Why is foot care important in the diabetic patient?
In the evolution of diabetes, the most frequent complications are the involvement of nerves and arteries. Vascular alterations alter the blood circulation and facilitate the appearance of edema and poorly vascularized areas, which hinder the healing of injuries and wounds. Diabetic neuropathy causes loss of sensation, muscle atrophy and pain.
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Both alterations have special repercussions on the feet, increasing the frequency of production of erosions, punctures, cuts, burns ... that if not taken care of become ulcers, facilitate infection and can lead to gangrene and the need for amputations.
How should the feet be taken care of in the diabetic patient?
To avoid the appearance of ulcers, lesions, infections and necrosis in the feet, it is very important that the diabetic patient maintains a good control of the glycaemia and avoids the factors that can increase the risk of vascular and nervous lesions by:
- Control of blood glucose, maintaining correctly the treatment with insulin and / or oral hypoglycemic agents;
- Dietary diet that facilitates the stability of blood glucose levels, prevents obesity and ensures an adequate supply of proteins, vitamins and minerals to the body;
- Physical exercise that facilitates the maintenance of adequate weight, glucose metabolism and correct blood circulation in the feet;
- Keep good control of blood pressure and blood lipid levels;
- Do not smoke or consume alcohol or other drugs.
It is also essential to take care of the feet daily, checking them to see if wounds, chafing, blisters or cracks appear. For the daily review it is advisable to perform it with good natural lighting and inspecting all the areas of the floor and the interdigital spaces with the help of a mirror. You should go to the doctor in case of lesions, changes in color, pain or swelling in the feet.
The correct hygiene of the feet and the right choice of footwear is the basic strategy to avoid the appearance of chafing, wounds, burns and injuries:
- Wash your feet daily with warm water (not too hot, not exceeding 37 degrees or too cold). It is advisable to check the temperature of the water with a bath thermometer or with the elbow, since it is common for the feet to lose sensitivity and not to perceive the actual water temperature;
- Dry the feet well with a soft towel and without rubbing, with special care in the interdigital spaces. If the skin is very dry you can apply a moisturizer but with the precaution of not applying it in the interdigital spaces.
- Keep feet dry by using non-medicinal talcum powder before putting on shoes every morning and every time you change socks or footwear.
- The toenails should be cut with blunt-tipped scissors, and in a straight line to avoid incarnation, without rushing the cut or eroding the fingers. It is advisable to use a file to maintain the length of the nails and polish the edges.
- Do not cut or remove the hardness and calluses of your fingers, or use callicides, if necessary you should consult a podiatrist.
- Ointments, alcohol or disinfectants should not be used for foot wounds, as they can irritate the skin or change the color of the skin and wound, making it difficult for medical follow-up. The wounds should be washed with soap and water, following the doctor's recommendations.
- Feet should not be placed near fire, stoves or sources of heat.
- You should avoid the use of rubber bands, rubber bands or socks with elastics on the edge, since they hinder blood circulation.
- Avoid walking barefoot.
- Use sunscreen also on your feet if you are exposed to the sun.
How to choose the footwear?
In conjunction with hygiene standards, good habits of selection and use of footwear must be maintained:
- Footwear should always be used with socks.
- Do not use sandals, flip flops or shoes that leave your feet uncovered.
- The use of shoes with heels and ending in pointed shoes should be avoided.
- The footwear must be comfortable, that does not adjust or cause chafing or injury to the feet.
- The shoes are recommended to be leather, without internal seams, flexible, lightweight, breathable and with the floor that does not slip.
- It is advisable to buy the shoes at the end of the day, when the feet are more swollen, so the shoe that at that time is comfortable, it is guaranteed that it will be throughout the day.
- New shoes should be used for short periods during the first days.
- The purchase of orthopedic shoes must be made under criteria and medical prescription.
- The shoes must be properly maintained, repaired and ensuring the good condition of the soles.
- You should check the inside of the shoe before putting it on, to avoid any element (stone, gravel, any part of the shoe ...) that could injure the foot.
- It is advisable to have more than one pair of shoes to change them every day and to alternate them, thus ensuring a good ventilation of the shoes and avoiding the pressure always in the same areas of the foot.
- The socks and stockings must be made of natural fabrics (linen, cotton, wool) and without seams. No synthetic stockings or socks should be worn, with elastics or rubber bands. They should not be tight or loose in the leg and foot.
- The socks or socks should be changed daily, and if the feet sweat a lot or much exercise has been done more than once a day.
Very important!
- All diabetic patients must be properly vaccinated against tetanus.
- It is fundamental that the diabetic patient is going to check the feet by the sanitary equipment periodically, fulfilling his indications and watching the wounds and injuries of the feet.