Putting Your Feet First

Do you take good care of your feet? Many people with diabetes don't and risk foot ulcers or worse. In this Health Alert Johns Hopkins specialists provide the essentials of good foot care for people with diabetes.

People with type 2 diabetes are at higher risk for slow-healing foot injuries that can become infected and progress to amputation. The underlying reasons are poor blood flow to the extremities and less sensation to pain due to neuropathy (nerve damage). Insensitivity to pain means you may not notice cuts and wounds until they get infected. Poor circulation means the wound heals slower. Blood glucose itself fuels the infection. The result can be a foot ulcer -- an open, unhealed wound on the foot.

If you are at risk of foot ulcers it's important to do everything you can to prevent injuries or catch them early. The way to start is with good diabetes foot care:

Diabetes Foot Care Do's:

• Inspect your feet every day, looking for any cuts or abrasions. If you have trouble seeing the bottoms of your feet, use a hand mirror. Ideally, have a regular examination by a podiatrist. Make sure your primary care provider inspects your feet at every routine office visit.
• Wash your feet daily, but do not soak them in hot water. Use a skin lotion suggested by your diabetes doctor or podiatrist to prevent cracking and drying of the skin, but don’t apply it between your toes. If you have moist, sweaty feet, a light coat of foot powder between the toes helps to prevent fungus.
• Your diabetes doctor should screen for diabetes-related nerve damage (neuropathy) of the feet. Neuropathy can make you less sensitive to pain, allowing cuts and abrasions to go unnoticed until they become infected.
• Wear soft, breathable socks made of a material, such as a cotton-acrylic blend, that wicks moisture away from the skin. Avoid 100% cotton socks or those with elastic bands that could constrict blood flow.
• Cut your nails straight across and carefully file the edges smooth without damaging the skin. If you find it difficult to trim your own nails for any reason, don’t do it. See a podiatrist.

Diabetes Foot Care Don'ts:

• Don’t walk barefoot -- even indoors.
• Don’t smoke. Smoking reduces blood circulation; this can lead to the loss of a leg.
• Don’t cut corns or calluses yourself.
• Don’t use caustic chemical agents or any other irritants for the removal of corns and calluses.
• Don’t wear open-toed shoes, particularly sandals with thongs between toes.