Diabetes and Manifestations in the Foot and Ankle

By: Zacharia Facaros

According to the American Diabetes Association, over 25 million people in the United States, roughly 8% of the population, have Diabetes, however, there are many more who are undiagnosed.  Diabetes can have a huge impact on the health of your feet and ankles. The Diabetes Association of America notes that 60-70% of people with diabetes develop peripheral nerve damage, and up to 29% of these patients may develop a specific type of fracture/dislocation in the foot or ankle, referred to as Charcot Neuroarthropathy.

Nerve damage, or neuropathy, is a well-known complication of diabetes, as well as other conditions, which leads to a loss of sensation in the feet. Patients with nerve damage can no longer feel when something has irritated or even punctured the skin. An irritation or puncture to the feet commonly creates a wound as small as a blister, but the wound can progress to a serious infection in a matter of days.

If you have diabetes, you need to be aware of how foot problems can arise and how to treat them.  Outlined below are important steps to take for close monitoring and management of your lower legs and feet:

CONTROL YOUR DIABETES

• ·         Work with your doctors to keep your blood sugar within a good range and to keep all other medical illnesses closely monitored.  The more stable your blood sugar remains, the less likely you are to succumb to neuropathy and/or infection.

INSPECT YOUR FEET DAILY

• Look at your bare feet every day to check for scratches, cuts, blisters, open wounds, red or warm spots and swelling.  If any are present, the risk of getting an infection is increased, and you should contact a Weil Foot and Ankle physician for an evaluation.
• Check the bottoms of your feet daily with a mirror. Checking the bottoms of your feet will reveal any potential at-risk areas that one may not appreciate if their sensation is not intact. If you have trouble bending your leg or seeing, ask a family member for help. 
• Contact a Weil Foot and Ankle physician immediately for evaluation if one foot is swollen or warmer than the other. This swelling or warmth may represent a potential urgent medical condition.

WASH YOUR FEET WELL DAILY, PARTICULARLY IN BETWEEN YOUR TOES

• Wash your feet daily in the shower or in lukewarm, not hot, water with mild bath soap. This provides a stable, clean, non-toxic maintenance.  Test the water temperature with your hand first to avoid a potential skin burn.
•  Do not soak your feet. Soaking your feet can weaken the skin, and this weakened skin will not maintain as strong a barrier against bacteria and/or fungus infections.   
• Dry your feet well, particularly in between the toes, to avoid a damp/moist environment that makes skin prone to infections.

KEEP YOUR SKIN SOFT AND SMOOTH

• Rub a thin layer of skin lotion over the tops and bottoms of your feet to prevent dry, cracked skin. Ask your Weil Foot and Ankle Physician for recommended products. Avoid putting lotion on the area between your toes. By avoiding this area, you will avoid making the skin susceptible to bacterial and/or fungal infections.
• Do not use strong antiseptic solutions, drugstore over the counter medications or heating pads.  Do not put your feet on or near radiators, nor to close to a fireplace or heating lamp. All of these actions may cause skin compromise and rapid drying of the skin.

NEVER TRIM OR SMOOTH CORNS AND CALLUSES YOURSELF OR CUT YOUR OWN TOENAILS IF IT IS DIFFICULT TO DO SO

• Following evaluation by your Weil Foot and Ankle physician, and if your feet are at low risk for problems, you may be allowed to use a pumice stone or emery board to smooth corns and calluses, but it is IMPERATIVE that you do not rub the skin too vigorously. Vigorous scrubbing may create an open wound.
• See a Weil Foot and Ankle physician right away if you have an ingrown toenail, especially if it has turned red, hot and swollen.  This condition requires expedited treatment for proper healing.
• Cut toenails straight across to limit the possibility of the corners becoming ingrown. Due to the high risk of causing a skin cut that may also lead to a potential infection, never dig into the corners of your nails. 

WEAR PROTECTIVE FOOTWEAR AT ALL TIMES

• Never go barefoot, or limit times when you do.  This will ensure proper protection of your skin or at-risk pressure points.
• Wear comfortable shoes that fit well and protect your feet. Walking or running shoes may be helpful for some diabetics, whereas others require specific therapeutic shoe gear. The Weil Foot and Ankle Institute has a great selection of shoes and can create custom shoes for diabetic patients. Be sure to ask your Weil Foot and Ankle physician about diabetic shoe options.
•  Purchase new shoes at the end of the day when your feet have natural swelling and are typically larger. Doing this will enhance a proper fit.  Check how your shoe fits in width, length, back, bottom of heel, and sole. Have your feet measured every time you buy new shoes because your foot will change shape over the years.
•  Wear new shoes for only 2 hours or less at a time, particularly if you have neuropathy. New shoes will cause increased pressure points until they are adequately broken in.
• Do not wear the same shoes everyday. Alternating the shoes that you wear will allow them to dry completely and to limit the quantity of potential infectious organisms. It will also allow your feet to maintain adaptation and functioning capacity.
• Feel the inside your shoes before putting them on each time to make sure the lining is smooth and there are no objects inside, such as small pebbles or other foreign objects.
• Do not lace your shoes too tightly or loosely. Lacing your shoes comfortably will help to avoid increased friction or pressure points that may lead to blistering or even ulceration. 
• Choose socks and stockings carefully. Wear clean, dry socks every day and avoid socks with holes or wrinkles. Avoid stockings with elastic tops. Seamless socks are available for those with neuropathy, and therapeutic compression stockings are recommended if your feet and legs swell often.  In socks and stockings, certain materials are recommended over others, so check with a Weil Foot & Ankle physician for further recommendations and advice.
• Wear socks at night if your feet get cold to avoid possible irreversible abnormal sensations.
• Wear protective footwear at the beach, swimming pool or on hot pavement to avoid potential cuts or abrasions.

KEEP ACTIVE TO PROMOTE MUSCLE STRENGTH AND GOOD BLOOD FLOW TO YOUR FEET

• Wiggle your toes and move your ankles up and down for 5 minutes, 2-3 times per day. This will aid in maintaining strength and flexibility.
• Keep awareness on long walks and remember to periodically remove your shoes and socks, checking for signs of redness or bruising.
•  If you smoke tobacco products, you MUST stop. Smoking damages blood vessels by decreasing the ability to deliver oxygen to your skin. When combined with diabetes, smoking significantly increases your risk of amputation.

If you have any questions regarding good foot health practices for your specific needs, contact the Weil Foot & Ankle Institute right away to schedule an evaluation. Our doctors can make sure that you take the right steps to monitor and treat your feet, and help you to maintain your foot and ankle health for years to come.