most people can prevent any serious foot problem by following some simple steps. So let's begin taking care of your feet today.

There are many things you can do to keep your feet healthy:

Take care of your diabetes

Work with your health care team to keep your blood glucose in your target range.

Check your feet every day

Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.

Be more active

Plan your physical activity program with your health team.

Wash your feet every day Dry them carefully, especially between the toes.

Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. Do this daily.

If you can see, feel and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.

Wear shoes and socks at all times Never walk barefoot. Wear comfortable shoes that fit well and protect your feet.  A foot specialist can help you choose the right shoes for your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.

Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.

Keep the blood flowing to your feet Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.

Get started now. Begin taking good care of your feet today.  Set a time every day to check your feet.

Source: Text taken and adapted from American Diabetes Association Website, 2012; International Working Group on the Diabetic Foot Guidelines, 2011


We are here to help you

Bermuda is fortunate to have several foot specialists (chiropodists and podiatrists) available for consultation. All foot specialists are licensed to conservatively treat disorders and diseases of the feet. Here is a list of all foot specialists in Bermuda. 

Bermuda Podiatry Centre Neil Moncrieff
Natalie Bennett
Rosemary Head
Stuart McIntosh
The Colonial Building
9 Gorham Rd
Hamilton HM08
Tel: 292-0243
Fax: 292-7442
Email: info@podiatry.bm
Web site: www.Podiatry.bm
B.N. Henagulph & Associates Nadine Henagulph
Lachlan Armour
Phillippa Jones
Tobi Mark
The Armoury Building
37 Reid Street
Hamilton HM11
Tel: 295-4811
Fax: 295-0235
The Foot & Ankle Clinic Germaine Binns 48 Cedarparkade Center
Cedar Ave
Hamilton HM11
Tel: 296-1288
Fax: 296-0180
Footcare Services
(Mobile Chiropody)
Donna Hendrickson PO Box SN64
Southampton SN BX
Tel: 238-8530 or 238-2860
Email: footcare99@ibl.bm