Diabetic foot problems are one of many major health issues. They are a frequent cause of hospitalisation.

There are two serious complications that are responsible for most foot problems that diabetics face — nerve damage and poor circulation. Loss of sensation and poor blood flow can lead to a tiny blister progressing into a serious infection in just a matter of days. Chronic nerve damage, also known as neuropathy, can cause dry and cracked skin, which creates a risk of bacteria entering and causing an infection.

As a result, the patient may have to be hospitalised for antibiotics or even have their toe or foot amputated. It is crucial for their overall health and the prevention of damaging foot problems that diabetics carefully inspect their feet every day.

Wash the feet with mild soap and warm water every day

First, one should test the water temperature with their hand. It should be lukewarm, not hot. Be careful not to soak the feet. Gently wash them using a soft sponge or washcloth. When drying, pat or blot each foot with a towel instead of rubbing forcefully. Extra care should also be taken when drying between the toes.

Keep the skin of the feet soft and moist using lotion

Doing so will prevent cracks in dry skin and thus decrease the risk of infection. However, take note not to apply any lotion between the toes.

Refrain from using antiseptic solutions, drugstore medications, heating pads or sharp instruments on the feet

Do not place the feet near radiators or in front of the fireplace.

Never treat calluses or corns without a doctor

It is not wise to perform one’s own “bathroom surgery” or use medicated pads without first seeking the doctor for appropriate treatment.

Trim toenails straight across

Proper nail care is crucial in preventing infections. Avoid cutting the corners and use a nail file or empty board. If an ingrown toenail is discovered, consult a doctor.

Keep the feet warm at all times

Wear loose socks to bed. Prevent the feet from getting wet in the rain and wear warm socks and shoes in colder weather.

Do not walk barefoot

Because the nerve damage decreases sensation, a diabetic may not notice little pebbles or objects that get stuck in the foot. As a result, serious infection can occur. To prevent this risk, one should always wear shoes or slippers.

Do not smoke

Smoking damages blood vessels and decreases the bodily function of delivering oxygen. Paired with diabetes, it majorly increases one’s risk of amputation.

Go for regular foot examinations

Seeing a foot and ankle surgeon on a regular basis can help prevent and reduce the risk of foot complications of diabetes.

• Examine the feet every day.
• Look out for scratches, cuts, bruises, redness, warmth, blisters, ulcers, puncture wounds, pressure areas and nail problems.
• Use a mirror or get someone’s help if it is hard to carry out alone. As a diabetic may not feel that damage has occurred to the skin, it is important to inspect for skin breakdown.
• Examine and feel each foot for swelling. Swelling in only one foot is an early indicator of Charcot (pronounced “sharko”) foot. A unique condition that can occur in people with nerve damage, Charcot foot can destroy bones and joints.
• Inspect the bottom of the feet and toes. Take note of these six major locations on the bottom of each foot:
  • The tip of the big toe
  • The base of the little toes
  • The base of the middle toes
  • The heel
  • The outer edge of the foot
  • Across the ball of the foot

It is important for a diabetic patient to pick and wear their shoes carefully. This is because an ill-fitting shoe can cause an ulcer and eventually lead to an infection.

• Buy shoes that fit comfortably without needing a “breaking in” period. It is advisable to purchase shoes late in the day when the feet are larger.
• Look out for how the shoe fits in width, length, back, the bottom of heel and sole. Your feet should be measured every time when purchasing new shoes. This is because your feet may change shape over time.
• Refrain from getting pointed-toe styles and high heels. Shoes made with leather upper material and deep toe boxes are generally more advisable.
• Only wear new shoes for 2 hours or less at a time. Avoid wearing the same pair of shoes every day.
• Examine the inside of each shoe before wearing them. Lace the shoes with a nice fit, not too tightly or loosely.
• Try not to walk for long periods of time without any breaks. Remove the socks and shoes and check for signs of pressure, redness or ulcers.

Typically, the cost of orthotics for diabetic patients is covered by insurance companies. These companies have an understanding of how crucial it is to minimise the risk of a pressure sore in the patients. This can be discussed with your primary doctor or orthopaedic surgeon.

Plastizote, an accommodative orthotic made from a soft material, is usually prescribed. The orthotics should not be hard, so as to not increase the risk of a pressure ulcer. In addition, the orthotic can be transferred between different pairs of shoes and should be used at all times when standing or walking.