People with diabetes can develop different types of foot problems.Even what appears to be a minor problem can get worse and lead to serious complications. Foot ulcerations are a common cause for hospital admissions among persons with diabetes, resulting in prolonged hospital stay, loss of the limb (amputation) and even death. Many of these serious foot problems can however be prevented through proper foot care, early identification of foot problems and prompt treatment by a skilled health care provider.

What foot problems may occur in persons with diabetes?
Diabetes can lead to many different types of foot problems including fungal infections, calluses, corns, nerve damage, blood vessel damage, foot deformities, dry skin of the foot and foot ulcers/wounds.

How does diabetes lead to foot problems?
Nerve damage (neuropathy): Nerves can be damaged by high blood glucose levels. This usually affects the nerves of the foot. This can lead to reduction or a total loss of feeling in the feet. As a result, the feet are greatly at risk of injury and persons with diabetes may not even be aware of any foot problems or injury until it is very serious. Remember that even if foot problems are painless, they can still be serious. Sometimes nerve damage may also lead to abnormal sensation in the feet like numbness, burning, aching pain or pins and needles and this can be very uncomfortable.

Blood vessel damage (ischaemia): Elevated blood glucose levels can lead to narrowing or complete blockage of the blood vessels that carry blood to the legs and feet and reduce the blood supply to the feet. This is known as ischaemia. Ischaemia of the lower limbs increases the risk of developing foot wounds which often fail to heal. A reduction in the ability of the body to fight infection and gangrene (death of tissue) is more likely to occur. Other factors which can also damage blood vessels are high blood pressure, high blood cholesterol levels and cigarette smoking.

Persons with diabetes are at very great risk for developing foot wounds/ulcers if they have any of the following: nerve damage, blood vessel damage, a previous foot ulcer or amputation, poorly controlled blood glucose levels, long diabetes duration, wearing inappropriately fitting shoes particularly in the presence of nerve damage, foot deformities, inadequate foot care knowledge, poor vision and kidney complications

For persons with diabetes, foot complications are an ever-present risk. However, it is possible to prevent many foot problems. It is important for persons with diabetes to learn as much as possible about preventive foot care and to be active participants in their care. Everyday foot care plays a big role in preventing serious foot complication.

What can I do to take care of my feet and prevent foot problems?

Aim for good blood glucose control
Test and record your blood glucose levels regularly and aim to keep your blood glucose as close as possible to normal.

Examine/check your feet daily
Carefully check your feet and toes every day, especially the sole of your feet and between the toes. If you can’t see them properly, use a mirror to examine them or ask a relative/caregiver to help if it is too difficult for you to examine your feet personally).

Look for: cuts, blisters with blood or fluid in them, cracks or breaks in your skin, sores, bruises, changes in normal colour, unusual swellings, hot/cold spots, areas of discharge or any other thing that is not normally there.

If you find something wrong, report it to your doctor without delay.

Keep your feet clean and supple
Wash your feet everyday with soap and water. Take time to also wash between your toes.

· Dry your feet carefully, especially between the toes with a clean dry towel.

· Use lubricating oils, lotions or cream on your feet to keep your skin soft, but do not apply between the toes. (Dry skin can lead to cracks and potentially the development of ulcers).
· When washing your feet, be careful to check that the water is not hot enough to burn them. You can use your elbow to test the water temperature. (If you have been told that you have nerve damage (neuropathy), you may not be able to determine this accurately, and should seek assistance from a relative/your doctor).
· Avoid soaking the feet in hot or cold water, because it may damage the skin.
Take good care of your nails
· Cut your nails carefully using nail cutters and file any sharp edges. They will be easier to cut after bathing. If you are unable to see or reach your feet, let a relative do it for you.
· Cut the nails straight across
· Do not use blades or knives to cut your nails.
· Do not cut into the sides of your nails and don’t cut them too short
· If available, have regular chiropody (podiatry treatments for your nails and feet).

(To be continued next week)