Diabetes mellitus (or simply, diabetes) is a rapidly growing issue in today’s fast paced developing world, with stress, anxiety, smoking, drinking, sedentary lifestyles and obesity being the major reasons for increased levels of glucose. The International Diabetes Federation has projected India to have the largest diabetic population by the year 2030, with a major portion of the population belonging to the age group of 45-65 years.

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One of the most widespread and debilitating complication of diabetes is diabetic neuropathy (prevalent in 70% of the people with diabetes), which leads to pain, instability, sensory loss, tingling and burning sensation, malfunctioning organs, loss of muscle functions and sweating, ulcers and sometimes even amputations, if not taken care of at the right time.  

The key to preventing diabetic neuropathy is to maintain the accepted levels of glucose in the body, which when not maintained, lead to damage of blood vessels in the nerves passing through the hands and the feet, causing neuropathy. Diabetes increases the risk of developing calluses, corns, bunions, blisters, and ulcers, in the feet and high blood sugar means even little injuries and changes can turn into gateways to potentially disabling illnesses.

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The key to preventing the adverse effects of diabetic neuropathy on the feet includes taking proper care of the feet while adhering to certain essential precautions, listed below:

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DON’T’s FOR DIABETIC FEET 

1. Don’t walk barefoot (even at home!) as loss of sensation due to neuropathy can make you unaware of objects hitting your feet, cuts, wounds, scrapes and sores due to splinters, glass shards or other dangerous objects. As patients with diabetes heal at a very slow pace, such injuries can lead to infections.

2. Don’t wear flip-flops, sandals, high heels, pointed shoes or old shoes with worn-out soles. You should always avoid shoes with seams in the interior, as these can rub your feet and cause blisters.

3. Don't wear new shoes for more than an hour at a time as they can cut into your skin and cause wounds.

4. Don’t wear your shoes if they are tight and cramming your feet. Use this simple test to check if your shoes are tight - (i) Stand on a piece of paper in bare feet. (Make sure you're standing and not sitting. Your foot changes shape and trace the outline of your foot). (ii) After this, put your shoe on and stand on another piece of paper and trace the outline of your shoe. Finally, compare the tracings. (iii) The shoe should be at least 1/2 inch longer than your longest toe and as wide as your foot.
   It’s best to shop for shoes at the end of the day, when your feet are usually at their largest.
    

5. Don't use your feet to test hot water as it can be hard to tell if bath water is too hot due to loss of sensation. Stepping into a bath before checking the temperature can cause serious damage to your feet, since burns and blisters are open doors to infection. Instead use your elbow to check the water temperature before getting into the tub or shower.

6. Don’t skip drying the spaces between your toes. The skin between the toes can be watertight, locking in moisture, and can lead to a fungal infection and cause the skin to break down.

7. Don’t apply lotion or moisturizers in the spaces between your toes for the same reason mentioned above.

8. Don’t keep your feet soaked in water for a long period of time as this can dry the skin and lead to cracks, providing an entry point for germs and bacteria.

9. While drying your skin always pat it dry. Never rub the skin as it is already sensitive and the resulting friction will lead to blisters.

10. Heating pads, electric blankets, hot water bottles, or even extremely hot baths can all be relaxing and soothing, but for someone with diabetes, they can be dangerous. If you already have nerve cell damage, you may not be able to tell how hot a heating pad is, and you run the risk of burning your feet.

11. If you smoke, you must immediately quit smoking as the chemicals in cigarette smoke damage and constrict your blood vessels, which means that if you smoke, you're depriving your feet of the nutrient- and oxygen-rich blood that fights infection and keeps them healthy.

12. Don’t remove corns or calluses yourself, and especially don’t use over-the-counter products to remove them—they could burn your skin.

13. Don't wait to treat a minor foot problem if you have diabetes. Report foot injuries and infections right away.

14. Don’t let the corners of your toenails grow into the skin. This will lead to the growth of an ingrown toenail, which is often painful and dangerous.

15. Don't cut cuticles and also, don’t use anything sharp to clean under your toenails or to remove calluses. You don’t want to accidentally get a cut that could let an infection set in

16. Don’t ignore any numbness that may occur. Numbness usually signifies nerve damage and any nerve damage that isn’t addressed can become permanent.

17. Don't let your feet get wet in snow or rain. If you live in a cold area and get your feet wet, you increase the risk of frostbite. There is already a decreased blood flow to your feet, so your feet have a higher chance of experiencing damage.

18. Don't wear tight, elastic or thick, bulky socks. Also, it is recommended to avoid nylon socks and socks with inseams that can cause blisters and sores.

19. Don’t cross your legs or ankles for a long period of time. Crossing your legs for a prolonged period can cause improper blood supply, also create pressure points and lead to unwanted breaks in your skin.

20. Don't exercise when you have open sores on your feet.

21. Do not use any medication, drug, antiseptic or plaster on your feet that have not been prescribed.

22. Don't take your feet for granted. Instead, set aside some time every day to pamper them and help keep them healthy.

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DO’s FOR DIABETIC FEET

1. Make sure to keep your glucose levels under control to avoid complications related to neuropathy. Out-of-control blood sugar leads to neuropathy, and the better you are at controlling your blood sugar, the healthier your feet will be over the long term.

2. Examine your feet every day for cracks, wounds, and sores because neuropathy makes it hard to feel when you have sores or cracks in your feet. If it is difficult for you to check your feet, you can place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.

3. It is advisable to buy and wear shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot.

4. Wear shoes that fit well. For the best fit, try on new shoes at the end of the day when your feet tend to be largest. Break in your new shoes slowly—wear them for an hour or two a day at first until they’re completely comfortable.

5. Shake out your shoes and feel for objects inside your shoes before wearing them. You may not feel a small foreign object when your shoe is on your foot, particularly if you suffer from diabetic peripheral neuropathy also known as nerve damage.

6. Always wear socks with your shoes for an additional layer of protection for your feet and change your socks daily.

7. Use soft socks without seams, preferably socks that are padded and made from a material that controls moisture. It is advised to wear natural-fibers: cotton, wool, or a cotton-wool blend

8. Keep your feet dry to reduce the risk of infection because the space between the toes is very airtight. Any moisture between the toes leads to skin breakdown, causing infections. The most simple and effective way to prevent this is by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately.

9. In case of dry and cracked skin, use petroleum jelly, moisturizers or lotion but avoid putting it between your toes.

10. Wash your feet daily with mild soaps and warm (NOT hot) water. Never soak your feet in the water for too long.

11. Cut toenails after bathing, when they are soft. Trim them straight across, then smooth with a nail file. Avoid cutting into the corners of toes as it can lead to wounds and injuries.

12. Put your feet up when you’re sitting, and wiggle your toes for a few minutes several times throughout the day to ensure a good and constant flow of blood throughout the lower limbs. You can also massage your feet to improve blood flow.

13. Choose feet-friendly activities that don’t put too much pressure on your feet. Also, make sure you have the right shoe for whatever activity you choose, such as walking, riding a bike, or swimming. Check with your doctor about which activities are best for you and any that you should avoid.

14. See a foot and ankle surgeon for regular foot exams to prevent complications. Ongoing preventive care can reduce the risk of toe or foot amputation by 45-85%.

15. You must always protect your feet from temperature extremes. Always wear shoes at the beach and on hot pavements.

16. It is wise to support your feet in comfort with orthotics. Custom orthotics designed with diabetic needs in mind can fitted by your orthotist.

17. Taking care of your whole body helps you care for your feet, too. You can do that by sticking to your diabetes meal plan, checking your blood sugar, limiting alcohol, and not smoking. Getting 30 minutes of physical activity most days will not only help to reduce excess weight, but it can also reduce triglyceride levels, blood sugar, blood pressure, and cholesterol levels!

 

DAILY FOOT EXAM CHECKLIST

When examining your feet, look for:

• Cuts/scratches: Wash any you find with mild soap and water. Use antibiotic creams recommended by your doctor and apply sterile bandages to protect cuts. If your cut has redness, is oozing, or has a foul-smelling discharge, contact your doctor right away.

• Ulcers: Minor scrapes or cuts that heal slowly -- or sores from badly-fitting shoes -- can become infected, causing ulcers. To prevent foot ulcers, treat scrapes or cuts right away. Talk to your doctor about any foot sores you have. It's important to get them treated immediately.

• Dry skin: Use moisturizing soaps and lotions to keep your skin soft, but don't put lotion between toes; moisture there can cause fungus growth.

• Blisters: If shoes don't fit properly, blisters can develop. Don't break a blister open, risking infection. Simply clean it and apply an antibacterial cream, then cover it with a bandage.

• Cracking, itching, red skin between the toes are signs of athlete's foot fungus. Treat it right away to prevent further infection -- your doctor can recommend a pill or cream.

• Corns/calluses: After every shower or bath smooth these with an emery board or pumice stone -- but don't try to remove a callus all at once, give it several attempts. Do not use drugstore remedies for corns and calluses and do not try to cut or remove a corn or callus.

• Plantar warts: These painful callus look-alikes are caused by a virus and develop on the foot's underside. See a doctor for treatment.

• Ingrown toenails: Trimming toenails regularly -- cutting only across the top -- helps prevent ingrown toenails. When toenails cut into the skin, pain, redness, and infection may result. See a doctor if you develop an ingrown toenail.

• Discolored/yellowed toenails that are thick and brittle means you likely have a fungal nail infection. Your doctor can prescribe long-term medication to treat the infection and improve your nail's appearance.

• Redness, warmth, swelling, or pain: These are symptoms of inflammation and infection. See a doctor right away.

• Blue or black skin color indicates blood flow problems. If you're foot is cold and blue or black this is an emergency; get to a hospital immediately.

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Contact Invigo Rehab (0091-8800973649,0091-9315414056) for specialized footwear as well as customized foot inserts, made especially for patients with diabetes.