The importance of foot care for people with diabetes

As a family caregiver, maintaining proper foot care for yourself and for the person in your care is important, especially if one or both of you have diabetes.

According to Diabetes Canada, diabetes is a chronic condition that, if poorly managed, could lead to nerve damage (neuropathy)   in the hands and feet. Nerve damage can make activities like walking or standing difficult and painful. It can also negatively affect a person’s sense of balance which can lead to injuries due to falls.

Did you know that if a person with diabetes has nerve damage in their feet, they may not feel when a shoe is too tight or rubbing? They could step on a sharp object and not even realize that they’ve been injured. An untreated wound (or lack of blood flow to the extremity because of nerve damage) may even lead to amputation of the limb. See our article Foot care tips for people with diabetes [link blog]

What are foot ulcers?

A foot ulcer is an open sore on the foot that can range from anywhere between a shallow, red crater that affects only the surface skin to a very deep crater that goes through the full thickness of the skin and may extend to bone. It can be very difficult to heal a foot ulcer, especially diabetic foot ulcers, so it’s important to do everything possible to prevent infection because it can develop into:

• An abscess: a collection of pus under the skin
• Cellulitis: a spreading infection of the skin and underlying fat
• Osteomyelitis: a bone infection in the feet
• Gangrene: an area of dead, darkened body tissue caused by poor blood flow

First aid for foot ulcers

Diabetes Canada states that approximately, “15 per cent of Canadians with diabetes, or over 400,000 people, will develop a foot ulcer in their lifetime.”  They also warn that, “Nearly one third of people with diabetes who require an amputation will die within the following year and two thirds will die within 5 years.” In short, foot care is extremely important to the ongoing health and wellbeing of anyone who has diabetes.

If you notice a foot ulcer in your own foot or in the foot of the person in your care:

• Wash any minor scrapes or skin openings gently
• Apply an antiseptic cream and cover with a bandage
• See a nurse practitioner or medical doctor for advice
• If the area around the wound becomes hot, red, swollen, smelly, or painful, see a health care provider immediately

Remove the cause of foot ulcers

Most foot ulcers begin because of these reasons:

1. Friction  – Two surfaces rubbing across one another
2. Shear – Usually the result of poorly fitting shoes where pulling and damage of underlying tissues is caused by movement of the bone without movement from the overlying skin
3. Pressure – From shoes, a surface like a bed, or because of the shape of the foot
4. Trauma – Such as standing on a sharp or hard object

If you or the person in your care have a foot ulcer, speak to a chiropodist (a doctor who specializes in feet) or a pedorthist (pedorthics is the design and fitting of footwear) about what options are available to take the pressure away, such as professionally fitted footwear or an off-loading device.

Eat a balanced diet

Energy and nutrients are required to heal wounds. Choose foods that are well-balanced, provide vitamins and minerals, and include protein such as meats, fish, milk, and peanut butter.

A dietician can work with you and/or the person in your care to create a meal plan with the foods that you both like and can afford.See also our Elizz article called Nutrition and Wound-Healing Foods.link]

Prevent wound infection

Here are some tips you can use to prevent a foot wound from becoming infected:

• Follow the wound care advice provided by the doctor or nurse. This includes how to clean the wound and apply the most appropriate dressing.
• Don’t walk barefoot on the ground. It is covered with bacteria which can enter an open, unprotected wound.
• Wear cotton, diabetic socks designed to control moisture and reduce the risk of fungal infection. Fungus causes inflamed skin that may be red, itchy, and leak fluid. Contact a health care provider if you think you or the person you’re caring for have a fungal infection.
• Wipe your shower down after each use with an antiseptic solution.

If you or the person in your care have diabetes, monitor blood sugar levels closely. To maintain mobility and independence for you or the person in your care, plus reduce the risk of more severe health complications, it is imperative to keep feet healthy.

This article should not be considered a substitute for medical advice. Consult with a health care professional if you notice a wound or any other foot problems so that a proper treatment plan can be initiated to prevent further damage.