Precautions for Diabetic Foot Care
There are various common complications associated with the diabetic foot. Common foot complications of uncontrolled diabetes include:
- Dry Skin
- Fungal infection
- Ulcers and other wounds
- Hammertoes, bunions & blisters
- Ingrown nails
Many of these complications are a direct result of diabetic neuropathy and vascular disease.
Diabetic neuropathy is characterized by pain, tingling and numbness leading to the loss of protective sensation. Once diagnosed, it is vital that patients are re-tested at least once annually in order to identify any progression of this condition.
Patients suffering from neuropathy often present with open sores, hammertoes, bunions or blisters because they're not capable of identifying pain and sore spots caused by improper footwear.
Loss of sensation can also lead to a recurrence of ingrown toenails. Ingrown toenails can develop in anyone with a wide nail plate but tend to occur more often as patients age.
Vascular disease in diabetic patients contributes to slow healing once a sore (or “wound”) develops. Diabetic patients who have not taken control of their blood sugar for long periods of time are at risk for infection from these sores/wounds. Severe untreated infections that cannot be controlled and result in amputation are a significant indicator of a shortened lifespan. Since the diabetic patient often doesn’t feel the sore, they don’t get medical help. This can lead to significant infection and even amputation.
Poor circulation from vascular disease also often results in dry and/or itchy skin, including cracked heels. While a topical cream such as this is designed to provide effective relief for this condition, it is not a substitute for controlling underlying diabetes.
Patients with diabetes may be predisposed for fungal infections. Once a fungal infection develops, it may be difficult to control with over-the-counter medications. Aggressive topical medications such as tineacide can prevent prolonged skin infections that put the patient at risk for sores/wounds.
Diabetic Foot Exam
In order to properly treat your patients, it's important to be able to identify them for risk factors. An initial inspection under proper lighting will help you to identify obvious trouble spots such as:
- Ulcerations, cuts or other wounds
- Hammertoes and bunions
- Nail dystrophy/deformity
Identifying the physical signs of high-risk feet is essential to the treatment plan you will provide in your practice as well as any additional recommendations you may have for the patient's primary care physician.
Make note of other risk factors such as:
- Thin skin
- Dry skin
- Skin temperature changes
In order to prevent foot complications resulting from diabetes, proper measures should be taken when you provide treatment to these patients. These treatments should include:
- Treating and preventing ingrown nails
- Proper debridement of corns, calluses and dystrophic nails
- Provide your patient with educational information and literature about properly monitoring blood sugar and administering prescribed diabetic medications
- Encourage your patient to perform a foot inspection every day. The sooner problems are discovered, the better the outcome.
One of the most common signs of improperly fitted footwear are bulges at the top of the shoe within the toe box area. This can be caused by contracted digits commonly called hammertoes. Diabetic shoes are designed to provide the wearer with additional depth in the front of the shoe (toe area). This can help to prevent these most common hammertoe pressure points: at the top of the toe, on the bottom of the toe and on the plantar bottom surface of the foot.
A comfortable tennis shoe is an affordable alternative to a more expensive extra-depth shoe, which may not be covered by all insurance providers. Quality foam or plastazote bilayer insole, which can be purchased for under $20, should replace the tennis shoe's original. Pressure relief pads or control aids such as this one can be worn to provide additional prevention in patients with flexible hammertoes.