Why caring for your feet is so important if you have diabetes

Both type 1 and type 2 diabetes affect your feet, and other parts of your body, by compromising the blood supply to these areas.

Matthew Fitzpatrick, a podiatrist from The College of Podiatry says that diabetes can affect organs or parts of the body that are at the end of the circulatory system.

He explains: "With diabetes your body has an inability to keep glucose levels in the system controlled."

High levels of glucose affect the complex and sensitive interplay of chemicals and enzymes in the walls of blood vessels, leading to damage. Tiny blood vessels are easily damaged, meaning blood supply to your feet and other areas - including the kidneys and eyes - may be compromised.

How does diabetes affect the feet?

When blood vessels in your feet are damaged, you will often notice a loss of sensation - usually starting with tingling in your toes which progresses into your foot.

"It starts as a little bit of tingling, leading to absence of feeling, sometimes to the point where you could drive a knife through your foot and you wouldn't even flinch," says Fitzpatrick.

Compromised blood supply also means that any wounds to your foot will take longer to heal. The combination of these two factors can have consequences.

"For example, if you stand on a pin, the immediate thing you do is remove your foot," explains Fitzpatrick. "If you have diabetes and no feeling in your feet you could stand on burning hot coals and not know it.

"Then when you do get an ulcer or a wound, the compromised blood supply makes healing difficult - posing the likelihood of infection."

Dan Howarth, former Head of Care, Diabetes UK says the end treatment of foot complications may be an amputation.

"It's worrying, but it's important to understand that it can happen," he warns.

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Who is most at risk of foot problems?

Everyone with diabetes has a chance of developing foot problems. However, managing the condition effectively can reduce this chance.

Fitzpatrick says that even if you are strict with your diet and meticulous with taking your medicine you will still experience damage and deterioration over time - although it won't happen at the same pace.

Many with the condition don't take these health concerns seriously until issues occur.

"The challenge is that when you are first diagnose with diabetes, you do not feel anything unless your blood sugars are very high," explains Fitzpatrick. "If you have a back pain, you don't do things that make your back sore. If you have an infected cut you take steps to stop it getting worse.

"But with type 2 diabetes in particular, you won't necessarily see anything wrong."

There has been much discussion about reversing type 2 diabetes.

Howarth says, however, that whilst the condition can be minimised with correct management, the term 'reversal' is misleading and can lead to people underestimating their susceptibility.

"We use the term 'remission' rather than 'reversal'," he explains. "In remission you still have diabetes but you don't have the symptoms. It's too soon to say whether being in remission will prevent people from developing complications.

"If you have been told you are in remission, continue to have your checks, including a yearly eye check, appropriate blood tests and foot screening. People with all types of diabetes - no matter what stage - require these tests in order to prevent long-term damage and to help manage your diabetes on a day-to-day basis."

How can I keep my feet healthy?

Whilst damage to the blood vessels in your feet is a problem for all people with diabetes, managing your condition well should reduce these odds. As well as following medical advice and taking prescribed medicine, this means keeping a careful eye on your feet so that any potential problems can be dealt with before they worsen.

Thorough checking

Fitzpatrick advises that people with diabetes should check their feet twice-daily.

"Top, bottom, in between the toes, all around the feet, and behind the heels for anything that might look like a break in the skin, the development of hard skin, a bump a bruise, or an injury," he says.

"If you lack the flexibility to inspect your feet manually, try putting a small mirror on the floor," adds Fitzpatrick. "Move your foot over it to see whether you can see anything untoward underneath."

Proper washing and drying

Wash your feet with soap and warm water - but make sure it's not too hot. Then dry your feet well, taking particular care between your toes. Drying your skin properly will prevent infections - such as athlete's foot - from forming.

Careful moisturising

Fitzpatrick points out that you also need to keep your skin supple, so it's important to moisturise your feet.

"Loss of blood supply and nerve damage reduces the hydration so feet then become dry," he says. "This may lead to cracking - which can become a point of infection."

A review of studies shows that it can be effective in a wide variety of conditions, including eczema and dermatitis, and has a good safety profile. You can use a low-concentration (10%) urea cream for daily maintenance, while a stronger cream (25%) can be useful for treating calluses.

Further tips

Another important aspect of caring for your feet is ensuring that you wear suitable footwear. Ill-fitting shoes can lead to nail-damage, blisters, calluses or other foot problems, which can in turn lead to infection. It's worth getting your feet measured and choosing shoes that are the right fit.

Specialised footwear is also available, and for those with particular needs, certain footwear may be available on prescription. Talk with your podiatrist about your particular foot needs and make sure you follow advice carefully.

"My advice is that if you have diabetes and experience any loss of sensation in your feet and you have a wound on your foot, you should go to see a doctor," Fitzpatrick advises. "It's absolutely about stopping the problem getting worse."