foot care for people with diabetes

• diabetic neuropathy, with damage to the nerves supplying the feet
• peripheral vascular disease, with decreased blood flow to the feet
• a history of 10 years or more of diabetes
• male gender
• blood sugar levels that are not under control
• diabetic retinopathy, or damage to the retina of the eye caused by diabetes
• cardiovascular problems caused by diabetes
• kidney problems caused by diabetes, including chronic renal failure
• a history of skin ulcers or amputation of a limb
• conditions caused by increased pressure on the feet, such as corns and calluses
• foot bones that are deformed or have limited movement, such as bunions
• thick toenails

• Inspect the feet daily for blisters, cuts, scratches, scalings, discolourations, and unusual swelling of the feet or toes. Pay particular attention to the area between the toes. If vision is poor or if reaching the feet is difficult, a member of the family should assist.
• Clean and soak both feet in tepid water for 15 minutes before trimming toenails.
• Trim toenails so they are even with the end of the toe, and file sharp edges smooth. Corners should never be cut or dug out.
• See a healthcare professional if the nails grow into the flesh or if they are difficult to cut.
• Wash feet daily with warm water and mild soap. Dry feet completely, especially between the toes.
• Gently massage a bland lubricating cream into the feet after drying them, especially around the toenails and heels. Do not put creams or ointments between the toes. Dust a non-medicated powder between the toes.
• Never use strong antiseptics, especially tincture of iodine, disinfectants, or bleaching agents, on the feet.
• If a cut is present, wash the area with an antibacterial soap. After drying the area, apply an antibiotic ointment and cover it with a sterile dressing.
• Avoid extremes of temperature. Protect feet from sunburn and frostbite.
• Wear clean cotton or wool socks to bed if feet are cold. Hot water bottles or heating pads should not be used.
• Change socks and stockings daily. Circular garters or stockings with elastic at the top should not be worn. They may cause a tourniquet effect that will lead to swelling of the lower leg.
• Wear properly fitted shoes with soft uppers and flexible soles, preferably with adjustable straps or laces. Avoid walking barefoot or wearing open-toed or open-heeled shoes.
• Break new shoes in gradually, by wearing them for a short time each day. Check inside shoes daily for foreign objects, nail points, and torn linings. If the linings are torn or crumpled, the shoe should be discarded.
• Corns or calluses should be treated by a healthcare professional. Never cut them with a razor blade or use chemicals to remove them.

• On each visit, the doctor should specifically ask about any foot problems or leg or foot pain when the person is sitting, standing, or walking.
• The doctor should check the pulse in the groin, behind the knees, behind the anklebones, and on top of the feet. He or she should listen with a stethoscope to the blood vessels in the legs.
• The doctor should test the person's ability to feel sharp and dull sensations, vibrations, and light touches to the feet and toes.
• The doctor should look for corns, calluses, deformities, cuts, bruises, bunions, diabetic foot ulcers, and infections.