DIABETIC FOOT

People with diabetes should regularly monitor their feet, as the consequences of foot injuries can be severe, including amputation.

Minor injuries can quickly become major emergencies. Diabetes decreases blood flow, so injuries can be slow to heal. With a diabetic foot, a wound as small as a blister can cause a lot of damage. A wound that is not healing is at risk for infection, which can spread quickly.

People with diabetes should inspect their feet every day looking for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts and nail problems. Feel each foot for swelling. Examine between toes. Check the bottom of each foot. Avoid tight shoes that may cause pressure and create damage to the skin.

If there are any injuries, go to a doctor right away.

Diabetic patients should take good care of their feet:

• Wash feet every day with mild soap and warm water. Be sure to dry between toes.
• Use quality lotion to keep the skin soft and moist. Don't put any lotion between the toes.
• Trim toenails straight across. Use a nail file or emery board. If you find an ingrown toenail, see a doctor.
• Don't use antiseptic solutions, drugstore medications, heating pads or sharp instruments on your feet.
• Keep your feet warm. Wear loose socks to bed. Don't get your feet wet in snow or rain.
• Keep blood supply flowing to your feet. Don't sit cross-legged or smoke.

Here is some basic advice about shoes and socks: Never walk barefoot or in sandals or thongs. Choose and wear your shoes carefully. Buy new shoes late in the day when your feet are larger. Wear new shoes for only two hours or less at a time. Don't wear the same pair every day. Inspect the inside of each shoe before putting it on. Don't lace your shoes too tightly or loosely. Wear clean, dry socks every day. Avoid socks with holes or wrinkles. Thin cotton socks are more absorbent for summer wear. Square-toed socks will not squeeze your toes. Avoid stockings with elastic tops.

Ulcers can cause infection to develop in the foot. Another problem is the development of Charcot (pronounced "sharko") change in the foot and ankle. This is one of the most serious foot problems a diabetic can face. It deforms the foot because the bones fracture and disintegrate. Unfortunately, the person experiences no pain and continues to walk.

A total contact cast may be used to treat diabetic foot ulcers and early phases of Charcot fractures. These can be effective in the healing process by distributing weight and relieving pressure. The cast is changed as the swelling goes down.

A custom-walking boot may be used after the total contact cast to support the foot until all the swelling goes down, which can take as long as a year. Surgery is considered if the deformity is too severe for a brace or shoe.