Foot care for those at high risk of developing a foot ulcer
Every person with diabetes needs to be careful about the feet. However, if the risk is high because of neuropathy or peripheral vascular disease or other factors (see the section on Foot Examination), then particular attention is needed. This section is specifically for this group of individuals.
Look at your feet - every day. Look at the top and bottom of your foot. Look and feel in between your toes and around the heel area.What to look for:
If you are unable to see your feet use a mirror or ask someone to help you if you cannot manage to examine your own feet.
Check for Corns and Calluses (hardened skin).
Corns and calluses can be a problem. They cause pressure and can lead to ulceration. Never trim or cut a corn yourself. Do not use a corn pad, they burn the skin and you may develop an ulcer from this. Using a pumice stone can also be dangerous, as you cannot feel your feet. The only safe way to treat a corn or callus is to see a podiatrist.
Wash your feet every day using warm water and mild soap. Check the water with your elbow first to make sure it is not too hot. Dry your feet using a light coloured towel, especially between the toes. Look at the towel to make sure there is no blood or pus on it. If you can see any blood or pus tell your doctor immediately.
It is important to dry between your toes well. If the skin between your toes becomes white and soggy (macerated) apply some methylated spirits using a cotton bud. If the problem doesn't go away in a couple of days, see your doctor. You may need a tinea lotion.
Rub cream into your feet to stop them getting dry and cracked. Do not put cream between the toes. Use the cream twice a day if your feet are very dry. There are special creams for very dry and cracked heels containing urea. A cream in a pump bottle is preferable as it rubs in more easily.
Nail care : Do not cut your nails too short. Cut your nails straight across. Always check your nails for sharp edges. To smooth sharp edges use a nail file. If you are unable to cut your nails, see a podiatrist..
Removal of callus on a regular basis. Again this is preferably done by a podiatrist in this group of high risk individuals.
Callus before and after removal
Soaking the feet is not recommended as daily footcare. However
if the feet are soaked for any reason it should be no longer
than 2-3 minutes as this makes the skin too soft and fragile.
Bare feet are not only at high risk of injury, but the pressure under the foot is increased when walking without the cushioning of shoes to protect the feet. Wear thick socks with well cushioned, closed shoes which are large enough to fit the foot and sock.
Be careful about exposure to direct heat such as bar heaters
or hot water bottles to warm the feet as these can cause burns
in someone with diminished sensation. Wear thick socks to keep
the feet warm.
Surf shoes commercially available
Wearing new shoes is one of the commonest precipitating causes of developing foot ulceration. Buy new shoes in the afternoon when the feet are at their largest. Have your feet properly measured as shoe size not only changes as we get older but people with neuropathy can have a change in foot shape and size. Also, people with neuropathy tend to buy shoes that are too small as they cannot feel that the shoe is too tight.
Further information on shoes for high risk feet can be found on our next topic.