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Foot Clinic Home |
Introduction |
Risks |
Prevention |
Treatments
What can I do to
prevent diabetic foot problems?
Every person with diabetes - with
or without any of these risk factors - should take proper care of their feet. Routine
foot inspection and preventive care can minimize or prevent foot problems. Below are
things to make sure you ask your doctor about:
- You should have a thorough foot examination by a professional at least once a year.
This includes checking the sense of feeling and the pulses in your feet.
(See box.)
- Ask for a risk evaluation. Specific follow-up and treatment will be based on what
risk category your feet are in. Ask for special instructions for people with high-risk
feet, if applicable.
- If you have lost some sensation in your feet, they should be visually inspected at
every visit. Take off your shoes and socks at every visit and make sure this happens.
- Ask your provider to check your
footwear
to make sure that the style and fit are appropriate for the condition of your feet.
Ask if special shoes would help your feet stay healthy.
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Components of a good foot
exam:
At least once a year, everyone with diabetes should have a thorough foot examination.
It should include an assessment of:
- Protective sensation - using a monofilament or vibratory sensation test
- Foot structure
- Biomechanics - including any limits in joint mobility or problems with gait and
balance
- Vascular status - including questions about painful walking and determination of
pulses in your feet
- Skin integrity - especially between your toes and on the ball of your foot
- Increased pressure on the soles of your feet; areas of warmth, redness, or
callus
formation may be indicative of tissue damage
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Many diabetes treatment programs operate regular foot clinics to help patients
with routine foot care and to make sure that preventive measures are taken. Some
pharmacists specializing in diabetes care offer similar programs. Be sure to take
advantage of any foot care programs that are available to you.
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Preventive foot care
- for all
Of course, the best way to prevent foot
problems is to keep your blood glucose under
control. But there are also specific things you should do EVERY DAY to make sure
your feet stay fit. Here are some of them:
- Examine your feet EVERY DAY to look for cuts, sores,
blisters, redness, etc. If you
have anything of that nature, and it doesn't heal in a day or two, notify your doctor.
If you have trouble seeing or reaching your feet, ask someone to help, or use a mirror
to help you see better.
- Wash your feet EVERY DAY with lukewarm water and mild soap. Dry them carefully and
thoroughly with a soft towel. Dust your feet with talcum powder, which will help keep
them dry.
- Don't soak your feet - this will make your skin too dry.
- If you have dry skin on your feet, use a moisturizing lotion to prevent cracking -
but NEVER use a lotion or cream between your toes, as this can lead to infection.
- If you have corns or calluses,
DO NOT cut them, don't use corn plasters or liquid corn and callus removers - they
can damage your skin. Check with your doctor or foot care specialist who may advise
you to use a pumice stone to smooth calluses or corns.
- Keep your toenails trimmed. Trim them with toenail clippers after you have washed
and dried your feet. Trim the nails following the shape of your toes, and smooth them
with an emery board or nail file. Don’t cut into the corners of the nail, which could
trigger an ingrown toenail. If your nails are very thick or yellowed, have a foot care
specialist trim them.
- Don't go barefoot - not even indoors. Always wear socks, stockings, or nylons with
your shoes to help avoid blisters
and sores. Choose soft socks made of cotton, wool, or a cotton-polyester blend, which
will help keep your feet dry. Avoid mended socks or those with seams, which can rub to
cause blisters.
- Avoid wearing socks or hose that are too tight around your legs. Knee-high or
thigh-high stockings as well as elasticized men's dress socks can constrict circulation
to your legs and feet.
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Choose the proper footwear
- for all
Choosing the right footwear is an
important part of foot care, since poorly fitted shoes are involved in as many as half
of serious foot problems. Here are some tips for choosing the best footwear:
- Wear well-cushioned walking shoes or athletic shoes. If you have foot deformities
such as hammertoes or
bunions, you may need extra-wide
shoes or depth shoes. Depth shoes have more room in them to allow for different shaped
feet and toes or for special inserts made to fit your feet. If problems are severe,
custom-molded shoes are available. Medicare provides coverage for some special shoes;
your doctor or foot care specialist can help determine if you qualify.
- Don't wear shoes with high heels or pointed toes. They can create pressure, which
might contribute to bone and joint disorders as well as diabetic ulcers.
- Don't wear open-toed shoes or sandals with a strap between the first two toes.
They increase the chance that you'll injure a toe.
- When you buy new shoes, be sure your feet are properly measured and fitted. Your
feet can change size and shape, so an experienced shoe fitter should measure them
whenever you get new shoes. Shoes should fit both the length and width of your foot,
with room for your toes to wiggle freely.
- Your new shoes should be sturdy and comfortable. They should have leather or canvas
uppers, which breathe to keep your feet from getting sweaty. Avoid vinyl or plastic
shoes, because they don't stretch or breathe.
- When you get new shoes, break them in gradually so you won't get blisters.
- Shake your shoes before you put them on. Even a small pebble in your shoe can
lead to problems.
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Special care
for high-risk conditions
If you do have any of the high-risk
conditions, there are specific things you should do to keep your feet healthy.
- If you have neuropathy or evidence of increased pressure on the soles of your feet,
wear well-cushioned walking shoes or athletic shoes.
- If you have lost some sensation in your feet, be sure to carefully inspect them
often to identify any problems early.
- If you have calluses, have a
foot care specialist treat them.
- If you have bony deformities such as
hammertoes or
bunions, you may need extra-wide
shoes or depth shoes. In extreme cases, custom-molded footwear may be needed.
- Promptly treat minor skin conditions such as
dry skin or
athlete's foot to keep
them from progressing.
- Have a complete foot examination every 3 to 6 months.
A formal, comprehensive program has been developed at the Gillis W. Long Hansen's
Disease Center in Carville, LA, known as the "LEAP program" for Lower Extremity
Amputation Prevention. It consists of 5 relatively simple activities:
- Annual foot screening to identify people who have lost protective sensation
- Patient education in self-management, with emphasis on proper foot care
- Daily self-inspection of the
foot
- Appropriate footwear selection
- Management of simple foot problems such as dry skin, nail and callus care, and
basic wound management
In a number of large clinical centers where formal preventive care programs such as
this have been implemented, the rate of amputations has been reduced by as much as 85%.
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