Put your best foot forward
Most people with diabetes that Joe Kelly, podiatrist, sees for their routine check do take care of their feet and this means they have few problems. He says that most foot problems are “earth bound and not heaven sent”. When people have a basic understanding of how their feet might be affected by diabetes and they take care of them and seek advice for any problems early they are unlikely to have any problems, says Joe Kelly. Joe is a podiatrist with a practice in Dublin and an adviser to the council of the Society of Chiropodists and Podiatrists in Ireland. He also works at the diabetes clinic in Tallaght Hospital.
It is possible to avoid most problems by routinely checking your feet, using a mirror if necessary and making sure that you:
• Detect problems early
• Manage problems early
• Control any infection
• Take good care of wounds.
Everyone with diabetes, no matter what age they are or how long they have had diabetes, should get their feet checked once a year. They should find out how to take care of their feet and what types of problems they should look out for. Those who have problems tend to be people with type 2. They may be obese, have poor control of their diabetes and do not comply with medical advice about medication, diet and lifestyle.
Minor feet problems
If someone does get a small crack or cut on their foot, Joe suggests that they:
• Put an antiseptic cream on it
• Cover it with a sterile, plain dressing
• Get it looked at by a professional like their GP, public health nurse or practice nurse.
“That’s the easiest way of preventing serious problems. But people often don’t. They wait until something is red and sore and they may ring up and make an appointment or they may turn up at the clinic. And generally that type of thing doesn’t get sore within a few minutes, it takes a day or so. “Time and time again, people go off abroad on holidays, they get into trouble with their feet, come home and sit at home for two or three days because they already have an appointment set up for then. Meanwhile, their GP is there with an open door and they could be seen straight away.”
The most common cause of foot problems in people with diabetes is neglected hard skin, said Joe. “Everyone develops a certain amount of hard skin around their heels or across the ball of the foot. If it’s left and left it might split and crack and keep building up until it is actually like a stone. Meanwhile, the person is walking around on it and that affects the underlying skin and can result in blisters.” Other common problems are poor nail care or incorrect toe-nail cutting and bad footwear. “Industrial footwear can induce problems for people with broad feet. There’s no room – they’re made to a certain width. Steel toecaps are not going to give. But that’s an issue we can’t get away from for insurance reasons. People have to put up with it.” Simple injuries like a stubbed toe can also cause problems. “Or what we call ‘bathroom surgery’ when people attempt to deal with problems themselves.”
Professional care
Joe recommends that people get their foot care done by professionals. The Department of Health has a list of recommended podiatrists and people should check that someone is on that list. It is also a good sign if they have a Bsc (Bachelors Science Degree) or a DPM (Diploma in Podiatric Medicine). In addition the clinic should seem clean and use proper disinfectant procedures. A GP, public health nurse or practice nurse can usually recommend a podiatrist in someone’s area. “When someone comes to have their feet assessed, we’re assessing them on the basis of their needs and what puts a foot at risk. Have they got good feeling in their feet? Have they got good circulation? Is there any foot or toe deformity? Is the footwear good? “Most people do have good feeling and good sensation and so are low risk. I have people 20 years with diabetes and they have excellent circulation and feeling and have never had any trouble with their feet. “So it is not inherent that once you have diabetes you will have problems. It comes down to a person recognising early on “oh I have something wrong, I should get this checked out”.’
How to look after your feet
Inspect your feet everyday, including areas between the toes
• If you cannot inspect your feet, get someone else to do it for you
• Wash your feet regularly and carefully dry them, especially between the toes
• The temperature of the water you put your feet in should always be less than 37° centigrade
• Avoid walking barefoot, outside or inside, and always wear socks with shoes
• Don’t use chemical agents or plasters to remove corns and calluses
• Change your stockings every day
• Inspect and feel the inside of your footwear for any grit, stones, hard seams or wrinkled lining
• If your vision is impaired, you should not try to treat the feet (eg. nails) by yourself
• Do use lubricating oils or creams for dry skin, but not between the toes
• Cut your toenails straight across
• Wear stockings with seams inside out or preferably without any seams at all
• Don’t cut corns and calluses yourself, but get it done by a health care professional
Taken from guidelines produced by the International Working Group on the Diabetic Foot. www.iwgdf.org
APP/KOL/AC 16/02/2010
Sheila O' Kelly,Diabetes Ireland Magazine
Last updated: February 2010