People with diabetes can have many foot problems, and these small foot problems can often turn into big problems! They most often occur with diabetic neuropathy, which can be accompanied by burning pain or pins and needles; but if the patient’s sensory nerves are also damaged, then they will lose perception of pain from a foot injury. Diabetes can also lead to blockage of blood vessels in the lower extremities and even changes in the shape of the feet or toes.
I. Neuropathy
Neuropathy leads to abnormal sensation in the feet of diabetic patients: such as pain, overheating or cold sensation in the feet; or reduced sensation or even loss of sensation, no perception of stones or large head pins in shoes, no perception of existing foot injuries (such as early pressure redness and blisters) until the skin breaks down and becomes infected and diabetic foot ulcers form (of the nearly 1,000 foot ulcer patients treated at the 454 Podiatry Center each year, more than 50% are incised and cleaned up when without even using anesthetic drugs!) .
Neuropathy can also cause changes in the shape and deformity of the diabetic foot (including the toes), so it is important to wear custom-made shoes rather than forcing the foot into a regular shoe.
Second, skin injury
Because the peripheral nerves of the lower extremities have the function of regulating the oil and moisture of the feet; once the peripheral nerves are damaged, the skin of the feet will become very dry, even causing skin loss or dry cracking (especially heel dry cracking).
Third, calluses or corns
Diabetic patients due to neuropathy resulting in abnormal pressure on the bottom of the foot, the formation of high pressure areas on the bottom of the foot, so calluses or corns more, and the formation of fast. Too many calluses or corns mean that you have abnormal plantar pressure and are prone to diabetic foot ulcers, so you need custom-made insoles and shoes as an adjunct to treatment. If they are not trimmed, they can become very thick, allowing bleeding, breakage, and ulcer formation inside the base. Get help from a specialized doctor to trim calluses or corns, and never try to trim them yourself or go to a roadside foot wash to treat them! And don’t use chemical drugs! Patients can choose to use pumice daily, but only on wet skin, and apply moisturizing water afterwards.
Fourth, foot ulcers
Ulcers often occur on the plantar metatarsal bulb or the bottom of the big toe, while ulcers that occur on the side of the foot are often worn down by poorly fitting shoes. Remember: even though some ulcers do no harm, once they occur, you should seek medical attention immediately! Negligence can lead to infection, or even amputation and eventually life threatening!
Your doctor will help you to.
1. Take an X-ray of the foot to see if any damage has been done to the bones of the foot;
2. Remove the necrotic and infected tissue;
3.If necessary, hospitalize you;
4.Wound bacterial culture + drug sensitivity to determine the type of infection and the most appropriate antibiotics;
5.Recommend custom-made shoes, insoles or supports for you, and change your original shoes to avoid aggravation of ulcers;
6.If the ulcer does not heal or the blood circulation is poor, ask a vascular doctor for consultation;
7.Good blood sugar control is the basis, poor blood sugar and infection are very difficult to control;
8. The scar tissue after ulcer healing is very easy to break again, so it is necessary to customize shoes to prevent ulcer recurrence.
V. Poor blood circulation in the lower limbs
Diabetes makes the lower limb blood vessels narrow and harden, and blood flow is obstructed. And insufficient blood flow, the patient foot ulcer infection is not easy to control, more difficult to heal. Do not smoke (smoking makes arteriosclerosis faster). Keep blood pressure and cholesterol normal. If your feet are cold, pay attention to keeping them warm, preferably with thick socks; but be careful with hot water bags, electric blankets and other warming appliances!
Some patients feel pain in their calves when hiking, or walking on hard surfaces, or walking fast, called “intermittent claudication”; the pain can be relieved if they stop for a while to rest. At this time, you should stop smoking immediately; and improve the circulation treatment with the help of a doctor. Exercise is good for circulation and stimulates blood flow to the lower extremities and feet; wear sturdy, well-fitting, comfortable shoes; once there is an ulcer, you can no longer walk.
VI. Amputation
People with diabetes are more likely to have their legs or feet amputated than the general population! What is the problem? Many diabetics have peripheral vascular disease (PAD) with reduced blood flow to the feet; many more have neuropathy with reduced foot sensation. Neuropathy or abnormal blood flow makes it easy for ulcers to form and infections to be easily controlled, leading to amputation. However, the vast majority of amputations can be avoided with good treatment and proper footwear (studies show that 85% of all amputations are avoidable with effort!)
One of the biggest threats to the foot is smoking! Smoking affects the small blood vessels, resulting in reduced blood flow to the foot and slower wound healing. Many diabetic amputees are smokers.
Tips: Fourteen tips for foot protection
1.Control blood sugar.
2.Stop smoking.
3.Customize insoles and shoes that fit your feet, wear shoes and socks all the time, and never walk barefoot (not barefoot at home either, and try not to wear flip-flops).
4.Check your own feet every day for red spots, cuts, swelling and blisters! Always ask family members to help look when you cannot look yourself.
5, wash your feet every day, to dry; do not soak your feet (that will make your skin more dry!) ；
6, keep the skin of the feet soft and smooth, apply a thin layer of petroleum jelly, odorless hand cream or other products (note: not between the toes).
7, nails should be trimmed horizontally and not dig too deep on both sides; elderly people or those with mobility problems, ask a specialist to trim.
8.Avoid overheating or overcooling.
9, do exercises to promote blood flow, sit, lift the leg, move the ankle joint up and down for 5 minutes, 2-3 times a day. Do not stilt.
10.See a doctor as soon as possible when there is an ingrown toenail.
11.See a doctor as early as possible when there is foot trauma.
12, have foot skin color, shape change or feel abnormal, see a doctor immediately
13, have corns and calluses, ask a doctor to remove them.
14, ask a specialist to help you check your feet regularly (at least once a year, problematic feet need several times a year).