It can be challenging to live with diabetes, especially if you have to limit your diet, monitor your blood sugar levels, and stay active. One aspect of managing diabetes that is often overlooked is proper foot care. Daily foot care and the right shoes are among the easiest ways to prevent complications related to diabetes.
Are you one of the two million Canadians currently living with diabetes? If so, did you know that one of the severe complications related to this disease is the amputation of a lower limb or foot?
It is estimated that 80,000 – 200,000 Canadians with diabetes will be affected by foot problems such as foot ulcers. Up to 24% of this group will risk losing a lower limb or foot through amputation.
The Dangers Diabetes Presents to the Foot
Diabetes is one of the most prevalent diseases and affects more and more Canadians each year. It is a disease where the body cannot produce insulin (type 1), or the body does not create enough or cannot effectively utilise the produced insulin (type 2). The third type of diabetes occurs during pregnancy and is called gestational diabetes.
Some people living with diabetes develop circulation problems in their feet (vascular disease) and lose sensation in the soles of their feet (peripheral neuropathy). These complications can have serious repercussions if the feet are not taken care of properly.
The gradual loss of sensation in the feet puts the person at risk of injuring their foot and not being aware of it. Improperly fitting shoes, unsupportive footwear, and even foreign objects (like a tiny pebble) can cause a wound to appear and often, the person cannot even feel it. If someone has neuropathy to this extent, they also likely have compromised circulation, which means a wound or ulcer will not heal as quickly, increasing the risk for infection. If an infection sets into a foot ulcer, immediate care is necessary to prevent the spread of the disease and reduce the risk of amputation.
With this in mind, people with diabetes should rely not only on how their feet feel but also on how they look. It is imperative to perform daily visual inspections of the feet to ensure there are no cuts, blisters, or abnormalities in the skin. Individuals who cannot see their feet properly should use a specialised mirror or ask for help from their spouse, family member, or caregiver.
Daily Foot Care Tips For People With Diabetes
- Do a daily visual foot inspection, and be alert for redness, swelling, broken skin, sores or bleeding. See a doctor immediately if any of these problems arise.
- Wear good-fitting shoes outdoors and around the house to protect the feet from injury.
- Wash the feet with soap and warm water every day, but do NOT soak them.
- Avoid socks with heavy seams as they can cause skin irritation and lead to breakdown or ulceration.
- Do NOT wear tight, constrictive socks or clothing that could limit circulation to the extremities.
Shoe selection is also vital for those who are living with diabetes. Canadian Certified Pedorthists are trained to troubleshoot shoe fit issues for people with diabetes and ensure the person is wearing correctly fitted shoes. If an off-the-shelf shoe does not fit properly, the Canadian Certified Pedorthist will modify the footwear to accommodate the problem.
A Canadian Certified Pedorthist will also build custom foot orthotics to offload any pressure points in the foot that pose a risk for ulceration. A properly fitted shoe and a custom foot orthotic are often the best way to prevent the severe complications of diabetes and ultimately help the person maintain an active and healthy lifestyle.
Essential Shoe Features to Prevent Problems
- Soft upper materials (including everything located above the sole) allow the shoe to accommodate boney prominences and reduce friction.
- Pressure points may develop in shoes with very tiny stitching or seams, and the shoe may not easily stretch when rubbing against the foot. (Shoes can be “spot-stretched” to alleviate specific pressure points like this).
- Removable insoles are beneficial for sizing as you can remove them and place your foot on top of the sole to ensure it does not overhang the insole. If the foot overhangs the insole, it is an indication that the shoe is too narrow or too short.
- Taking the insole out of the shoe every week will help identify high-pressure spots under the foot, as these areas will have compressed the insole more aggressively than any other area. Often this is a sign that a custom foot orthotic would be beneficial to help distribute pressure more evenly under the base of the foot and reduce any high-pressure spots that can be prone to ulceration.
- Avoid restrictive footwear such as high heels with pointed toes or narrow shoes. There should be a full finger width between the end of the longest toe and the end of the shoe.
Through regular foot examinations and by following the suggested shoe fitting tips, those living with diabetes can maintain the health of their feet. In the event of any complications, people with diabetes must visit their doctor right away. They will likely be referred to a foot specialist, like a Canadian Certified Pedorthist, to assess the foot for a custom foot orthotic or modify their shoes.
