Diabetic foot: how to protect your feet

What is diabetic foot and why does it develop?

Diabetic foot is a complication of diabetes in which nerve and blood vessel damage in the feet, together with a weakened immune system, leads to slow-healing ulcers, gangrene and serious bacterial infections. These ulcers can appear on the foot, the toes or the ankles.

Persistently high blood glucose, many years of diabetes and poorly controlled blood sugar all increase this risk. Two main causes are behind the ulcers:

• damage to the nerves of the foot and loss of sensation – peripheral diabetic neuropathy;
• narrowing of the arteries of the foot and weakened blood flow.

Why is neuropathy dangerous?

As sensation in the feet fades, a person does not feel an injury, trauma, wound, blister or ulcer – they may not even notice a burn after touching something hot. That is why people whose sense of pain is reduced, and especially lost, are much more likely to injure their feet and develop ulcers.

Because diabetes damages the blood vessels, wounds form easily and heal slowly, and bacteria and fungi cause infection more easily. If treatment is delayed, this process can end in gangrene and amputation.

Which signs need attention?

• reduced or completely lost sense of pain, touch and temperature in the foot;
• numbness, burning, pins and needles or “electric shock” sensations in the soles and toes;
• pain or cramps in the thigh and calf muscles during physical activity;
• dry skin and cracks on the feet, especially on the heels;
• changes in skin colour and temperature on the feet, loss of hair;
• thick, yellow nails or signs of fungal infection;
• a wound, ulcer, blister, infected callus or ingrown toenail;
• weakness, fatigue and deformities of the feet.

Daily foot care rules

Most foot problems start with incorrect foot and nail care: badly trimmed nails, ingrown nails, tight shoes, fungus between the toes. It is important to follow these simple rules every day:

• check your feet and toes every day, using a mirror if needed;
• wash your feet daily and dry them with a soft towel;
• check the water temperature before washing – with reduced sensation you can get a serious burn;
• do not keep your feet exposed to chemicals such as soap for a long time – this causes cracks and infection;
• you may apply cream to dry skin, but not between the toes;
• pedicures are risky – avoid them;
• trim your nails correctly and smooth their edges – this prevents nails from breaking and growing in;
• do not walk barefoot, either at home or outdoors (including on the beach);
• choose wide, comfortable shoes in your size and never wear them without socks;
• wear loose, seamless cotton socks;
• every time before putting on shoes, check inside them with your hand and shake them out – there may be a pebble or sand inside.

When should you see a doctor urgently?

If you notice any wound or change on your foot, see a doctor without delay. A wound on the foot that has not healed for more than three weeks shows that diabetes is getting complicated and definitely requires a medical examination.

If redness, swelling, warmth, pus or an unpleasant smell appears around a wound, the skin turns dark, or you develop a fever, this may mean the infection is spreading – in such cases you should see a doctor the same day.

Early diagnosis and treatment can prevent amputation. Keeping blood sugar within the normal range, keeping your feet clean and having regular check-ups even for minor complaints are the most reliable ways to protect your feet.