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Family Health Magazine
DIABETES

Toe the Line
Caring for your feet

Having diabetes puts your feet at risk. While the responsibility for protecting them is yours, both you and your health-care team must be involved. Understanding why and knowing how to care for your feet can help prevent injury.

Managing your blood glucose well is the starting point in protecting yourself from any complications related to diabetes.

To protect your feet, first look at them carefully. You may need a mirror to see the bottom of your feet. Has your foot changed shape? Do you feel pins and needles or numbness in your feet? These early signs of diabetic neuropathy (change in sensation) indicate that you should have your sensation tested. A podiatrist (foot care specialist), foot care nurse or family doctor can do this for you. You can also test sensation yourself using monofilaments (see sidebar). Lack of sensation confirms that you are at greater risk of injury.

If you do find numb areas, simple actions can help protect your feet.

• Do not use heating pads or hot water bottles. You might accidentally burn yourself and not realize it until an injury has occurred.
• Buy socks without elastic tops. Be careful that sock seams do not rub your feet, as this can cause blisters.
• Avoid walking barefoot, even in the house. If you step on something and cut yourself, you may not feel it.
• Pick up your shoes and shake them out before putting them. This reduces the chance of walking with a pebble or object in your shoe that could cause injury.
• Wash your feet daily and dry thoroughly, especially between your toes. Use lotion to keep your feet soft but do not use it between your toes.
• Exercise moderately.
• Limit smoking. It reduces the blood flow to your feet.
• Avoid using chemicals like corn or wart removers.
• Do not use your foot to check bathwater temperature.

If the shape of your feet has changed, have your shoes fitted by a professional. Mid-afternoon is the best time to be fitted. By this time of day your feet will be slightly swollen and at their largest, so you will be less likely to buy shoes that will pinch. Correct measurements are important. You need enough length that your toes do not press against the end of the shoe. As well, leave enough room (depth) so your toes do not rub against the top. Often over time, those with diabetes find their toes curl upward, so be sure that the toe area of your shoe has extra space. If you require special shoes, look in your phone book for suppliers. Phone ahead to be sure someone in the store (a pedorthist or orthotist) can professionally fit the shoes. Some provinces have government programs that offer this service at a subsidized rate. Check with your local health provider.

Look after your toenails. Regular trimming reduces the chance of injury. Have a professional foot care provider help you, especially if your eyesight is poor. Trim nails straight across to reduce the risk of ingrown toenails. Please do not soak your feet, as this dries the skin and increases the possibility of skin cracks, especially in the heel region. If your toenails are thick, your care provider should be able to use the right tools to cut your nails without having to soften them in water first.

A number of nursing agencies and special groups offer professional nail care. Check your local phone listing for nursing agencies or ask your diabetes care provider. You are responsible for managing your foot care. Looking at your feet is the most important thing you can do. Any sores, cuts or cracks in your feet should be checked as quickly as possible by a health care professional.