DIABETIC FOOT CARE
Whether you have just been diagnosed with diabetes or have been living with diabetes for a number of years, it is extremely important and critical to establish the proper care and maintenance of your feet and footwear.

Diabetic Foot Patient

Diabetic foot care and regular check ups are more important to maintain your healthy feet and/or check for potential problems. Our foot care professionals are trained to do simple tests to check for sensation and feelings in your foot. Any changes in appearance or any loss of feelings in your feet can lead to potential greater problems in the future. It is critical to have your feel evaluated on a regular bases to prevent more serious issues.

What is Diabetes? What causes Diabetes?

Diabetes often referred to as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination). They will become increasingly thirsty (polydipsia) and hungry (polyphagia)

There are three types of diabetes

The body does not produce insulin. Some people may refer to this type as insulin-dependent diabetes. People usually develop type 1 diabetes before their 40th year. Often in early adult hood or teenage years. Type 1 Diabetes patients will need to take insulin injections for the rest of their life.

Type 2 Diabetes, the body does not produce enough insulin for proper function, or the cells in the body do not react to insulin (Insulin Resistance).

Diabetes and Footcare

Are you one of the 2 million Canadians currently living with diabetes? If so, did you know that among the complications related to this disease requiring hospitalization is amputation of a lower limb or foot? It begins with foot problems that could have been prevented through daily footcare, proper shoe selection, and eating healthy.

It is estimated that 80,000 - 200,000 Canadians with diabetes will be affected by foot problems such as foot ulcers in their lifetime. And, of those 14-24% will be at risk of losing a lower limb or foot through amputation.

Diabetes is one of the most prevalent diseases of our time and is affecting more and more canadians each year. It is a disease where the body is unable to produce insulin (type 1), or the body does not produce enough or cannot effectively utilize the insulin that is produced (type 2). A third type of diabetes occurs during pregnancy and is called gestational diabetes.

Some people living with diabetes might experience reduced circulation or sensation in their feet and may not be able to feel if something in the shoe (or even the shoe itself) is irritating their foot. If the foot is irritated by the shoe, it can result in a wound or ulcer which can be very dangerous and could ultimately result in hospitalization or worse - amputation of a lower limb or foot.

Diabetic Foot Ulcer

What is a Foot Ulcer?

A foot ulcer is a defect or break in the skin. The skin functions as a wall that surrounds and protects the foot from bacterial thus, a defect and/or break in the skin leaves the foot vulnerable to invasion from harmful bacteria that can cause infection. The longer the ulcer remains open and untreated, the greater risk of infection.

Conditions such as peripheral neuropathy and vascular disease are some of the causes of infection and ulceration in those living with diabetes.

What is Peripheral Neruopathy?

Peripheral neuropathy is the gradual loss of nerve function in the feet and legs. Constant elevated blood glucose can damage nerve endings, causing numbness or a tingling feeling in the feet. The most common and significant change that is related to this condition is loss of feeling or touch sensation. However neruopathy is heightened by pain and it usually comes on slowly. The likelihood of developing neuropathy increases with age.

What is Vascular Disease?

                             Blood vessel damage in the feet may cause tissue damage.

                             Blood vessel damage in the feet may cause tissue damage.

Vascular Disease causes decreased circulation in the feet and lower limbs. Complications arise when small wounds do not heal as quickly for those affected; a small blister can develop into a serious ulcer without adequate circulation to allow rapid healing.

With this in mind, people with diabetes should rely not only on how their feet feel but also how they look. It is imperative to perform daily, visual inspections of their feet to ensure there are no breaks or abnormalities in the skin. Individuals unable to see their feet properly should seek help from a spouse, family member or a caregiver to inspect their feet.

Symptoms of abnormalities range from slight skin discoloration to severe skin breakdown (ulcers).

Some of these symptoms include "skin blanching" whereby skin will appear white when pressure is applied to a certain are of the skin and then removed. If significant skin blanching is present it can indicate that circulation is compromised to that area. Precautions must be taken to increase circulation and decrease pressure points. You might feel sharp pain under the ball of the foot and toes, like pins and needles, sticking in your feet.

Other abnormalities include 'red' areas that can appear on the feet even after shoes are removed. Typically the join of the big toes, and the tops of of the toes are areas where redness occurs. These skin irritations are of great concern to those with diabetes as they indicate high pressure from the shoe that ultimately could result in foot ulcer.

People with diabetes should also monitor the hair grown their lower limbs. Hair needs ovygen to grown and those with dry, flaky skin with very little hair on their calves and feet are typically experiencing limited circulation.

The Canadian Diabetes Association recommends that all people living with diabetes should be instructed on proper foot care and have examinations at least once a year to avoid the risk of developing foot problems.

Qualified healthcare professionals, including Canadian Certified Pedorthists, can assess structural abnormalities, signs of neuropathy and vascular disease, and evidence of any ulcerations and can perform foot examinations on those living with diabetes.

Along with regular foot examinations, a daily footcare routine is equally vital to help maintain the health of the feet and protect against foot problems that could lead to amputation.

Recommended Daily Footcare Tips for People with Diabetes Include:

  • Do a daily visual foot inspection, be alert of redness, swelling, broken skin, sores or bleeding. See a doctor immediately if any of these problems arise.
  • Wear proper fitting shoes around the house and outdoors to protect the feet from injury.
  • Wash feet with soap and warm water everyday, but do not soak them.
  • Avoid heat pads or hot water bottles, even though feet might get cold easily. With a lack of sensation it is easy to burn the feet if the water is too hot.
  • Avoid socks with heavy seams, as they can cause irritation of the skin and lead to breakdown or ulceration.
  • Do not wear tight, constrictive socks or clothing that can limit blood flow to the extremities.

Shoe selection is also vital to those living with the disease. Canadian Certified Perdorthists are trained to troubleshoot shoe fit issues for people with diabetes and help to reduce the risk of amputation by assessing structural features of the foot. Additionally, through the orthoses and shoe modifications, pedorthists are able to help alleviate the effects of lower limb and foot abnormalities to help prevent foot problems before they begin.

Shoe Fitting Tips for People with Diabetes:

  • Have shoes fitted by a trained specialist such as Gate Maxx Foot Care Clinics
  • Key features for footwear include soft uppers (everything located above the insole of the shoe including laces, tongue, etc..) with minimal seams, firm but cushioned soles, removable insoles, a strong heel counter (the hard piece of material located at the back of the shoe) and a rockered sole (bottom of the shoe designed to reduce any pressure under the heel and/or at the front of the foot.
  • Avoid restrictive footwear, such as high heels with pointed toes, or shoes that are too narrow.
  • When buying a new pair of shoes it is good practice to remove the insole from the shoe and stand on it to see if the foot overlaps the insole, indicating that the shoe is too narrow or short for the foot.
  • There should bea full finger width between the end of the longest toe and the end of the shoe.
  • Avoid seams over the toe area of the shoes.
  • If there is a problem with lower limb swelling, graduated compression stockings can help control swelling and maintain the fit of shoes over the course of the day.

Through regular foot examinations and by following the tips outlined in these daily footcare and shoe selection tips, those living with diabetes can better maintain the health of their feet.

As healthcare professionals educated in the assessment, fabrication, modification and fit of footwear and foot orthoses, Gait Maxx Foot Care Clinics work with physicians to help protect people of all ages living with diabetes acheive and maintain healthy lower limbs and feet.