I like to ask my diabetic patients an open-ended question during checkups or nail-care visits: “As a diabetic, what do you do to care for your feet?”
Their answers give me a lot of information. Some answer immediately with the standard routine I recommend. Some offer a few good habits and few that are not-so-good. Sometimes I just get a guilty smile and silence.
I can understand why patients may skip the full routine. Each task by itself might seem inconsequential, but the whole is greater than its parts. The beauty of the routine is what happens when every piece is done regularly. If you stay familiar with your feet and take care of them regularly, you have your best chance of avoiding wounds, infections and amputations.
Here are my four habits
for diabetic feet:
Look at them every day. It’s amazing how many people don’t know what their feet look like. I’ve asked patients how long a large freckle, healed scar or wound has been on their foot, and they say this is the first time they’ve noticed it. If you become familiar with your feet, you’ll notice when something pops up, like a bit of swelling, discoloration, loss of hair or texture changes in your skin. All of these things give your doctor information. For instance, hair on your toes is a sign of good blood flow. If you notice you’ve lost hair, it might be time to start monitoring your blood flow. If you’ve got diabetic neuropathy (loss of sharp sensation or numbness in your feet), you may even step on something without noticing. Looking at your feet each day can alert you to possible wounds or other problems, and the quicker you jump on these things, the faster you heal with fewer complications.
No bare feet. Especially if you have diabetic neuropathy, but even if you don’t, you should be in shoes. Many people like to take their shoes off at home, out of habit. But most accidents happen at home when it comes to diabetic feet. People will stub their toes, get splinters on the deck or step on broken glass’'s best friend. Your insurance may cover them. Also be mindful of the fit. If you have diabetic neuropathy, you may not feel shoe pressure. Properly fitting shoes may feel too big, and the increased pressure from a size too small may feel more appropriate. If your nerves are compromised, you can’t always trust them to tell you when a shoe fits.
Use lotion, don’t soak. The idea that soaking your feet is good is a common misconception. Soaking feet in warm water after a long day can feel fantastic, but it’s not actually helpful. It will dry out your feet and can worsen calluses. Just like chapping your lips by licking them, too much water over the skin on your feet will pull the natural oils and moisture out. A better bet is to use a hydrating lotion. There are some good over-the-counter brands, or you can ask for a prescription. Apply it liberally to your feet. Put on a pair of clean white cotton socks to trap the moisture of the lotion on your feet. Don’t put lotion between your toes. This area tends to stay moist enough, and adding to it can promote skin breakdown or athlete’s foot. Wipe out excess moisture in there before putting on your socks. This is also important after bathing.
Control your blood sugar. This is the most important habit, and unfortunately requires the most time and energy. When your blood sugar is too high, it damages nerves as well as small blood vessels, and not just in your feet. If your nerves no longer function normally, you may experience pain, burning, tingling or numbness. These malfunctioning nerves can’t tell when you’ve hurt yourself, whether it’s a blister in too-tight shoes or glass you stepped on. And once you’ve lost the sensation, it’s usually irreversible. In order to keep your nerves working for you and not against you, you need to keep them happy. If you’re having trouble controlling your blood sugar, talk to your primary-care physician.
It is much easier to prevent problems in diabetic feet than it is to heal an ulcer or recover from an amputation. Take a few minutes each day to take off your supportive shoes and look at your feet as you apply lotion.
Putnam is a podiatrist with Atlantic Foot and Ankle Specialists. She graduated from the Scholl College of Podiatric Medicine in 2009 and completed her residency at the VA Palo Alto Health Care System.