Dr Aidin Rawshani

The diabetes foot: risks, causes, symptoms, prognosis, treatment


People with diabetes often develop problems with feet and lower legs. Diabetes is a disease that eventually contributes to atherosclerosis and narrowing of the blood vessels, especially in the blood vessels that supply the toes, feet and lower legs with oxygen-rich blood. You can reduce your chances of developing diabetic foot problems by taking care of your feet every day. Coping with blood sugar levels and other risk factors such as high blood pressure, smoking and high blood lipids, can also help keep your feet healthy.

How diabetes affects your feet

Over time, diabetes can cause nerve damage, also called diabetic neuropathy, which can cause tingling and pain, and may cause you to lose sensation (sensory) in your feet. When you lose sensation in your feet, you cannot feel a stone inside your sock or a blister on your foot, which can lead to wounds that in turn can become infected.

Diabetes can affect the blood flow in your feet. When constrictions occurred in the blood vessels that supply blood and lower leg, blood flow is negatively affected. Impaired blood flow leads, among other things, to hard-to-heal infections, which can lead to gangrene.

Gangrene and foot ulcers that do not get better with treatment may result in amputation of your toe, foot or part of your leg. A surgeon can perform an amputation to prevent a severe infection from spreading to the rest of the body and thus save your life. Good foot care is very important to prevent serious infections and gangrene.

Although rare, nerve damage from diabetes can lead to changes in your feet, such as Charcot’s foot. Charcot’s foot is a condition characterized by redness, heat and swelling of the foot. Your feet and toes can subsequently become deformed and develop an odd shape.

What can I do to keep my feet healthy?

Collaborate with your diabetes nurse to jointly develop a health care plan for diabetes, i.e. an action plan for how to manage your diabetes. This plan should include regular foot care. A foot specialist and other specialists can be part of your medical team.

Include these steps in your foot care plan:

Tips for caring for your feet

  • Check your feet every day.
  • Wash your feet every day.
  • Scrub off skin calluses and dehydrated skin areas
  • Cut your toenails regularly and avoid cutting deep in the nail fray.
  • Always wear shoes and socks.
  • Protect your feet from heavy heat or cold.
  • Activate your feet regularly to stimulate blood flow to your feet.
  • Get a foot examination at every visit to the doctor.
  • Check your feet every day

You may have problems with your feet, but do not feel any pain in your feet. Checking their feet every day will help you detect problems early before they get worse. A good way to remember is to check your feet every night when you take off your shoes. Also check between your toes. If you have trouble bending over to see your feet, try using a mirror to see them, or ask someone else to look at your feet.

Immediately fix the following problems if they occur

  • Cuts, wounds or red spots
  • Swelling or fluid-filled blisters
  • Ingrown toenails
  • Corns or calluses, which are spots of rough skin caused by excessive rubbing or pressure in the same place
  • Warts

People with diabetes who are at high risk of suffering from foot problems can be offered a medical instrument that measures the temperature of different parts of the foot. This allows you to detect for yourself whether the temperature increases in certain parts of the foot, which may suggest that you will soon develop an inflammatory condition in that area. A heat increase (hot spot) may be the first sign that a blister or wound begins.

Tips on how to protect your feet

  • Wash your feet every day
  • Wash your feet with soap in lukewarm water. Test the water to make sure that it is not too hot.
  • After washing and drying your feet, you can apply corn starch between your toes if it tends to get damp.
  • Corn starch will keep the skin dry and thus prevent infection.

Be careful with pimitors and skin calluses. Thick portions of skin called tansy and can grow on your feet. If you have pours or dehydrated areas of skin, talk to your orthopest about the best way to care for these foot problems.

One method of treatment is to use a pumice stone to smooth out pimples or dehydrated skin areas, preferably do this after bathing or showering. A pumice stone is a type of stone used to smooth out the skin. Gently rub, only in one direction, to avoid tearing the skin. Please consult your doctor before you start treating foot problems.

To keep the skin soft and moist, apply a thin layer of emollient cream or Vaseline on the top and bottom of your feet. Do not apply emollient cream between your toes, as moisture can cause an infection.

Cut your toenails correctly

Cut your toenails correctly, after washing and drying your feet. Using nail clippers, cut your toenails across. Do not cut into the corners of your toenail. Gently smooth each nail with an unsharp nail file. Trimming in this way prevents you from cutting your skin and preventing the nails from growing into the skin.

Check with a foot specialist if any of the following arise

  • If you can’t see, feel or reach your feet
  • Your toenails are thick or yellow
  • Your nails curl and grow into the skin
  • If you want to get a pedicure in the salon, you should bring your own nail tools to reduce the risk of infection. You can ask your caregiver what other measures you can take in the salon to prevent infection.

Always wear shoes and socks

Always wear shoes and socks. Do not walk barefoot or just in socks, even when you’re indoors. You can step on something and injure your feet. Maybe you don’t feel any pain and maybe you don’t know that you hurt yourself. People with diabetes usually develop loss of sensitivity in the feet and lower legs first, then poor shoes or stones cause minor wounds that the person does not feel and they also take longer to heal.

Check the inside of your shoes before putting them on, to make sure that the lining is smooth and free from pebbles or other objects. Make sure you wear socks, socks or nylons with your shoes so that you do not get blisters and wounds. Choose clean, slightly padded socks that fit well. Socks without seams are best. Wear shoes that fit well and protect your feet.

Here are some tips for finding the right type of shoes

  • Training shoes are good for daily wear. They support your feet and allow them to “breathe”.
  • Do not wear vinyl or plastic shoes, as they do not pull or “breathe”.
  • When buying shoes, make sure that they are good and have enough space for your toes. Buy shoes at the end of the day, when your feet are largest, so you can find the best fit.
  • If you have deformed toes, for example, hammertoe, you may need extra-wide or deep shoes. Do not wear shoes with pointed toes or high heels, as they put too much pressure on your toes.
  • If your feet have changed shape, for example, like Charcot’s foot, you may need special shoes or shoe inserts. When buying new shoes, wear them only for a few hours first, then check your feet for tenderness.

Protect your feet from hot and cold

If you have nerve damage as a result of diabetes, you can burn your feet and not know that you hurt yourself. Take the following steps to protect your feet from heat:

  • Wear shoes on the beach and on hot sidewalks.
  • Put sunscreen on top of your feet to prevent sunburn.
  • Keep your feet away from hot and open fires.
  • Do not put a hot water bottle or heating pad on your feet.

Wear socks in bed if your feet get cold. In winter, wear lined, waterproof boots to keep your feet warm and dry.

Try the following tips to improve blood flow to the feet

  • Put your feet up while sitting.
  • Touch your toes for a few minutes as often as possible. Turn the ankle in all different directions to help the blood flow in your feet and legs.
  • Do not wear tight stockings or elastic stockings. Do not try to hold up loose socks with rubber bands.
  • Be more physically active. Choose activities that are light for the feet, such as walking, dancing, yoga or stretching, swimming or biking.
  • Quit smoking.

Smoking can affect the blood flow to your feet. If you smoke, ask for help to stop.

Get a foot examination at every care visit

Ask your medical team to check your feet at each visit. Take off your shoes and socks while you’re in the examination room so they’ll remember to check your feet. At least once a year, get a thorough foot examination, including a check of the sensation and pulses in your feet.

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