- Diabetic Foot Care Guidelines and Amputation Prevention
- Always keep your feet warm.
- Don’t get your feet wet in snow or rain.
- Don’t put your feet on radiators or in front of the fireplace.
- Don’t smoke or sit cross-legged. Both decrease blood supply to your feet.
- Don’t soak your feet.
- Don’t use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
- Trim your toenails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, contact our office.
- Use quality lotion to keep the skin of your feet soft and moist, but don’t put any lotion between your toes.
- Wash your feet every day with mild soap and warm water.
- Wear loose socks to bed.
- Wear warm socks and shoes in winter.
- When drying your feet, pat each foot with a towel and be careful between your toes.
- Buy shoes that are comfortable without a “breaking in” period. Check how your shoe fits in width, length, back, bottom of heel and sole. Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes. Wear new shoes for only two hours or less at a time. Don’t wear the same pair everyday. Inspect the inside of each shoe before putting it on. Don’t lace your shoes too tightly or loosely.
- Choose socks and stockings carefully. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toes socks will not squeeze your toes. Avoid stockings with elastic tops.
- Infections and ulcers (sores) that don’t heal. An ulcer is a sore in the skin that may go all the way to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily turn into ulcers that become infected and won’t heal. This is a common – and serious – complication of diabetes and can lead to a loss of your foot, your leg, or your life.
- Corns and calluses. When neuropathy is present, you can’t tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
- Dry, cracked skin. Poor circulation and neuropathy can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores and can lead to infection.
- Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they are not properly treated, they can lead to infection.
- Hammertoes and bunions. Nerve damage affecting muscles can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
- Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that surgery, and occasionally amputation, may become necessary.
- Poor blood flow. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. This prevents wounds from healing and may cause tissue death.
- Inspect your feet daily. If your eyesight is poor, have someone else do it for you. Inspect for:
- Skin or nail problems: Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing).
- Signs of fracture: If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot and ankle surgeon immediately.
- Don’t ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
- Nail cutting. If you have any nail problems, hard nails, or reduced feeling in your feet, your toenails should be properly trimmed.
- No “bathroom surgery.” Never trim calluses or corns yourself, and don’t use over-the-counter medicated pads.
- Keep floors free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor.
- Don’t go barefoot. Wear shoes, indoors and outdoors.
- Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren’t bunched up.
- Have your circulation and sense of feeling tested. Your foot and ankle surgeon will perform tests to see if you’ve lost any feeling or circulation.
According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.
Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.
With a diabetic foot, a wound as small as a blister from wearing a shoe that’s too tight can cause a lot of damage. Diabetes decreases blood flow, so injuries are slow to heal. When your wound is not healing, it’s at risk for infection. As a diabetic, your infections spread quickly. If you have diabetes, you should inspect your feet every day. Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Get someone to help you, or use a mirror.
People with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.
Having diabetes increases the risk of developing a wide range of foot problems. Furthermore, with diabetes, small foot problems can turn into serious complications.
Diabetes-Related Foot and Leg Problems
What Your Foot and Ankle Surgeon Can Do
Your foot and ankle surgeon can help wounds heal, preventing amputation. There are many new surgical techniques available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other health care providers to prevent and treat complications from diabetes.
Your Proactive Measures
You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:
When is Amputation Necessary?
Even with preventative care and prompt treatment of infection and complications, there are instances when amputation is necessary to remove infected tissue, save a limb, or even save a life.
Here’s some basic advice for taking care of your feet:
