Diabetics are more susceptible to serious injuries to their feet

Have you ever really thought about your feet?

We run, jump, squat, climb and do so many other activities that put pressure on our feet, but we rarely stop to look at them, rub them or think about them. We often pick our shoes based on their looks instead of for comfort or for the health of our feet.

I talked a little bit about feet in a column about shoes for Bloomsday, but I would like to tell you more about the feet of people who have to be especially careful not to take them for granted: those with diabetes.

Uncontrolled blood sugar levels over time injure nerves in the body, but the nerves in the legs and feet are damaged most frequently. When these nerves are damaged, a person can have tingling, shooting pain and aching and can lose the ability to sense pressure or pain in the damaged area.

If you cannot feel pain or pressure in your feet, then you might not be aware of a pebble in your shoe or be able to feel when the shoe is rubbing a blister on your foot. Walking around all day with this going on could cause a serious wound or ulcer (a wound that does not heal or keeps returning).

The most common place to develop a diabetic foot ulcer is the bottom of the feet, but they can also occur on the top or bottom of toes.

Because diabetes also causes poor circulation in the legs and feet, any wounds are more difficult to heal and recover from and will be at greater risk of infection than they would be in a person without diabetes.

My friend’s uncle fell and broke his ankle and required surgery to repair it. He has diabetes and is a smoker, which also impairs blood circulation.

It took well over a year for his ankle to heal up after surgery, and it did not heal completely until he stopped smoking and got his blood sugar under better control.

People with diabetes are far more likely to require having a foot or leg amputated than the general population because wounds of the feet and legs are so much more difficult to get healed completely. I think it was the fear of amputation that helped my friend’s uncle quit smoking.

Another way damaged nerves can affect you is the loss of control of muscles in the legs and feet and these extremities can lose their shape or become deformed.

Foot deformities can make walking difficult and painful. Specialized shoes may be needed to accommodate changes in foot shape so as to prevent wounds and make walking more comfortable.

Damaged nerves may also lose the ability to control the oil and moisture in the skin of your feet. The skin may peel and crack and be uncomfortable.

A thin coating of plain petroleum jelly or unscented hand cream after showering and drying your feet thoroughly can help with dry skin.

If you have diabetes, there are things you can do to prevent foot wounds and ulcers:

• Look at your feet every day to make sure you do not have any wounds or other skin problems that you cannot feel.

• Have your health care professional examine your feet during office visits.

• Make sure there are no loose objects in or rough edges on your shoes before you put them on.

• Make foot care part of your daily routine, like brushing your teeth.

• Do not use over-the-counter medicines to remove calluses.

• Do not cut off corns or calluses.

• Keep good control of your blood sugar and blood pressure to reduce damage to your nerves and blood vessels in your feet.

• If you do smoke, get some help to quit as soon as you can.

• See your health care professional for any foot problems as soon as you notice them to avoid developing an infection.

If you learn good foot-care habits now, then if you do develop a foot problem or injure your foot, it will be easier to care for it and get it to heal in the future and lower your risk of amputation.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Send your questions and comments to drhideg@ghc.org.

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