Those with diabetes need to take care of their feet so they can avoid infection or worse, amputation.

BY: Kenneth Koh

Some individuals with diabetes may develop diabetic foot problems that can affect their day-to-day activities. They also may face dangers of ulceration, infection and worst, amputation. The risks are high especially for diabetics. They are more likely to get lower limb arterial narrowing, loss of sensation, foot deformities and weaker immune systems. This increases the likelihood of amputation in persons with diabetes to be 30 times higher than the general population.

Furthermore, 15 percent of all those with diabetes have non-healing or poor healing foot wounds or ulcers, and approximately six to 43 percent of patients with diabetes and a foot ulcer eventually progress to amputation. Foot ulcer precedes approximately 85 percent of all major amputations of the lower limb.

And within a year of amputation, about nine to 20 percent of those with diabetes undergo a second amputation. They also have a higher risk of death post-amputation and in Singapore, 22 percent of those with diabetes dies within one year of lower extremity amputation.

 

Prevention care

With these sobering statistics, how can patients with diabetes prevent further injuries and infections to the foot? Here are some tips:

• Be sure to clean your foot every day by washing with mild soap and warm water.
• Dry your feet well, especially between the toes.
• Make sure you apply moisturisers to avoid feet from cracking, as there would then be wounds. If you have Athlete’s foot (one in five have Athlete’s foot where fungus grows on the skin), do not apply between the toes as Athlete’s foot can then further spread.
• Check your feet every day between your toes, around the heel and the sole. Look for any cuts, swelling, redness, blisters or discharge of pus. If you have difficulty checking your sole, ask someone to help or use a mirror.
• You can use a clean toothbrush to clean the sides of your toenails from debris.
• Do not cut your nails too deep but straight lines across and don’t cut along the sides. You can also file nails if you are not comfortable cutting your loved one’s nails and don’t forget to file the corners of the nails. Do not share equipment and do not go for pedicures.
• When having corns and calluses, use moisturisers that contain 10-percent urea to soften the corn and do not use treatments, corn plasters or blades to cut the hard skin. You can use instead a pumice stone or seek help from a podiatrist.
• With wound care, do not wash or wet your wound with tap water even in the shower. If the wound is wet, change your dressings immediately. Do not use “waterproof dressings” but use breathable dressings such as gauze and micropore.

 

Choosing the suitable shoe

If there is excessive rubbing of the feet in your shoes, you can get blisters and wounds, and these can further worsen if you don’t pay close attention. So wear a pair of cotton socks or stockings with your shoes at all times and make sure they are not too tight. Also, do not wear open-toe slippers or massage slippers, or high heel shoes; covered shoes like sports shoes are the best. And at home, shoes such as bedroom slippers or sandals are preferred, to avoid getting any wounds.

Ideal shoe requirements:

• Your shoe should support your heel and prevent excessive motion within the shoe. It should not collapse when pressed inward.
• Laces, adjustable Velcro straps or a buckle are ideal as they prevent the foot from moving forwards within the shoe.
• Do not choose shoes that have thin soles. Make sure they have adequate cushioning and after a few years, do check them for wear and tear.
• The sole should bend at the front of the sole, and the middle and back portions of the sole should be firm to provide adequate support. The sole should feel stiff when wrung like a towel.

Buying shoes:

• Getting the length and width right – there should be one thumb width’s space between the longest toe and the tip of the shoe. The width of the shoe should be as wide as the widest part of your foot. There should be some space allowance around when you compare the widest part of the shoe with the soles of your feet.
• Always buy shoes to fit the largest foot if your feet are of different sizes.
• Buy your shoes at the end of the day to factor in any swelling which may occur.
• A shoe does not need expansion. They should fit and feel comfortable when you buy them.
• Do not buy them if you do not feel right.
• Wear new shoes at home for two to three hours so you can observe your feet in a controlled environment.
• Check the inside of the shoe when buying for notches and seals, as this may further cause injury to your foot.

 

Kenneth Koh is a podiatrist in the Department of Podiatry at Tan Tock Seng Hospital.

 

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