It’s likely that you are reading this article because you, or someone close to you, is diabetic. There’s no shortage of good advice about diet, exercise and general lifestyle regimens and all this should be taken to heart.
What is quite surprising is the lack of emphasis and information on foot disease. When someone is given the news that they have diabetes, in amongst what is no doubt a confusing list of subjects will be mention of foot problems, but all too often that’s relegated to something that “happens to other people”, or something “you’ll think about later”.
That can be a very costly mistake. Everyone with diabetes has a chance of developing a foot ulcer. 300 people every day get the news they have one. Half of each day’s 300 will not survive 5 years, indeed around 20,000 people die prematurely every year in the UK alone as a result of foot disease.
See also: Wound Care for Legs and Feet
Foot ulcers are basically wounds that won’t heal. They tend to start with something minor so cuts, blisters and skin breakdown are things you really want to avoid.
Making matters more complex is one of the very common side effects of diabetes called Peripheral Neuropathy. That’s the medical term for nerve damage that causes loss of sensation, most often in the feet. This happens gradually, so tends not to be immediately obvious.
Consequently, getting a cut by standing on something sharp, or a blister due to badly fitting shoes can go unnoticed because it doesn’t hurt. Neuropathy also means you are likely to have uneven pressures on the sole of the foot, typically the front (forefoot) and the skin can actually wear down. Wounds such as these might heal but because of the other main “risk factor”—reduced circulation or Ischaemia—it may well not and that small cut gets infected and becomes a foot ulcer.
Once you have an ulcer, hopefully clinicians manage to get it to heal, but you now have a 50/50 chance of it coming back within a year, so many clinicians now consider “healing” more as a period of remission.
So what can you do? It’s actually quite straightforward so here are some tips:
- Avoid walking barefoot – never outdoors or on the beach
- Check your shoes before you put them on for any stones or sharp objects
- Check your feet daily – tops, soles and between toes – looking for any changes in colour, blisters, sores or skin – if you see anything new, visit your doctor
- Be careful cutting your toenails – never too short
- Wash your feet daily and dry between the toes.
- Use a moisturising cream if the skin is dry.
Remember that if you suffer from neuropathy, you can have a wound but you will not even be aware, so check the soles of your feet using a mirror.
See also: Diabetes and Foot Care
The NHS promotes annual foot checks—make sure you get yours. A foot check is quick, painless, designed to highlight risk factors and assess your chances of developing an ulcer. Because the checks are annual, they highlight gradual changes.
The latest NICE and SIGN guidelines on avoiding foot disease in diabetes advocate those “at risk” should be advised on appropriate footwear and insoles.
The most common cause of a foot ulcer is excessive pressure on areas of the sole wearing away the skin combined with poor circulation.
Recently, the NHS introduced an insole on prescription which is the first ever preventative device against foot ulcers. Clinical trials were carried out by the NHS and the results were hugely significant for those with diabetes.
This insole (called Liqua Care) was shown to reduce the excessive pressures (peak forefoot pressure) by an average of over 21 percent. The other major and unique advantage is the fact that these insoles were actually proven to increase the circulation by a “clinically significant” percentage—the only insoles in the world with such clinical evidence.
So, by simply wearing them in your ordinary footwear, you are reducing the odds of developing a foot ulcer, indeed the post-trial checks two years after the event were considered “remarkable” by the National Diabetes Foot Coordinator because not a single patient had developed an ulcer in that time.
See also: Tom Hanks Helps Raise Diabetes Awareness
Until now, there has been a significant element of chance in terms of who will get the bad news—with simple daily checks and the right preventative measures you are now able to reduce the odds in your favour. You only get one pair of feet – look after them!
Our thanks to Autonomed for their assistance with this article on foot ulcers in diabetes.
If you want to read more on Celebrity Angels about foot ulcers in diabetes, click here.