Improving Foot Care

With diabetes, nonhealing foot ulcers are the leading cause of infection and amputation. Prevention is key. Check your feet daily to decrease your risk of foot problems. Foot care is even more important for those who have: Loss of feeling in the feet Changes in the shape of the feet Sores or ulcers that do not heal. The National Institute of Diabetes and Digestive and Kidney Disease suggests following these steps to prevent foot problems: 1. Control your diabetes. Make healthy lifestyle choices to help keep your blood sugar levels controlled. Work with your healthcare team to make a plan that fits your lifestyle best. 2. Check your feet every day. You may not be aware that you have foot problems if you have loss of feeling. Look for blisters, calluses, red spots and swelling. If you have a hard time seeing, use a mirror to check the bottoms of your feet. Ask a family member to help you. 3. Wash your feet every day. Wash your feet in warm (not hot) water every day. Do not soak your feet. Soaking can cause them to dry out and crack. Dry your feet well. Don't forget to dry between your toes. 4. Keep your skin smooth and soft. Apply lotion over the tops and bottom of your feet. Avoid lotion between your toes. This might cause infection. 5. Smooth corns and calluses. After washing, use a pumice stone or emery board to smooth areas of callus build-up. Rub in one direction to avoid tearing the skin. Do not use razor blades or liquid corn removers. These can damage your skin. Make sure your doctor inspects your feet at every visit. He/she will want to check for pulses and sensations. If your doctor does not offer to check your feet at every visit, take off your shoes and socks. Ask your doctor to check your feet. 6. Trim your toenails weekly. After washing your feet, trim your toenails straight across. File the edges with an emery board. If you cannot see very well or your toenails are thick, have a foot doctor (podiatrist) trim them. 7. Wear shoes and socks at all times. Never walk barefoot. It is too easy to step on something and hurt your feet. Choose socks that are polyester or a cotton/polyester blend. Wear comfortable shoes. Make sure they fit well and protect your feet. Check inside your shoes. Make sure they are smooth. Check shoes for objects or rough areas inside them. This could cause skin breakdown. Break in new dress shoes slowly. 8. Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Wear sunscreen on the tops of your feet to prevent sunburn. Do not put heating pads on your feet. Wear socks at night if you get cold. 9. Keep the blood flowing to your feet. Put your feet up when you are sitting. Wiggle your toes often. Do not cross your legs for long periods of time. Smoking reduces the blood flow to your feet. If you smoke, stop. Do not wear tight socks or elastic around your ankles. 10. Be more active. Plan your activity with your doctor. Walking and swimming are good exercises that are easy on your feet. 11. Wear proper footwear. Athletic or walking shoes made of canvas or leather are good for daily wear. They support your feet and allow them to "breathe." Try to avoid high heels or shoes with pointed toes. The less pressure on your feet, the better. Ask your doctor about special shoes or inserts that will help prevent ongoing foot problems. 12. Check with your doctor. Remember you may not feel the pain of an injury. Be sure your doctor checks your feet at every visit. Call your doctor right away if you find a cut, sore, blister or bruise and it does not begin to heal after one day. Accessed 07/05/19. QUIZ QUESTIONS 1. The key to improving foot care is _____________. 2. Which of the following is not a step in preventing foot problems? a) Trim your toenails weekly. b) Manage your diabetes. c) Wear shoes and socks at all times. d) Check your feet weekly. 3. True or False: Plastic or vinyl shoes are good choices because they stretch and breathe. ANSWERS 1. prevention 2. d 3. False
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Foot Care

People with diabetes are at higher risk for foot problems. People who have had diabetes for many years and those whose blood sugar is not controlled, are at highest risk. Diabetes can affect the blood vessels. Weakened blood vessels result in poor blood flow to the lower parts of the legs and feet. This causes slow healing of injuries. Diabetes can also affect the nerves in the feet. This reduces the ability to feel cuts, sores or blisters on the feet. For people with nerve damage, it is possible for a foot to become injured. A foot injury can become badly infected without any pain or discomfort. Daily foot care and attention to foot injuries can prevent serious problems and most amputations. What are the things you should do every day to care for your feet? Important steps to take: Wash your feet every day with mild soap and water. Test the water with a thermometer or your elbow, since your feet may not be able to feel very hot temperatures. Dry feet with a soft towel. Dry in-between the toes. Keep toenails trimmed. Using a toenail clipper, cut straight across and file edges with an emery board or nail file. Nails are softer and easier to trim after bathing. Check the top and bottom of your feet every day. Look for cuts, cracks, blisters, calluses, bruises or red spots. Use a mirror if needed to see the bottom of your feet. If your skin is dry, use oil-based cream to keep your feet soft. Do not apply lotion between your toes. If your feet sweat a lot, use powder. Use padding on corns and bunions. Do not use home treatments such as corn removers or razor blades because they can make the problem worse. Padding like sheepskin or cotton can be placed between toes that overlap. This will help prevent blisters. Things you can do to prevent foot problems: Avoid going barefoot both indoors and outdoors. Socks should be thick and soft. They should be made of cotton, polyester or cotton-polyester blend. Do not wear socks that are mended or have seams. They can cause blisters or other skin injuries. Avoid socks with tight elastic on the top. Do not use garters to hold up your stockings. Avoid panty girdles that are too tight around your legs. Wear shoes that fit so your feet do not get blisters, sores or calluses. Buy shoes made of leather or canvas so your feet can "breathe." Shop for shoes later in the day when your feet are at their largest. Try on both shoes and buy the size for your bigger foot. Make sure you have room for your toes to wiggle. Buy shoes that cover your whole foot. Sandals, open-toe and open-heel shoes do not give you enough protection. Keep the heel low, about one inch or less. Break in new shoes slowly by wearing them for one or two hours a day. Shake out your shoes. Feel the insides. Before putting them on, make sure there are no pebbles or sharp or rough spots. Heating pads, hot water bottles, microwavable warmers and vibrating footbaths should not be used on your feet because they can cause burns. In the winter, wear wool socks for warmth and waterproof shoes or boots for outdoor activities. At the beach, protect your feet by wearing swim shoes. Prevent sunburn by applying sunscreen on the tops of your feet. Do not soak your feet. Soaking can cause dry skin. When problems arise, the following can help: Improve your blood flow by starting an exercise program. Try walking and foot exercises. Check with your doctor before starting an exercise program. If you smoke, give up the habit as tobacco will add to your circulatory problems. Small cuts should be washed and rinsed well. Cover with a sterile gauze pad and hold in place with nonallergic tape. Products like iodine, mercurochrome and merthiolate can burn the skin and should not be used. Because they discolor the skin, you may not be able to see early signs of a problem. If cuts are not getting better after two days, contact your doctor. He/she can suggest a podiatrist (foot care specialist) or order something for the cut. How can your doctor help you? Your doctor should check your feet at every visit. Always take your shoes and socks off. If your doctor does not check your feet, ASK! Your doctor can check for feeling in your feet with a small device called a monofilament. A thorough foot exam should be done once each year.
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Non-Healing Foot Ulcers

Nerve damage to the feet (neuropathy) is a major risk factor for foot ulcers. Non-healing foot ulcers can lead to infection and amputation. A minor foot sore can become very serious for a person with diabetes. Damaged sensory nerves cause loss of feeling in the feet. When there is loss of feeling or pain, foot injuries can occur. What causes foot ulcers? When the motor nerves are damaged, some of the foot muscles may lose their tone. This changes the normal position of the foot. It can cause hammer or clawed toes (flexed toes). The fat pads protect the bony structures of the feet. With damaged motor nerves, the pads get very thin. Walking or standing for long periods of time puts pressure on these weakened areas. This causes injury. When the autonomic (involuntary) nerves are damaged, normal sweating of the feet is decreased. This can cause dry, brittle skin that cracks easily. Cracked skin makes it easy for germs to enter. Foot ulcers are also the result of poor circulation in the legs and feet. This is known as peripheral vascular disease (PVD). Blood carries oxygen, nutrients and antibiotics to injured sites. Healing becomes difficult when blood flow to an injury or ulcer is reduced. How can you prevent foot ulcers? A monofilament test can be done in many areas of your feet. This is done during a yearly foot check up. If you do not feel the monofilament at four or more sites, you may have loss of feeling. If you cannot feel an injury to your foot, this can lead to an ulcer. Look at your feet every day. Check for signs of pressure, blisters or small cuts. This may prevent a small problem from turning into a bigger one. What are the treatments? Treatment involves: Keeping weight off the foot Cleaning the ulcer, treating infection and removing any dead tissue Wearing special shoes, insoles or socks to keep pressure off of the ulcer Using a protective bandage on the ulcer Having surgery to improve the blood flow to the legs and feet Good nutrition, controlled blood sugar levels and quitting smoking are also important parts of the treatment. Many people can continue treatment at home. However, in some cases, you may need treatment at the hospital. Important things to remember: Practice good foot care. Keep your blood sugar levels within your target range. Follow your exercise and meal plan. If you smoke, stop. Check your feet daily. Look for any signs of injury, pressure spots or signs of infection. Report any problems to your doctor. When wounds or ulcers develop, follow the treatment your doctor gives you. How can your doctor help you? Talk to your doctor about any risk factors you may have. Ask if you need to make any changes to improve your blood sugar levels. At each doctor visit, remove your shoes. Ask your doctor to check your feet. If an ulcer develops, follow your doctor's treatment plan. Be certain you understand your role in the care of your foot ulcer.
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How To Take Care of Yourself

FEET Watch out for: Pain or numbness Swelling or redness A change in the size or shape of your foot or ankle Sores that do not heal Ingrown toenails Corns or calluses with a skin color change What can I do to prevent problems? Check your feet every day. Use a mirror to see the bottom of your feet. Tell your doctor if you see new blisters, sores, cracks, cuts or anything unusual. Have a foot exam each time you see the doctor. Wash your feet with soap and warm water everyday. Dry them well. Do not go barefoot. Wear thick, soft socks. Wear shoes that fit right. Break shoes in slowly. When you put your shoes on, make sure they do not have any pebbles or sharp objects in them. Get blood sugar levels under control. If you smoke, stop. EYES Watch for: Blurry or changing vision Floating spots in your eyes Straight lines that look crooked Flashes of light in your eyes Loss of vision What can I do to prevent problems? Call your doctor right away if you have any change in vision. Get an eye exam at least once a year. Get blood sugar levels under control. Get blood pressure under control. KIDNEYS Watch for: High blood pressure Protein in urine (ask the doctor to do this) What can I do to prevent problems? Lower blood fat levels. Lower blood pressure. Have a yearly test to see if you have kidney problems. If you have a bladder infection, get it treated right away. Get your blood sugar levels under control. If you smoke, stop. NERVES Watch for: Numbness or pain in hands and feet Feeling light headed when you stand up Problems with sex Sweating more Sores that do not heal quickly Feeling sick to your stomach Constipation and/or diarrhea Problems urinating What can I do to prevent problems? Tell your doctor about problems and get tested for nerve damage. Take any medicine your doctor orders. Get blood sugar levels under control. Check feet each day for any changes. If you smoke, stop. BLOOD VESSELS Watch for: Chest pain or pressure Shortness of breath Dizziness Fast heart beats or skipped beats Sudden loss of sight Slurred speech Weakness in arm or leg Pain in legs while walking What can I do to prevent problems? Tell your doctor of any of these problems. Eat a healthy diet. Exercise. If you smoke, stop. Lower your blood pressure. Lower your blood fats. Get blood sugar levels under control. TEETH Watch for: Pain or bleeding Sore, swollen or red gums What can I do to prevent problems? Brush and floss your teeth every day. See a dentist at least twice a year. SKIN Watch for: Red or itchy rashes Red, swollen or painful skin Very dry or cracked skin What can I do to prevent problems? See your doctor about any skin problems. Keep skin dry. Use mild creams on dry skin. Take care of cuts or burns right away. Drink lots of water. Get blood sugar levels under control.
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Take Care of Your Feet!

April is National Foot Health Awareness Month, a perfect time to focus on the importance of keeping our feet healthy. This should be a priority for everyone, and especially for people with diabetes.
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Nerves send messages to and from the brain. Nerves are named by what they do: Sensory nerves send messages to your brain about what you feel (touching a hot stove). Motor nerves send messages from the brain to a body part causing it to react (removing your hand from the hot stove). Autonomic nerves control the things your body does naturally (digest food, heart rate, blood pressure, breathing). What is neuropathy? Damage to nerve cells is called neuropathy. It is the most common problem with diabetes. It is unclear why this happens. When blood sugar levels remain high, nerve endings are damaged. Damaged nerves cannot send messages through the body as they should. Nerve damage can happen slowly. You may not even notice the earliest signs of nerve damage. Diabetes can affect all types of nerves. What happens to the feet, legs and hands? Neuropathy can affect the feet, legs and hands. Symptoms depend on the type of nerves involved and the amount of damage. You could have numbness or tingling, pain and burning, decreased feeling and muscle weakness. It may come and go, and it may subside with lower blood sugar levels. If you are unable to feel heat or pain, you could easily injure yourself without knowing it. Decreased blood flow to the feet and legs presents another problem. Decreased blood flow could cause slow-healing wounds and lead to infection. Treatments for pain include medicines, walking (to decrease leg pain), relaxation exercises, hypnosis or biofeedback training, transcutaneous nerve stimulation (TENS) units and pain clinics. What is autonomic neuropathy? One type of autonomic neuropathy occurs when there is damage to the nerves that control digestion. Damage to the stomach nerves is called gastroparesis which may cause delayed stomach emptying. If the stomach remains full, nausea, bloating and vomiting occurs. Damage to the intestinal nerves leads to slower movement of food through the intestines. This results in a build-up of bacteria. It could cause constipation and/or diarrhea. Other signs of autonomic nerve damage include: Loss of ability to sweat normally. Feeling light-headed when standing up. This happens because of a drop in blood pressure. You may also find it hard to tell when your blood sugar is low. Leaking of urine or difficulty urinating. Damage to the nerves that control sexual function. This can happen in both men and women. There are treatments for this. There are things you can do to prevent or delay nerve damage: Keep your blood sugar levels normal. Any improvement in your blood sugar control helps to prevent problems. Reduce risk factors - smoking, obesity and high blood pressure. Take care of your feet. Check your feet daily. Have your doctor check them at each visit. Exercise to improve blood flow to feet and hands. Check with your doctor before starting an exercise program. See your doctor at least 2-4 times a year. Report any symptoms you are having. Early treatment is best. Read articles and go to support groups to learn as much as you can. How can your doctor help you? There are many new treatments for neuropathy. These include medicines, changes in diet and tight control of your blood sugar. Ask your doctor what your blood sugar targets should be. Discuss any changes needed to improve your control. This will help decrease problems and maintain good health. Accessed 6/17/19
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Foot Ulcers

Foot ulcers can often occur along with Peripheral Neuropathy, a loss of feeling in your limbs caused by nerve damage. The symptoms include numbness, burning pain and extreme sensitivity. Here are some simple steps to help prevent diabetic ulcers: Inspect your feet daily. Look at the soles, toenails and between your toes. Call your doctor if you notice: Hot spots, red streaks, swelling, cracks, sores or injuries Burning, tingling or a "pins and needles" feeling Toenail problems causing redness, pain, or changes in thickness or color Clean your feet daily. Use only lukewarm water and mild soap; always wash between your toes. Dry your feet well with a gentle patting motion. Apply moisturizing lotion, especially to the heel area, but not between the toes. Wear proper footwear. Never walk barefoot. Do not wear tight or uncomfortable shoes. Avoid shoes with open toes and heels. Remember to have regular check-ups. Foot problems develop quickly, so it's important to see a healthcare provider regularly to track blood flow and the feeling in your feet and recommend foot exercises to promote strength and flexibility. Read more about proper foot care. Updated references 06/28/19
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Keeping Fit with Physical Activity and Exercise

Physical activity is good for almost everyone. It is very good for those with diabetes. Exercise can improve your health in many ways. What are the benefits of exercise? For both type 1 and type 2 diabetes, exercise can help: You lose and keep weight off Make your muscles stronger Reduce blood fats Reduce blood pressure Decrease stress Decrease your risk of osteoporosis with weight bearing exercises Make your heart and lungs work better People with type 2 diabetes may see some added benefits from exercise. These include: Better use of your insulin Improved blood sugar and hemoglobin A1c levels Decreased risk of heart disease What special safety measures should you take? Since diabetes may be linked with other health problems, use extra care when beginning an exercise program. Always check with your doctor before starting any exercise program. Your doctor will check your health status if any of the following apply to you: Heart disease More than 30 years of age Have had type 2 diabetes for over 10 years Have had type 1 diabetes for over 15 years Have other risk factors for heart disease This will help your doctor decide on a safe level of exercise for you. What special rules do you need to follow? If you have type 1 diabetes or use insulin or certain diabetes pills, you should check your blood sugar before you start the exercise session. If you have type 1 diabetes, check your blood sugar before you begin. If your blood sugar is below 100 mg/dL, eat a snack. If your blood sugar is over 240 mg/dL and there are ketones in your urine, do not exercise. It is not necessary to avoid exercise based on high blood sugar if you feel well and you don't have ketones in your urine or blood. If you have type 2 diabetes and use diabetes pills, check your blood sugar before you start to exercise. Eat a snack if blood sugar is below 100 mg/dL. Take care of your feet during exercise. Always wear shoes that fit. Gel or air midsoles can give extra comfort. Wear polyester or cotton/polyester blended socks to prevent blisters. Keep your feet dry. If you have severe eye disease avoid weight lifting, jogging, high impact aerobics or racquet sports. Important things to remember for type 1 diabetes: Get medical consent from your doctor. Speak with your doctor about the right exercise for you. An exercise trainer can help you with safe exercise tips. Plan a daily exercise session. Choose the correct form of exercise and the best time for it. Pick an activity you enjoy. Check blood sugar before exercise. If you exercise for more than 60 minutes, also check your blood sugar during and after the exercise. Carry a quick-acting carbohydrate (carb) at all times to treat low blood sugars. Drink plenty of fluids. Try non-caloric, caffeine-free fluid before, during and after exercise. Do not wait until you are thirsty to drink. Carry I.D. (diabetes and personal information). Work with your doctor to develop an exercise plan and set some goals. Important things to remember for type 2 diabetes: Get medical consent from your doctor. Speak with your doctor about the right exercise for you. Choose the correct exercise and the best time for it. Pick an activity you enjoy. How can your doctor help you? Your doctor should check your health status. He/she can suggest safe exercises or refer you to an exercise trainer. At each visit, your doctor should check your blood pressure, feet, weight and blood sugar levels. Accessed 07/05/19.
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Peripheral Vascular Disease

When the large blood vessels are damaged due to high blood fat levels and high blood pressure, they become narrow, stiff„ and less flexible. As fats and other materials (plaque) build up within the walls of the blood vessels, blood flows at a much slower rate and disease begins. When the hands and feet have reduced circulation, it is called peripheral vascular disease (PVD). People with diabetes are at an increased risk for PVD. Early detection of PVD is critical in reducing leg and foot problems. What are the risk factors leading to PVD? High blood sugar - Can do damage to the blood vessels and nerve endings Diabetes - Leads to an increase in blood fats and build up in the arteries High blood fats - Causes blood vessel walls to thicken and become narrow High blood pressure - Damages blood vessels, kidneys and makes the heart work harder Smoking - Narrows the blood vessels Inactivity - Promotes obesity and may cause fats to build up in the blood vessels Obesity - Makes it harder for the body to use insulin and places stress on legs and feet Important things to remember: People with type 1 or type 2 diabetes are at risk for PVD, heart disease and stroke. Prevention of these problems is more likely to occur when you take good care of yourself. You can do this by decreasing risk factors. You also need to keep your diabetes under control. Steps to stay healthy: If you smoke, stop. Treat high blood fat levels by eating foods low in fat, losing weight and exercising. If blood fats remain high, there are medicines available. Keep your blood sugar levels under the goals established by your doctor. Lose weight. By losing 10 to 20 pounds, blood sugar, blood fat levels and blood pressure will often improve. Control high blood pressure by losing weight, exercising and taking blood pressure medicine. Meet with a dietitian to modify your meal plan. Eating the right foods can help to lower blood sugar, decrease blood fats and blood pressure. Decreasing portion sizes can also help with weight loss. Get regular exercise. Start slow and work up to 30 minutes daily. Check with your doctor before starting an exercise program. Check your feet daily for sores, redness, calluses, cracks, blisters and red spots. Trim your toenails straight across and file the edges with an emery nail file. Have an annual visit with a foot doctor who is familiar with foot problems for people with diabetes. Check with your doctor about taking a daily aspirin. This may help to decrease problems with your blood vessels. How can your doctor help you? Your doctor should do the following: Check your feet and pulses at each visit. Evaluate your blood sugar results at each visit. This will help you to reach your blood sugar goals. Have A1c levels checked at least twice a year and inform you of the results. Prescribe medicines and/or treatment to relieve the symptoms of PVD. Depending on your risk factors, your doctor may recommend a stress test before prescribing an exercise program. Check for protein in the urine yearly. Perform a blood fat check yearly. This will need to be done more often if your levels are high. Refer you to a foot doctor yearly for a foot exam. Refer you to a diabetes educator and dietitian
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Reducing Risks from Complications

Poorly controlled diabetes increases the risk of developing health problems. Studies such as the Diabetes Control and Complications Trials and the United Kingdom Prospective Diabetes Study have shown that the risk of developing problems such as eye disease, kidney disease and nerve disease can be reduced. Getting started It is most important for you to keep your blood sugar as close to normal as possible. Blood pressure and blood fat control is also needed. There are several steps you can take to prevent problems and stay healthy. 1. Control your blood sugar. Talk with your doctor about the blood sugar range that is best for you. Check your blood sugar regularly. 2. See your doctor regularly. See your doctor for check-ups 2-4 times per year. Know what exams and blood values the American Diabetes Association recommends for people with diabetes. 3. Control high blood pressure. Aim for blood pressure of 130/80 mmHg or less. Eat healthy to lose weight, decrease salt and alcohol use. Get regular exercise such as walking, swimming or biking. (See your doctor before starting an exercise program.) Ask your doctor about the benefit of taking aspirin and using a medicine called an ACE Inhibitor, an angiotensin receptor blocker (ARB) or a diuretic. 4. Control blood fats. Adults with diabetes should aim for triglycerides of less than 150 mg/dL, LDL of less than 100 mg/dL and HDL of more than 40 mg/dL for men and more than 50 mg/dL for women. Decrease your fat intake. Substitute small amounts of monounsaturated fats such as olive oil, canola oil and nuts. Aim for a modest weight loss. Always take any medicines prescribed by your doctor. Get regular exercise. 5. Quit smoking. Ask your doctor for suggestions or referrals to programs. If needed, get pills, patches, gum, or call your state's Quit Line to stop smoking. 6. Lose weight if you are overweight. Talk with your doctor or dietitian about setting practical goals for weight loss. Get a meal plan from a dietitian. Watch portion sizes and fat intake. Get regular exercise. Try to find out why you overeat. 7. Practice good foot care. Check your feet daily. At each doctor visit, have your doctor check your feet. Wear appropriate shoes and socks. Don't go barefoot. Keep feet clean and dry. Don't self treat corns, calluses or ingrown toe nails. Trim toe nails properly. 8. Avoid infections. Wash hands often. Take care of injuries promptly. Ask your doctor about flu and pneumonia vaccines. 9. Practice good dental care. Have regular dental exams every 6 months. Brush after every meal and floss daily. How can your doctor help you? Although there is no guarantee you will avoid problems from diabetes, you can decrease your risk by following the above steps. Work with your doctor to decrease problems.
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