For most people, a blister, cut, or scrape on the foot is no big deal -- an "ouch!" and a hurriedly applied bandage, and it's over. Not so if you have diabetes; meticulous daily foot care is as important as monitoring blood glucose, cholesterol, and blood pressure levels.
"Unfortunately, diabetes foot-health awareness doesn't have a colored ribbon or national voice," says foot care expert James Wrobel, DPM, of the University of Michigan Medical School. "If you don't manage them early, small problems that start in the feet can cause really big ones."
Show your hardworking feet some love by preventing ulcers -- open sores that can lead to serious complications like infection and even amputation. According to a report co-written by Wrobel, people who develop diabetic foot ulcers have a higher risk of dying within five years than people with some types of cancer, including prostate cancer, breast cancer, and Hodgkin's lymphoma.
Remember that what you can't feel might really hurt you later, especially if infection sets in. Uncontrolled glucose levels can lead to nerve damage called diabetic neuropathy, a numbness or tingling that may affect balance and prevent you from feeling hot, cold, and even pain. Nerve damage can also compromise your body's ability to sweat, which means skin on the feet can get dry and crack, opening the body's natural infection barrier. The foot's pressure-absorbing fat pads also harden and thin out, creating ideal conditions for foot ulcers to develop.
When cholesterol and blood pressure levels aren't controlled, narrowing or poor function of blood vessels in the arms and legs, called peripheral vascular disease, can reduce blood flow and circulation. Narrower vessels mean the feet get less oxygen and vital nutrients that fight infection and heal wounds. When tissue dies (a condition called gangrene), amputation may follow.
Diabetes Experts' Tips on Foot Care
The lifetime risk that a person with diabetes will develop a foot ulcer may be as high as 25%. To lower your chances of having this happen and to keep your feet in tiptop shape, Wrobel recommends taking these steps.
Take care. Wash feet daily with warm water and soap, dry well, then soften with lotion, cream, or petroleum jelly, avoiding the areas between toes. Trim or file toenails into a shape that's almost square but with no corner points to break skin or cause ingrown toenails.
Be sure the shoe fits. Indoors or out, wear properly fitting, closed-toe shoes to protect feet from stubs and bangs. After age 40, when feet get wider, consider prescription orthopedic footwear for better balance and stability. Never go barefoot.
Wear socks. Clean, light-colored, and lightly padded socks will show blood or draining wounds so you can easily spot problems. Avoid slow-drying, 100% cotton socks in favor of synthetic blends that wick moisture away and discourage fungus.
Fight fungus. Fungus, which thrives in moisture, can lead to infection. Where can you pick up fungus? From carpet, showers, and gym floors. To help kill it, use medicated foot powders like Tinactin or Micatin, and spray Lysol inside your athletic shoes.
Inspect daily. Take a good look at your feet every day. A recent study of male veterans with diabetes found that more than half couldn't see or reach the bottom of their feet. If you aren't flexible enough to see your soles, ask someone to help or use a magnifying mirror to scout trouble spots like redness, bruises, and tiny punctures.
Shake things up. Give your shoes a good shake regularly. Seemingly harmless debris like coins and pebbles can fall unnoticed into shoes, injuring feet.
Don't go to extremes. Insensitivity to temperature means you could accidentally damage your feet, so avoid becoming too hot or too cold.
Heat can cause feet to swell and can burn skin, so don't soak your feet in hot water -- and stay away from hot-water bottles, heaters, and fireplaces, too. Wear insulated boots and socks in very cold weather to help prevent frostbite.
Don't be callous. Don't attempt any kind of "surgery" by cutting your calluses yourself. You risk getting ulcers or infections, so call your doctor for help.
Mark the calendar. Schedule regular foot exams with your doctor -- every few months, or at least once a year -- to avoid emergencies later.
Managing Stress and Diabetes
Another critical aspect of diabetes management is staying stress-free. A little bit of stress can send your blood sugar out of control. Geralyn Spollett, NP, president of health care and education for the American Diabetes Association, offers these tips.
Exercise. "It's a great stress management tool. Walk on a treadmill or get out and hoof it in the fresh air."
Talk with a loved one. "Don't bottle it up inside. Find someone who will be sympathetic."
Don't overeat. "Many times, people who are stressed like to eat because it's a comfort for them. But overeating can cause high blood sugar, so if you must, snack on carrots or rice cakes."
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