Hi I'm Cathy with Level Up RN. In this episode of Ask a Nurse, I will be answering your questions about diabetic foot care, such as, "how does diabetes affect my feet?" and, "how do I take care of my feet if I have diabetes?"
Diabetes is associated with increased blood glucose levels, or hyperglycemia, and chronic hyperglycemia can result in damage to the nerves in the body, including the nerves in the legs and feet, which is called peripheral neuropathy.
Peripheral neuropathy is one of the most common complications associated with diabetes. Peripheral neuropathy associated with diabetes places you at increased risk for foot and leg pain, as well as foot wounds, infection, foot deformities, amputations, as well as systemic complications such as sepsis.
So as a certified wound care nurse, I have cared for many patients with diabetic foot wounds. And some of these wounds can be very serious and very debilitating. So if you have diabetes, it's imperative that you understand the risks associated with peripheral neuropathy and take measures to avoid complications.
Peripheral neuropathy can cause damage to the sensory nerves, the motor nerves and the autonomic nerves in your legs and feet. It can result in pain, burning, as well as numbness and tingling in the legs and feet, and because sensation is reduced when there's damage to the sensory nerves, you may injure your foot without even knowing it.
So for example, if your shoe is rubbing your foot or you have a rock in your shoe or you're walking around barefoot and step on something, this can cause trauma and damage to your foot, but you may not feel it due to the injury to those sensory nerves.
Damage to the motor nerves that control muscle function in the feet can result in muscle atrophy or the loss of muscle tissue. This can lead to foot deformities such as claw toes and hammer toes. It also changes the way you bear weight, which creates these abnormal pressure points and can lead to the formation of calluses and wounds on the bottom of the feet.
And finally, autonomic nerve damage causes decreased sweating in the feet, which causes the feet to become dry and cracked and makes it easier for bacteria to get in. Autonomic nerve damage also causes decreased bone density, which increases the risk for fractures with very minimal trauma. And sometimes people will have a fracture and not know it and they'll continue to walk on their foot and that will result in additional fractures as well as foot deformities, which includes something called Charcot foot.
Now that you understand how diabetes can affect the nerves in your legs and feet, let's talk about how you can care for your feet and avoid some of these complications. So I'm going to share with you my top 10 list of diabetic foot care recommendations.
Number 10, you want to inspect your feet daily using a handheld mirror so you can see all around your feet.
Number 9, you want to wash your feet daily with mild soap and warm, not hot water, and you always want to check the water temperature with your elbow or with a thermometer before stepping in a bath or shower.
Number 8, do not soak your feet as this can dry your skin out, resulting in cracks and increased risk for infection.
Number 7, after cleaning and drying your feet, you want to apply moisturizer all over your feet, but not in between the toes because that can result in infection.
Number 6, keep your toenails trimmed short, but not too short. Long toenails can dig into the neighboring toes, causing wounds. When you trim your nails, you want to cut straight across. You don't want to curve the edges because that can lead to ingrown toenails. And then after you cut straight across, you can use a nail file to just file off those sharp corners.
Number 5, do not use over the counter corn or callus remover products as they can cause damage to healthy skin and cause wounds as well as infection.
Number 4, avoid going barefoot or wearing open toe shoes. So wearing socks and closed toe shoes is best for protecting your feet. And you want to make sure your socks are soft, seamless, and in a moisture wicking material. And you always want to check your shoes for objects before putting them on.
Number 3, you want to see a podiatrist regularly and get professionally fitted shoes and/or insoles to make sure that you have even distribution of pressure when you are walking. And then you want to make sure you break in new shoes slowly.
Number 2, do not use heating pads or hot water bottles on your feet. So with decreased sensation, this can lead to significant burns.
And finally, number 1, last but not least, you want to closely manage your blood sugar levels in order to prevent or slow the progression of peripheral neuropathy.
I hope this episode of Ask a Nurse has been helpful. Be sure to take care of those feet and manage your blood glucose levels so you don't end up having to see me or another wound care nurse.
And if you have another health-related topic or question you would like me to address in a future episode of Ask a Nurse, then definitely leave it in the comments. Stay informed and stay well.
