Doctor's Notes on Diabetic Foot Care
Diabetic foot care is a condition that helps control and/or prevent the problems encountered with their feet. Common signs and symptoms in diabetics that suggest they need foot care include persistent pain, redness, swelling, limping and warmth of the feet. More serious signs and symptoms include numbness so injuries to the feet are not detected, skin breaks or wounds that don't heal, fevers, pus drainage, and/or red streaks moving up the leg from the foot.
The cause or need for foot care in diabetics is due to poorly fitting footwear, nerve damage from the disease, poor circulation due to diabetes, trauma (often undetected because of prior nerve damage), infections (bacterial and fungal) and smoking (decreases circulation) can contribute to cause a need for good diabetic foot care to treat or prevent signs and symptoms.
Diabetic Foot Care Symptoms
- Persistent pain can be a symptom of sprain, strain, bruise, overuse, improperly fitting shoes, or underlying infection.
- Redness can be a sign of infection, especially when surrounding a wound, or of abnormal rubbing of shoes or socks.
- Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation. Other signs of poor circulation include the following:
- Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
- Hair no longer growing on the lower legs and feet
- Hard shiny skin on the legs
- Localized warmth can be a sign of infection or inflammation, perhaps from wounds that won't heal or that heal slowly.
- Any break in the skin is serious and can result from abnormal wear and tear, injury, or infection. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
- Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
- A limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes.
- Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
- Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
- New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a persons risk for leg and foot problems.
Diabetic Foot Care Causes
Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.
- Footwear: Poorly fitting shoes are a common cause of diabetic foot problems.
- If the patient has red spots, sore spots, blisters, corns, calluses, or consistent pain associated with wearing shoes, new properly fitting footwear must be obtained as soon as possible.
- If the patient has common foot abnormalities such as flat feet, bunions, or hammertoes, prescription shoes or shoe inserts may be necessary.
- Nerve damage: People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.
- Because of the nerve damage, the patient may be unable to feel their feet normally. Also, they may be unable to sense the position of their feet and toes while walking and balancing. With normal nerves, a person can usually sense if their shoes are rubbing on the feet or if one part of the foot is becoming strained while walking.
- A person with diabetes may not properly sense minor injuries (such as cuts, scrapes, blisters), signs of abnormal wear and tear (that turn into calluses and corns), and foot strain. Normally, people can feel if there is a stone in their shoe, then remove it immediately. A person who has diabetes may not be able to perceive a stone. Its constant rubbing can easily create a sore.
- Poor circulation: Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.
- Trauma to the foot: Any trauma to the foot can increase the risk for a more serious problem to develop.
- Athlete's foot, a fungal infection of the skin or toenails, can lead to more serious bacterial infections and should be treated promptly.
- Ingrown toenails should be handled right away by a foot specialist. Toenail fungus should also be treated.
- Smoking: Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.
If you have nerve pain or peripheral neuropathy due to diabetes there is some evidence exercise may either improve or worsen nerve damage. Consequently, people with diabetes should always speak with their doctors to see which exercise program might be the best for them to participate in. People with diabetes will need to make exercise a regular part of their ongoing treatment.
Diabetic Neuropathy : Test Your Medical IQ QuizQuestion
What is diabetic peripheral neuropathy?See Answer
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.