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Sunday, 1 April 2012

Foot Care In Diabetes

Diabetes Awareness

Diabetes is a chronic disease affecting mankind all over the world.

Currently, India being the Diabetes Capital of the world, is home to 46.5 million diabetics.  According to IDF (2007), it is estimated that India would have around 80 million diabetics by 2025, a figure worth worrying about!

According to Elliot P. Joslin, a Clinician, "Diabetic who knows most of his disease lives the longest". Thus, education is very important and necessary for good management of this disease.

It is well known that prolonged diabetes affects many organs such as heart, kidney, eyes, nerves, skin, feet, teeth, etc.


20-30 million diabetics out of 246 million world wide suffer from Neuropathy, diabetes being the main cause. 

Diabetes affects the feet because the nerves in this region are the longest in the body. Deficiency of insulin causes under-utilization of glucose in the nerves. This glucose gets converted into toxic deposits in the nerves thus affecting circulation.
Neuropathy increases with age. High glucose levels damages the nerves and so there is loss of sensation  or reduced feeling of pain, temperature, numbness or tingling of feet, burning sensation, reduced blood circulation (peripheral vascular disease), weakness and wastage of small muscles of the foot leading to abnormal foot posture which increases the risk of foot injury. Foot infection is said to be the most common reason for hospitalization of diabetics.

Serious Foot Complications are caused due to:

Diabetic Neuropathy-

A lack of feeling accompanied by tingling, burning, pain, or numbness in the legs or feet due to nerves damage.

Peripheral Vascular Disease (PVD)

PVD causes poor circulation in the arms and legs that can affect the ability to heal a cut or sore leading to ulcers and gangrene.

Foot Injury- improper foot wear is the main cause

Foot Deformities- bunions, hammertoes

Warning Signs Of Foot Complications in a diabetic:
  • Changes in skin colour 
  • Elevation in skin temperature 
  • Swelling of the foot or ankle 
  • Pain in the legs 
  • Open sores on the feet that are slow to heal 
  • Ingrown and fungal toenails 
  • Bleeding corns and calluses 
  • Dry cracks in the skin especially around the heel.

Common Foot problems in diabetics can lead to serious complications such as:

Athlete's foot - It is a fungus that causes itching, redness and cracking. 

Fungal Toenail- Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick and brittle, and may separate from the rest of the nail.

Calluses-  A callus is a build-up of hard skin, usually on the underside of the foot. Calluses are caused by an uneven distribution of weight, generally on the bottom of the forefoot or heel.

Corns- A corn is a build-up of hard skin near a bony area of a toe or between toes. Corns may be the result of pressure from shoes that rub against the toes or cause friction between the toes. Proper care is necessary if you have a corn.

Blisters- Wearing shoes that do not fit properly or wearing shoes without socks can cause blisters, which can become infected.

Bunions- A bunion forms when your big toe angles in toward the second toe. Often, the spot where your big toe joins the rest of the foot becomes red and callused. This area also may begin to stick out and become hard.

Dry Skin - It can crack and let germs enter thus increasing risk of infection.

Hammertoe- It is a toe that is bent because of the weakened muscle that makes the tendons shorter, thus causing the toes to curl under the feet.

Ingrown Toenails- It occurs when the edges of the nail grow into the skin causing redness, pain, swelling. drainage and infection.

Foot Ulcer- It is a break in the skin or a deep sore that can get infected.

Why has a Diabetic to take care of his feet? Here are some very important statistics that is an eye-opener for all the diabetics. They are as follows:

> Every 30 seconds, a leg is lost to diabetes somewhere around the globe.
> 70 % of all leg amputations world wide are caused by diabetes.
> Most amputations begin with foot ulcers. But the good news is that 85% of amputations caused by diabetic foot ulcers are preventable.
> 5% of Indian Diabetic population have one or the other foot problem.

Learn How To Prevent A Foot Problem If You Are A Diabetic:


  • Check and examine your feet daily for blisters, cuts, scratches or other sores.
  • Consult your doctor immediately if you notice any of the following danger signs:  swelling, colour change of a toe, nail or a part of the foot, pain or throbbing, thick hard skin or corns, breaks in the skin including cracks and blisters. 
  • Check for redness, increased warmth, or tenderness when touching any area of your feet.
  • Check for ingrown toenails, corns, and calluses.
  • If you get a blister or sore from your shoes, do not "pop" it.
  •  Use a mirror to look at the bottom of your feet. Call your doctor if you notice anything. If your eyesight is poor, have someone else do it for you.

  • Wash your feet in lukewarm water using a mild soap. Wipe dry using a soft cloth. Do not rub.
  • After washing, thoroughly dry your feet and moisturize them using a prevent cracking. Do not put lotion between your toes.
  • Smooth the corns or calluses using an emery board or a pumice stone

  • Check and trim your toenails once a week.
  • Cut toenails after bathing, when they are soft.
  • Cut toenails straight across and smooth with a nail file.
  • Avoid cutting into the corners of toes.
  • You may want a podiatrist (foot doctor) to cut your toenails.

Protect Your Feet With Shoes and Socks

  • Never walk barefoot, not even at home. You could step on something and get a scratch or a cut. Always protect your feet by wearing shoes or hard-soled slippers or footwear.
  • Avoid shoes with high heels and pointed toes.
  • Avoid shoes that expose your toes or heels (such as open-toed shoes or sandals). These types of shoes increase your risk for injury and potential infections.
  • Try on new footwear with the type of socks you usually wear.
  • Do not wear new shoes for more than an hour at a time.
  • Look and feel inside your shoes before putting them on to make sure there are no foreign objects or rough areas.
  • Avoid tight socks.
  • Wear natural-fiber socks (cotton, wool, or a cotton-wool blend).
  • Wear special shoes if your health care provider recommends them.
  • Wear shoes/boots that will protect your feet from various weather conditions (cold, moisture, etc.).
  • Make sure your shoes fit properly. If you have neuropathy (nerve damage), you may not notice that your shoes are too tight.


  • Regular monitoring of blood glucose and maintaining it near normal levels. 
  • Put your feet up to maintain good blood flow.
  • Smoking can make blood flow problems worse.

When Should I Contact My Doctor?

Visit your doctor or a Podiatrist for regular check-up of your feet, even if you don't have any foot problem.

  • The old saying,  "an ounce of prevention is worth a pound of cure" was never as true as it is when preventing a diabetic foot ulcer. The best way to treat a diabetic foot ulcer is to prevent its development in the first place.
  • People should treat their "Feet" like they would treat their "Face" 

  • Periodic examination of foot is mandatory for diabetics.
  •  Identification of early foot problems prevents major events and costs.
  • Achieving and maintaining of blood glucose is essential in prevention of foot problems.