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Diabetes: Protecting the feet from diabetic foot ulcers

Checking the feet daily is an important part of diabetes management.

Diabetic foot complications are a leading cause of lower limb amputation.


In this article:


 

"Carers play a key role in diabetic foot management. Carers can help a person with diabetes by checking the feet daily, paying particular attention to any injuries such as small wounds on the base of the feet."

"Use a simple moisturiser such as sorbolene cream every day over the base of the foot not between the toes to keep skin in good condition"

Brendan Brown, vice president Australasian Podiatry Council 
  


 

Who is at risk of diabetic foot ulcers?

Older people who have had diabetes for many years are at risk of the long term complications of diabetes.

High blood glucose levels can, over time, damage blood vessels and nerves. A condition called diabetic neuropathy causes pain and loss of feeling in the feet. Reduced sensation can mean a small blister or sore can go unnoticed. A minor sore can quickly get infected and turn into a foot ulcer.

Inadequate blood supply can also delay healing and increase the risk of chronic ulcers developing. If diabetic ulcers become infected they can be very hard to heal, in serious cases amputation may result.


 

How does a diabetic ulcer start?

Diabetic foot ulcers can develop over boney areas of the foot. Problems with bunions, calluses and hammer toe can lead to pressure points developing and skin breakdown.

Diabetics with foot or joint deformities should be careful to select shoes that provide adequate support and fit well. Getting the feet measured or wearing custom shoes can help protect the feet.

Even small changes to the condition of the feet and nails should be treated seriously. Minor cuts, scrapes and blisters should be seen by a doctor if they don't heal rapidly.


 

Diabetes and podiatry assessment

Diabetic foot care and regular visits to a podiatrist is the key to detecting foot problems early and avoiding serious complications.

A podiatrist assessment involves reviewing a person's risk status by checking foot pulse, circulation and sensation.

All of these factors give a podiatrist a clearer picture of the overall condition of a person's feet. In some cases a person may be referred to a specialist high risk foot clinic.

The Australian Podiatry Council recommends seeing a podiatrist every 6 months. Any changes to the feet should be reported to a doctor.

All major health funds cover podiatry and a referral is not needed. Medicare covers patients with a history of diabetes and arthritis, check with Medicare first. Department of Veterans Affairs also cover podiatry for some people.

To find a podiatrist that specialises in diabetes, follow this link www.findapodiatrist.org/


 

Tips to prevent diabetic foot problems 

  •  Inspect feet daily, ask a podiatrist to show you how
  •  Wash feet daily in lukewarm water (not hot)
  •  Dry feet carefully, pat dry with a soft towel. Do not rub
  •  Avoid going barefoot, wear shoes to protect feet from injury
  •  Avoid extreme temperatures e.g hot water bottles, heat packs and baths
  •  Avoid socks and stockings that are too tight
  •  Consult a podiatrist to treat calluses, corns and bunions
  •  See a doctor or podiatrist if heels are cracked, use specialised heel balms for cracked heels
  •  Avoid getting feet too hot or too cold
  •  Control blood glucose levels
  •  Stop smoking
  •  Enjoy gentle exercise and follow a healthy eating plan
  •  Cut and file nails as directed by a podiatrist
  •  Don't use commercial corn products, ask your podiatrist for advice
  •  If you notice any changes such as wounds that don’t heal, bruising, increased temperature and pain see your doctor immediately.

 

Pay careful attention to shoes and socks

Difficulty seeing or reaching the feet can make it harder for some people to inspect their feet. A handheld mirror can be a useful tool for inspecting the feet.

  •  Avoid socks with inside seams and elastic bands
  •  Check with a podiatrist before using special shoe inserts
  •  Check shoes daily for sharp objects or torn linings
  •  Change socks daily
  •  Don't buy shoes that need breaking in
  •  Try special commercial diabetic socks
  •  Buy shoes at the end of the day when feet are a little swollen
  •  Avoid slip on shoes that encourage the toe to 'claw' to keep the shoe on 

 


 

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References
American family physician
Diabetic foot ulcers:Prevention, Diagnosis and classification
Accessed 21/08/08

Australasian Podiatry Council
Your podiatrist talks about diabetes
Accessed 20/08/08