About 10% of the Maltese population is affected by diabetes. Uncontrolled diabetes may cause serious complications such as heart disease, stroke, kidney disease, eye damage, foot and skin problems. The first signs of complications might be noted in the peripheries and the first symptoms may be observed in the foot before any other part of the body.
How does diabetes affect your feet? Prolonged high sugar levels in our bodies have an adverse effect on arteries, veins and nerves.
Peripheral neuropathy is when we start having loss of sensation in our extremities (such as our toes and fingers) due to gradual nerve damage. This may at first go unnoticed, however accompanying the loss of sensation there may be pain or a burning sensation. This is known as ‘painful neuropathy’.
This lack of sensation is of concern since one may no longer feel heat, cold or pain. The slightest lesion such as formation of corns (due to ill fitting footwear), cuts, simply by walking barefoot and burns due to extreme water temperature can go unnoticed. These skin lesions hidden in footwear may become infected and lead to further complications. Lack of muscle innervation may cause less or no stimulation to muscle groups and in turn this may cause changes in foot structure such as hammertoes or cavus feet (high arched feet).
Diabetes may also reduce blood flow in the foot which in turn may cause delay in healing, and thus reduce the natural ability to fight bacteria. Poor circulation may cause the skin to become dry, shiny and discoloured. One may also note loss of hair on the dorsum of the digits. Change in foot temperature, frequent night cramps or calf pain when walking are all signs of bad circulation.
If you have an infection that will not heal because of poor blood flow, you are at risk of developing gangrene, which is the death of tissue due to a lack of blood. To keep gangrene from spreading, the doctor may have to remove a toe, foot, or part of a leg. This procedure is called amputation. Diabetes is the most common, non-traumatic cause of leg amputations. Each year, a high percentage of people with diabetes have amputations. However, research suggests that more than half of these amputations can be prevented through proper foot care.
In order to prevent any complication one should start with controlling blood sugar levels. These should be checked regularly especially when blood sugar level is uncontrolled. It is possible to prevent and delay changes if you follow medical advice and keep blood sugar, cholesterol and blood pressure levels within the target range set by your doctor. Follow your healthcare provider’s advice regarding nutrition, exercise, and medication.
Simple day-to-day advice to prevent any foot problems
Inspect your feet daily, look out for any discolouration, cuts or blisters. Check between the toes regularly as these may be cracked due to excessive sweat caused by heat in shoes. Clean and dress any cuts, scratches or wounds. Shoes are the perfect home for bacteria to survive and only need a small scratch to enter our body. These little cracks in the skin are a great way that opportunistic bacteria can enter the foot.
Always use suitable moisturising cream to keep the skin soft and supple; this will prevent the skin from breaking easily. You may use a soft pumice stone to file off any excess dry skin. Have the lesions checked and treated by a podiatrist and do not use any acids to remove any corns or callus. These acids burn the dead skin and there is no differentiation from healthy skin and unwanted piled up skin. There are protective foot care items to offload or protect any prominence such as corn caps to protect hammer toes from rubbing against footwear.
Always wear shoes that fit properly. Make sure you can wiggle your toes in shoes. Avoid high heels as these may increase pressure to the forefoot and make the food slide forward, increasing the chance of foot lesions. Avoid walking barefoot especially if you know you have lack of sensation. Wear specific diabetic socks that are seamless and contain a high percentage of cotton. Offer good protection and do not obstruct the blood flow to your foot. These will help to keep the feet dry, protect prone areas and avoid the sock from slipping down to cram the toe box area.
Apart from your regular home care, it is important to have your feet checked by a podiatrist, at least once a year if you are at low risk. However, if you suffer from any lesions, make sure they are treated correctly regularly and try and follow any advice given. The podiatrist will check circulation and look for evidence of loss of sensation to your feet. They will also map any increased pressure areas to avoid high impact areas that are continuously in risk of ulceration. Even a simple task as trimming your toenails may be dangerous especially if they are out of your reach or can’t be seen properly. Some nails also get very thick due to bad circulation so the podiatrist will be able to reduce thickness effectively.