Foot care

Q	What first-aid measures should be taken to treat foot injuries in persons with diabetes?
A	Gently clean the area with soap and water and cover with sterile gauze to treat minor abrasion and cuts. If there are blisters do not burst them, cover gently with sterile gauze. Do not apply any strong medicines locally. Never cover the wound directly with adhesive strapping. Contact a doctor as soon as possible.	Top
Q	How can I avoid heat injury to the foot?
A	If your temperature sensation is affected due to nerve damage - avoid very hot baths. Avoid walking bare foot in hot climates, sitting too close to the heater or fire and if you are a pillion rider on a two-wheeler keep your feet away from the exhaust pipe. Do not use hot fomentations, or hot water bottles, electric blankets in the bed at night.	Top
Q	How can I prevent foot problems?
A	Begin by protecting the feet. Never walk barefoot - indoors and outdoors. Wear comfortable and well fitting shoes. Look and feel inside the shoes for any rough surfaces before putting them on. Use clean and dry cotton socks or stocking of the correct size, avoid, too large socks that bunch up in the front and too tight that squish the feet. Avoid socks with tight elastic tops. Keep the feet clean. Wash feet daily with a mild soap, do not soak for more than 15 minutes. Rinse the skin well after applying soap and dry with a soft towel. Take care to dry the area between the toes. Dust with plain talc and wipe off excess. If skin is dry, apply a moisturising/lanolin lotion or ointment. Inspect feet regularly (preferably daily) the top portion of the feet, the area between the toes and the sole, and look and feel for breaks in the skin, cuts, scratches, bruises, blisters, sores, and discolouration. Check if any portion feels hot and red. Use a mirror to look at the sole or ask a friend/ relative to help you. Take proper advice and care in case of ingrown toenails, calluses, corn or breaks in the skin or change in temperature or colour of the skin or if feet are swollen or throbbing. Do not use corn caps and callus removers. Request the doctor to check your feet during every visit. Stop smoking as nicotine causes blood vessels to shrink further slowing down the already reduced blood flow to the feet because of diabetes.	Top
Q	How should a person with diabetes cut his nails?
A	Cut toe nails after a bath, when the nails are soft and pliable. Cut them in a straight line and not too far back on the sides. Do not use sharp instruments to clean under the nail, or in the grooves. In case of difficulty in cutting, consult your nurse or doctor	Top
Q	Are any special precautions necessary to select shoes for persons with diabetes?
A	Shoes must provide proper support to the foot. They must be of the correct shape and size for the feet. Select a broad rounded shoe design; avoid pointed narrow shoes that cramp the toes. Always shop for shoes in the evening when the feet are the largest. Check the size of the shoes wearing the thickest socks. Always choose flat shoes. Thick, sturdy soles protect the feet from sharp objects. Leather shoes let the foot breathe freely. Draw the outline of your feet by placing them on paper and using a pencil to trace along the outer side of the foot. Cut this outline and carry it when you buy shoes. The cut paper must fit the inside of the shoe properly without crimping or folding anywhere. This is the correct and comfortable shoe size for you. If possible have 2 pairs to alternate and let one shoe dry before wearing again. Slippers and sandals do not provide adequate support to the feet and should be avoided for full daywear. They should be used only for short periods like early morning and nightwear. Sandals must have a band to support the back of the ankle.	Top
Q	I have a corn in my foot. What should I do?
A	Consult your doctor or a podiatrist [specialist in foot care e.g. removal of corns, calluses and other problems of the foot] or a qualified nurse. Avoid self-surgery and getting treated by well meaning family and friends or any unqualified persons (quacks) as this may cause great harm.	Top
Q	I don't have any sensation in my feet. What should I do?
A	Loss of sensation can be due to a variety of causes ranging from vitamin deficiency, to nerve disease. Nerve disease may be caused by compression of the nerve due to thickening and compression against the head of a bone. Consult a qualified doctor who can examine and diagnose the condition. In persons with diabetes this is most likely to be nerve damage caused by prolonged improper blood glucose control. It is often reversible in the early stages by good glucose control and although not fully reversible, in the later stages further progression can be halted. Even in persons with diabetes the other causes must be looked for and ruled out by proper medical examination. The important precautions, that persons with impaired/lost sensation in the feet can take is to ensure use of proper fitting shoes, clean and comfortable socks. Examining the feet at regular intervals. Always keeping the feet clean and dry. Proper cutting of toenails is also very important.	Top
Q	The wound in my leg is not healing. What should I do?
A	Non-healing wounds can occur because of a variety of reasons like, poor blood flow to the area, impaired defence function, and presence of uncontrolled infection due to uncontrolled diabetes, or inadequate wound hygiene, improper wound dressing, use of strong ointments or antiseptics, inadequate rest to the affected part, etc. Consult your doctor to make sure that each of the above listed points are checked and ruled out. Wounds that are too large or too deep require special surgical procedures, and a surgeon; preferably a plastic surgeon's opinion must be sought.	Top