How does diabetes affect the feet and toes?

Why do they talk so much about diabetic foot care?

It's that same old vascular story. Diabetes causes hardening and narrowing of the blood vessels. This, in turn, causes poor circulation of the blood. Since the feet are farthest away from that great blood pump, the heart, they get the worst deal. Poor blood circulation is also part of the aging process. So if you're older and diabetic, you've really got to watch those feet. And we do mean watch, because if you also have a touch of neuropathy, you may not feel a cut, sore, blister, or ingrown toenail and let it go until it becomes infected. Infections are particularly hazardous because, combined with diminished circulation, they provide a welcome mat for gangrene (tissue destruction), which can necessitate amputation.

Here are the foot care dos:

1. Wash your feet every day and wear clean socks.
2. Always dry well between your toes.
3. Cut your toenails after bathing, following the shape of the ends of the toes. Do not cut too short.
4. Wear well fitting shoes and change them frequently.
5. Examine your feet daily for signs of infection. 6. If you develop foot problems, go to a podiatrist (foot doctor) and tell him you are diabetic. In fact, we favor regular visits to a podiatrist.

Here are the foot care don'ts:

1. Avoid crossing your legs.
2. Avoid elastic garters or anything tight around the legs or ankles.
3. Do not use heating pads or hot water bottles on your feet.
4. Avoid smoking; it reduces the blood supply to the feet.
5. Never walk around barefoot.
6. Do not use corn plasters or any over the counter medications.
7. Do not cut corns or calluses.
8. Do not put your feet in water above eighty five or ninety degrees.

If you need convincing to make you behave yourself in the foot department, the Loma Linda Diabetes Education Program offers the story of a man who didn't take care of his diabetes or his feet. As he aged and deteriorated, he lost his sight and all feeling in his feet. Well, it came to pass that one night, without knowing it, he knocked his watch off his bedside table and into his shoe and broke the crystal. He walked around on said broken watch for two weeks. Needless to say, he wound up as a guest in the Loma Linda Hospital.

We don't want to give the impression that older diabetics are the only ones who have to be careful of their feet. Although younger people generally have better circulation, they still can get into trouble, especially if their diabetes is out of control.

A young attorney stopped by the Sugarfree Center one day just after having been released from the hospital. She had stepped on a toothpick and her foot had "swollen up like a balloon."

She had had diabetes for seven years but had not been taking care of herself. As she admitted, "It's just been two weeks [the length of her hospital stay] since I've accepted the fact that I have diabetes." The foot problem, which had been exacerbated by her poor control, had turned her into a born again diabetic who was devouring diabetes books, restricting her diet, starting an exercise program, and testing her blood sugar in short, becoming a model diabetic, but that's doing it the hard way.

The purpose of these stories is not to scare you out of your wits. It's more to scare you into your wits. As Loma Linda's Dr. Charles Brinegar put it, "We wouldn't tell you these things unless there was something you could do to avoid them." If you are a middle aged or older diabetic, you should watch for symptoms of diminished circulation. They are weak pulses in the feet and legs; cold, dry, pale skin on the feet and legs; lack of hair growth on the toes; and toes that turn a dusky red color when they hang down as when you're sitting on the edge of the bed. Be sure to mention it to your doctor if you notice any of these symptoms.

It is possible to improve or maintain the circulation in your feet with a simple exercise. Lie on a bed with your feet raised above your hips. Alternate pointing your toes and heels toward the ceiling. Do this several times. Make circles with your feet. First clockwise, then counter clockwise. Sit up with your feet hanging over the edge of the bed. Repeat the same maneuvers as above. Do this exercise a couple of times a day. When you get your feet in good shape, walking a mile or more daily in comfortable shoes (runner's training shoes are good) can be of great benefit.


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