They move you from A to B. They let you know when the sand at the beach is blistering hot. They also take the painful hit when you connect with the edge of the coffee table. Feet rarely complain, they just get on with doing their job of supporting you. But outside of putting on your shoes and socks each day, how well do you know your feet?
For people with diabetes, feet are often over-looked as the management of other aspects of diabetes takes higher priority. However, foot problems are extremely common and often debilitating for people with diabetes. So slapping on a band-aid, ignoring foot changes, or saying 'She'll be right in a few weeks' could be putting your valuable feet at risk of diabetes-related foot problems.
The good news is that there are several preventative steps you can take yourself to help reduce the chances of developing diabetic foot disease. By following a daily foot care routine at home and having regular foot monitoring with your health professional, most foot problems are avoidable.
So, are you putting your healthiest foot forward?
Why is foot care so important?
A common symptom of diabetes is damage to the nerves in your feet. The damaged nerve function is called neuropathy, and about half of all people with diabetes have some form of nerve damage.
Neuropathy results in either pain, tingling, weakness or reduced sensation in the feet and lower limbs. A loss of sensitivity in the feet often leads to an abnormal walking pattern causing increased pressure in certain areas of the foot.
The development of callus can be an indication of abnormal pressure being applied and continuing to walk unnaturally on an ‘insensitive foot’ increases the likelihood of ulcers forming, and reduces the ability of the body to heal an existing ulcer.
Because of the loss of sensation in the foot, a person with diabetes is less likely to realise when they’ve injured their foot, as they may not feel the pain. This means they are less likely to notice and treat an injury, allowing it to progress to a more serious, advanced stage.
The most common of these problems is the diabetes-related foot ulcer, which is a wound occurring on the foot, commonly caused by a lack of sensation and/or poor blood supply in a person with diabetes.
Acting on foot changes
In these ever changing COVID-19 times, it's extremely important to look after your feet. So don't wait for the problem to get worse as time is an important factor for foot changes. If you are experiencing any of the following foot problems call your health care professional as soon as possible.
You have a current, untreated ulcer or your feet show any sign of injury that becomes red or isn’t healing.
Your feet have noticeable changes in sensitivity (or loss of sensation) or appearance.
You notice pain, swelling, throbbing, temperature changes in the feet (especially heat) or changes to skin colouration.
Daily steps you can take to reduce your risk
Check your feet daily
Look for Damage
Check for ulcers, cuts, sores, bruises, redness, new calluses and other signs of injury or damage, including between toes and on lower legs. A mirror may be helpful for examining the bottom of your feet.
Feel your Feet
Take note of changes in feeling which can include numbness, tingling or loss of feeling to touch. Be aware that you may not feel pain from visible injuries due to loss of sensation in your feet. These injuries still need attention even if they are not currently causing you pain.
Check foot temperature
Be aware of the temperature of your feet, and monitor for noticeable changes (hot or cold).
Wash your feet daily
Use soap/body wash and warm (not hot) water, including between toes and around toenails. Keeping your feet clean will help reduce the risk of infection.
Dry your feet
Dry your feet well, including between the toes.
Ask for help
If you have difficulty reaching your feet to clean and dry them, discuss options with your health professional and carer.
Care for your feet
Moisturise your feet and lower limbs
Apply moisturiser all over your feet to keep your skin supple. Don't moisturise between the toes or on broken skin as this may lead to infection.
Long or ingrown toenails can cut into the skin of your feet, potentially causing infections and ulcers. Toenails should be cut straight across. Seek assistance from a carer or health professional if you have difficulty maintaining your toenails..
Check for Corns or Calluses
Corns and Calluses are signs that your feet are getting too much pressure. In people with limited feeling, they are also a warning sign of ulcers forming. Don't use over-the-counter corn or callus removal methods as these can cause wounds. Consult with your health professional for treatment options.
Wear appropriate shoes
Protect your feet
Wear well-fitting footwear, both indoors and outdoors. This is important as you can easily injure yourself without realising (due to loss of sensation in the feet) by stepping on something hard or sharp. Wear clean socks to protect skin from chafing. Avoid sock seams where possible.
Check your shoes
Never store things in your shoes, as injuries can result. Check inside shoes before putting them on, for small pebbles, foreign objects or rough stitching.
Avoid ill-fitting shoes
When shoes don't fit well and are too tight, chafing and blisters may result. It's important for people with diabetes to wear footwear that fits, protects and accommodates their feet. Speak to a podiatrist to see if you require specialised insoles or custom-fitted footwear.
Care for your general health
Avoid heat and cold
As the nerves in your feet may be less efficient at communicating temperature and pain messages than before, it's important to take preventative measures: Avoid exposure to hot pavements, sunburn, heaters, and hot water. Avoid exposure to the cold and cold water. Wear warm socks and shoes in cooler months, and non-constrictive socks to bed if needed.
Manage blood flow
Keeping the blood flowing to your extremities can help reduce foot ulcers and improve healing. Avoid tight socks or stockings. Avoid sitting in the same position (especially with legs crossed) for extended periods. Exercise, especially walking, not only benefits your diabetes but can help with maintaining blood flow to your feet.
Manage your diabetes
Maintaining activity levels are also important, so talk to your health care professional about a gentle exercise program suitable for you. Monitor your blood sugar levels, take any prescribed medications and eat a healthy diabetes-friendly diet.
Talk to a health professional
Chat to your health care professional about your foot care management plan and ask for their support.
Maintain regular foot checks
Incorporate a foot check into your regular appointment. Ensure your GP, Podiatrist or other diabetes-advisor professional inspects your feet at least once every 12 months, or more regularly if you have a current (or history of) foot problems.
Report any foot changes
Report any signs and symptoms to your Health Care Professional as soon as possible for examination. By following your daily foot care checklist, any changes can be reported early.
Focus on your Footwear
Wearing the right footwear and introducing a footwear routine is one of the easiest ways to help take care of your valuable feet.
Protect your feet
Wear well-fitting footwear, both indoors and outdoors. This is important as you can easily injure your feet, by stepping on something hard or sharp, without realising (due to loss of sensation).
People with diabetes should always wear socks within their footwear to reduce rubbing. Socks should be made of mostly natural materials, should be seamless and shouldn't have elasticated cuffs.
Check your shoes
Never store things in your shoes, as injuries can result. Check inside shoes before putting them on, for small pebbles, foreign objects or rough stitching. Also check your feet when you take your shoes off.
Avoid ill-fitting shoes
When shoes don't fit well and are too tight, chafing and blisters may result. It's important for people with diabetes to wear footwear that fits and protects. Speak to a podiatrist to see if you require specialised insoles or custom-fitted footwear.
The serious impact of diabetes-related foot ulcers
Even minor injuries caused by a small cut, bruise or a blister can develop into a diabetes-related foot ulcer.
Diabetes-related foot ulcers can occur in people with both Type 1 and Type 2 diabetes. The term 'foot ulcer' refers to a break in the skin on the feet. For people with diabetes, high or fluctuating blood sugar levels, reduce blood flow to the extremities and nerve damage can inhibit the ability of the skin to repair itself. Because of this impaired rate of healing, even a minor injury can start a foot ulcer.
The occurrence of a foot ulcer is an unpleasant experience, causing pain and discomfort, the need for regular attention (eg. wound dressing), and often taking a lengthy time to heal. If you notice an injury or ulcer on your foot or lower leg, we recommend seeking advice from a health care professional (such as a GP or podiatrist) as soon as possible. Prompt attention will allow treatment to start as early as possible, giving you the best chance of faster and more successful healing.
Unfortunately, foot ulcers that progress to more advanced stages may become infected and can ultimately result in amputation. The personal impact of amputation is of course significant, resulting in reduced mobility, and often a sense of dependence and isolation. Don't wait for the problem to get worse as time is an important factor for foot changes. If you are experiencing any of the following foot problems make an appointment with your health care professional as soon as possible.
Things to discuss with your Healthcare Professional
Ask your health care professional to check your feet at each diabetes check-up and mention any changes you have noticed in your feet or legs.
- Ask your doctor or health care professional to check your feet
- Mention any injuries, pain, wounds, ulcers
- Mention any changes in skin sensitivity / loss of sensation
- Discuss your Daily Foot Care routine
- If you experience issues adequately caring for your own feet at home (eg. due to mobility issues), please discuss options with your doctor
Where to get help
Diabetes Feet Australia advocates the involvement of your General Practitioner or Health Professional to support you in your Diabetic Foot Disease management journey. If you are unsure of who to talk to about your diabetes and the health of your feet, the following types of health care professionals can assist: General Practitioner (GP), Podiatrist, Diabetes Educator or Nurse, Local community health centre.
Find a clinic
The following clinics are well regarded and may be helpful to your General Practitioner or Health Professional in realising your rapid recovery.
Over the last 30 years, expert multidisciplinary teams have been shown to be more effective in managing diabetes-related foot ulcers compared to solo expert health practitioners. So what should you expect when checking in with your own diabetes-related foot team?
Your current medication should be checked for both your foot health and general health.
Your ulcer should be properly assessed to see if it's improving or needs different treatment.
Any unhealthy skin on and around your ulcer should be removed if possible.
If your ulcer has become infected, new antibiotics should be prescribed.
The correct dressing should be applied that properly absorbs the ulcer fluid.
The right offloading device should be prescribed to remove the most pressure on the ulcer.
If the ulcer needs more specialised treatment, your team should refer you to the specialist you need.
Advise you on how you can help your ulcer at home and what to look out for between visits.