1.0.

Diabetic Foot Problems:-

Diabetes can cause two problems that can affect your feet:

i. Diabetic neuropathy: due to damage to your nerves resulting in the loss of

sensation for heat, cold, and pain there.

This can lead to:

 Trophic ulcers- “punched” out ulcers

 One not feeling a cut or sore on your foot resulting in an infected wound.
 The muscles of your foot not functioning properly because nerves to the
muscles are damaged. This could cause your foot to not align properly
and create too much pressure on one part of your foot. This can result in
pressure ulcers or corns

ii. Peripheral vascular disease: affecting blood flow to the limbs.

This increases the risk of developing
 Ulcers
 Gangrene

1.1. Common Foot Problems With Diabetes:-

i. Athlete's foot- Is a fungal infection that manifests with itching,

redness, and cracking.
ii. Fungal infection of nails.
 Nails that are infected may become
 Discolored (yellowish-brown or opaque),
 Thick, and brittle and may separate from the rest of your nail.
 Crumbled.
 The dark, moist, and warm environment of shoes is conducive for
fungal growth.
 An injury to your nail can also lead to a fungal infection.

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  Fungal nail infections are difficult to treat and may require oral
antifungal medications for a prolonged period (4-6 wks.)

iii. Calluses.
 A callus is a buildup of hard skin, usually on the underside of the
foot.
 Calluses are caused by:-
 An uneven distribution of weight.
 Poorly fitting shoes
 A skin problem.
 Taking care of a callus:-
 After your bath or shower, use a pumice stone to gently
remove the built-up tissue.
 Use cushioned pads and insoles in your shoes.
 Medications can soften calluses.
 DO NOT try to cut the callus or remove it with a sharp object.

iv. Corns.
 A corn is a buildup of hard skin near a bony area of a toe or
between toes.
 Corns may happen because of pressure from shoes that rub against
your toes or cause friction between your toes.
 Taking care Corns
 After your bath or shower, use a pumice stone to gently
remove the built-up tissue.
 Do not use over-the-counter remedies to dissolve corns.
 DO NOT try to cut the corn or remove it with a sharp object.

v. Blisters.
 Blisters can form when your shoes rub the same spot on your foot.
 Wearing shoes that do not fit properly or wearing shoes without
socks can cause blisters, which can become infected.
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  When treating blisters, it is important not to "pop" them.
 The skin covering the blister helps protect it from infection.
 Use an antibacterial cream and clean, soft bandages to protect the
skin and prevent infection.

vi. Bunions.
 A bunion forms when your big toe bends toward your second
toe.
 Often, the spot where your big toe joins your foot becomes red
and callused. This area also may stick out and become hard.
 Can form on one or both feet.
 May run in the family
 Are mostly caused by wearing high-heeled shoes with narrow
toes. These shoes put pressure on your big toe, pushing it
toward your second toe.
 Felt or foam padding may help protect the bunion from irritation.
 One can also use a device to separate the big and second toes.
 If the bunion causes severe pain or deformity, one might need
surgery to realign the toes.

vii. Dry skin

 Can crack allowing bacteria to enter.
 Use moisturizing soaps and lotions to keep the skin moist and
soft.

viii. Diabetic ulcers.

 A foot ulcer is a break in the skin or a deep sore.
 Can become infected.
 Foot ulcers can happen from minor scrapes, cuts that heal
slowly, or from the rubbing of shoes that do not fit well.

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  It is important to treat them as soon as they are noticed.
 Up to 10% of people with diabetes will get foot ulcers.

ix. Hammertoes.
 A hammertoe is a toe that is bent because of a weakened muscle.
 The weakened muscle makes the tendons in your toe shorter,
causing your toe to curl under your foot.
 Hammertoes can run in families.
 Shoes that are too short can also cause them.
 Hammertoes can cause problems with walking and can lead to
blisters, calluses, and sores.
 Splints and corrective shoes can treat them.
 In severe cases, one may need surgery to straighten your toes.

x. Ingrown toenails.
 Occur when the edges of the nail grow into your skin.
 They cause pressure and pain along the nail edges.
 The edge of the nail may cut into your skin, causing redness,
swelling, pain, drainage, and infection.
 The most common cause of ingrown toenails is pressure from
shoes.
 Other causes include improperly trimmed nails, crowding of the
toes, and repeated trauma to the feet from activities such as
running, walking, or aerobics.
 To prevent ingrown toenails Keep them properly trimmed.
 Surgery to remove part of the toenail and growth plate can treat
severe problems from ingrown toenails.

xi. Plantar warts.

 Plantar warts look like calluses on the ball of the foot or on the
heel.

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  They may appear to have small pinholes or tiny black spots in
the center.
 The warts are usually painful and may grow singly or in clusters.
 They are caused by a virus that infects the outer layer of skin on
the soles of the feet.
 They have several ways to remove them.

2.0. Tips for Diabetic Foot Care:-

Proper foot care can prevent these common foot problems or treat them before they
cause serious complications.
The following are tips for good foot care :
i. Well controlled blood sugar levels by following advice
regarding nutrition, exercise, and medication.
ii. Washing the feet in warm water every day, using a mild soap and drying
them well, especially between the toes. The temperature of the water should
be tested with the elbow because nerve damage can affect sensation in the
hands, too.
The feet should not be soaked in water.
iii. Checking the feet every day for sores, blisters, redness, calluses, or any other
problems.
iv. If the skin on the feet is dry, keep it moist by applying lotion after washing
and dry the feet. Do not put lotion between the toes.
v. Gently smooth corns and calluses with an emery board or pumice stone. Do
this after a bath or shower, when the skin is soft. Move the emery board in
only one direction.
vi. Check the toenails once a week and Trim them with a nail clipper straight
across. Do not round off the corners of toenails or cut down on the sides of
the nails. After clipping, smooth the toenails with a nail file.

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vii. Always wear closed-toed shoes or slippers. Do not wear sandals and do not
walk barefoot, even around the house.
viii. Always wear socks or stockings. Wear socks or stockings that fit your feet
well and have soft elastic.
ix. Wear shoes that fit well. Buy shoes made of canvas or leather and break
them in slowly. Extra wide shoes are also available in specialty stores that
will allow for more room for the foot if you have a foot deformity.
x. Always check the inside of shoes to make sure that no objects are left inside.
xi. Protect your feet from heat and cold. Wear shoes at the beach or on hot
pavement. Wear socks at night if your feet get cold.
xii. Keep the blood flowing to your feet. Put your feet up when sitting, wiggle
your toes and move your ankles several times a day, and do not cross the
legs for long periods.
xiii. If you smoke, stop. Smoking can make problems with blood flow worse.
xiv. Seek medical attention, if the foot problem gets worse or will not heal.
xv. Get a thorough foot exam once a year.
xvi. See a podiatrist (a foot doctor) every 2 to 3 months for checkups, even if one
does not have any foot problems.

3.0. Signs of Diabetic Foot Problems:-

If one has diabetes, seek immediate medical help doctor if any of the following
problems is noticed:
 Changes in skin color
 Changes in skin temperature
 Swelling in the foot or ankle
 Pain in the legs
 Open sores on the feet that are slow to heal or are draining
 Ingrown toenails or toenails infected with fungus

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  Corns or calluses
 Dry cracks in the skin, especially around the heel
 Foot odor that is unusual or won't go away

4.0. Complications of Diabetic Foot Problems:-

i. Skin and bone infections. A small cut or wound can lead to infections.
Infections can be treated with antibiotics. Severe cases may require
treatment in a hospital.
ii. Abscess. The common treatment is to drain the abscess. It may require
removal of some bone or tissue, but newer methods, like oxygen therapy, are
less invasive.
iii. Gangrene. Treatment is usually oxygen therapy or surgery to remove the
affected area.
iv. Deformities. Like hammertoes, claw feet, prominent metatarsal heads (ends
of the bones below your toes), and pes cavus, or a high arch that won’t
flatten when you put weight on it.
v. Charcot foot. Diabetes can weaken the bones in the foot so much that they
break. Nerve damage can lessen sensation and prevent one from realizing it.
One keeps walking on broken bones and the foot will change shape. It might
look like the arch has collapsed into a rocker shape.
vi. Amputation. Problems with blood flow and nerves make it more likely for
people with diabetes to get a foot injury and not realize it until infection sets
in. When an infection cannot be healed, creates an abscess, or if low blood
flow leads to gangrene, amputation is often the best treatment.