Protecting your Feet when you have Diabetes

The American Diabetes Association recommends that all patients with diabetes receive an annual comprehensive foot exam. People with diabetes are at increased risk of developing peripheral neuropathy - loss of sensation in the feet and hands. Foot care can be used as a preventative service and surveillance of abnormalities. A comprehensive foot exam should be done by your primary doctor, certified diabetes educator or podiatrist. If you have recently been diagnosed with Type 2 diabetes or have had diabetes for some time and have not received a comprehensive foot exam, it's important that you schedule an exam - ask your physician at your next appointment. What is a Comprehensive Foot Exam? The health care provider should request that you take your socks and shoes off (both feet). He or she will visually inspect the bottoms of your feet and between your toes to check for ulcers, wounds, fungal infections, and bony abnormalities. Next, he or she will check your feet for pulses, which can be a predictor for blood flow. Lastly, they will conduct a sensation assessment using a 128-Hz tuning fork, 10 g monofilament tool or another device. You will be asked to close your eyes and answer when you feel sensation - either a light pulsating vibration from the tuning fork or a gentle touch of the plastic monofilament tool. If the health care provider detects any visual abnormalities such as hammer toes, corns, bunions, hard-thick nails, wounds, cracked skin, fungal infections, you will likely be referred to a podiatrist. If you have diminished sensation or loss of sensation, you may also be referred to a podiatrist or vascular doctor for further testing to rule out peripheral arterial disease. What Can a Podiatrist Do For Me? A podiatrist is a doctor of podiatric medicine (DPM), also known as a podiatric physician or surgeon. Podiatrists diagnose and treat conditions of the foot, ankle, and related structures of the leg. Today, many podiatrists specialize in diabetes foot care. If you have a foot injury, ulcer, or other abnormalities such as bunions and calluses a podiatrist can prescribe accomodative orthotics or custom made diabetes shoes. If you have a bunion, for example, getting a pair of extra wide or deep shoes to aid in comfort and safety. As preventive services, a podiatrist can trim your nails and scale your feet. What Should I Be Doing at Home? Check your feet daily: This is especially important if you have been diagnosed with a loss of sensation or neuropathy. A quick visual inspection will do - check the bottoms of your feet and between your toes. If you notice a change - an open cut that isn't healing or a fungal infection contact - your health care provider. Wear protective shoes: Do not walk around barefoot or open toed shoes. If you have any type of neuropathy, you may not sense a hot surface or an object that is caught on your foot. It's important to purchase protective shoes that conform to your feet. Avoid getting shoes that fit too snugly which can increase the risk of rubbing your feet, creating blisters or broken skin. Shake out your shoes before putting them on: You never know what has made its way into your shoe - a pebble, your dog's toy - shaking out your shoes reduces the risk of foot injury if you have neuropathy. Dry well between your toes: Excess moisture can be a breeding ground for fungal infections. After bathing or showering, it's important to dry your feet well especially between your toes. Keep good hygiene: Change your socks daily. Purchase cotton socks and do not go sock-less in your shoes. Do not apply lotions between your toes: Avoid putting lotion between your toes, because this can increase the risk of fungal infections. You can apply lotion to the heels of your feet to prevent dry, cracked skin. Avoid nail salons: Getting pedicures at nail salons may not be the best idea. Nail salons can be a breeding ground for bacteria and fungus. You might be better off getting a 'pedicure' by your foot doctor where you'll know that your nails will be cut straight across and not too short with sterilized tools. If you must go to a nail salon, request that they clean the foot bath in front of you and purchase your own set of tools or bring your own from home. Resources: American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. 2014 Jan; 37 Suppl 1: S14-80. American Podiatric Medical Association. What is a Podiatrist. Accessed on-line: April 5, 2014: http://www.apma.org/learn/content.cfm?ItemNumber=992&navItemNumber=558