Diabetic Foot Care, Part I of III

There are several important things for a diabetic to keep in mind for both their general and foot health. Daily monitoring of blood sugar, and regular check-ups by your primary care physician are key factors to good health. Diabetics who are well controlled stave off some of the more adverse long-term effects of diabetes including: neuropathy (loss of sensation in the feet and hands), vision changes and kidney failure. Neuropathic changes in the feet can eventually lead to ulceration (large open wounds) and to amputation of the toe or leg. As the foot becomes neuropathic there is a loss of both the ability to react to pressure and to pain. Neuropathic changes are concerning because it can be considered a loss of protective sensation. When one loses the ability to feel, one looses the ability to help protect the body from danger. Your podiatrist can help you to identify any changes in protective sensation via testing with a Semmes Weinstein 10g monofilament. Once neuropathic changes are evident several things can be done at the home to help promote healthy feet. In addition, skin biopsies that measure the amount of nerve fibers “Epidermal Nerve Fiber Density - ENFD” testing can be done in the doctor’s office with a small amount of local anesthesia. These are excellent baselines tests to determine the fiber density and six-months later determine if medication is helping.

Some helpful hints:

1: Daily inspection of the feet, use a mirror to note any changes on the sole. Note any color changes, cracking, or any evidence of trauma. If concerning call.
2. Keep your feet moisturized by using a good foot cream, or lotion.

3. Check the bath water using your elbow or a thermometer, too hot of water can lead to burns to neuropathic feet and the hands.

3. Nails should be kept trim, cut straight across, and filed smooth. When the nails become problematic please have your podiatrist cut them or demonstrate the proper method of nail care.

4. A podiatrist should address any problematic corns and calluses, or lesions.

5. Wear supportive and properly fitting shoes. A protect slipper or shoe should be worn in the home. Don’t forget to wear socks.

Good foot health can be accomplished by teamwork with your primary care physician, your podiatrist and yourself.