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Diabetes Care
Since this is one of the most requested searches on our
sight, we have added more information for you below. If you are suffering
from foot pain and have diabetes, make sure your print out this
Foot Care
Checklist and follow it! (This is a .pdf file that requires Adobe Acrobat to
read. If you do not have Adobe, click the logo for a free copy.

Here is a list of topics to ease your search:
Foot Care Tips
Common Problem Definitions
Therapeutic Shoe Bill
Diabetes Resources Books on
Diabetes Buy for
Diabetic Shoes
Foot Care
Checklist
Certificate Statement
for Shoe Bill
Special Foot Measurement for Diabetics
People with diabetes can develop many different
foot problems. Even ordinary problems can get worse and lead to serious
complications.
Foot problems most often happen when there is
nerve damage, also called neuropathy, which results in loss of feeling in your
feet. Poor blood flow or changes in the shape of your feet or toes may also
cause problems.
Inspect your feet every day, and seek care early
if you do get a foot injury. Make sure your health care provider checks your
feet at least once a year - more often if you have foot problems. Your health
care provider should also give you a list and explain the do's and don'ts of
foot care. Most people can prevent any serious foot problem by following some
simple steps. So let's begin taking care of your feet today.
Neuropathy
Although
it can hurt, diabetic nerve damage can also lessen
your ability to feel pain, heat, and cold. Loss of feeling often means you may
not feel a foot injury. You could have a tack or stone in your shoe and walk on
it all day without knowing. You could get a blister and not feel it. You might
not notice a foot injury until the skin breaks down and becomes infected.
Nerve damage can also lead to changes in
the shape of your feet and toes. Ask your health care provider about special
therapeutic shoes, rather than forcing deformed feet and toes into regular
shoes.
Skin Changes
Diabetes can cause changes in the skin of your foot. At times your foot may
become very dry. The skin may peel and crack. The problem is that the nerves
that control the oil and moisture in your foot no longer work.
After bathing, dry your feet and seal in the remaining
moisture with a thin coat of plain petroleum jelly, an unscented hand cream, or
other such products.
Do not put oils or creams between your toes. The extra
moisture can lead to infection. Also, don't soak your feet - that can dry your
skin.
Calluses
Calluses occur more often and build up faster on the feet of people with
diabetes. This is because there are high-pressure areas under the foot. Too
much callus may mean that you will need therapeutic shoes and inserts.
Calluses, if not trimmed, get very thick, break down,
and turn into ulcers (open sores). Never try to cut calluses or corns yourself
- this can lead to ulcers and infection. Let your health care provider cut your
calluses. Also, do not try to remove calluses and corns with chemical agents.
These products can burn your skin.
Using a pumice stone every day will help keep calluses under control. It is
best to use the pumice stone on wet skin. Put on lotion right after you use the
pumice stone.
Foot Ulcers
Ulcers occur most often on the ball of the foot or on the bottom of the big
toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes.
Remember, even though some ulcers do not hurt, every ulcer should be seen by
your health care provider right away. Neglecting ulcers can result in
infections, which in turn can lead to loss of a limb.
What your health care provider will do varies with your
ulcer. Your health care provider may take x-rays of your foot to make sure the
bone is not infected. The health care provider may clean out any dead and
infected tissue. You may need to go into the hospital for this. Also, the
health care provider may culture the wound to find out what type of infection
you have, and which antibiotic will work best.
Keeping off your feet is very important. Walking on an
ulcer can make it get larger and force the infection deeper into your foot.
Your health care provider may put a special shoe, brace, or cast on your foot to
protect it.
If your ulcer is not healing and your circulation is
poor, your health care provider may need to refer you to a vascular surgeon.
Good diabetes control is important. High blood glucose levels make it hard to
fight infection.
After the foot ulcer heals, treat your foot carefully.
Scar tissue under the healed wound will break down easily. You may need to wear
special shoes after the ulcer is healed to protect this area and to prevent the
ulcer from returning.
Poor Circulation
Poor circulation (blood flow) can make your foot less able to fight infection
and to heal. Diabetes causes blood vessels of the foot and leg to narrow and
harden. You can control some of the things that cause poor blood flow. Don't
smoke - smoking makes arteries harden faster. Also, follow your health care
provider's advice for keeping your blood pressure and cholesterol under control.
If your feet are cold, you may be tempted to warm them.
Unfortunately, if your feet cannot feel heat, it is easy for you to burn them
with hot water, hot water bottles, or heating pads. The best way to help cold
feet is to wear warm socks.
Some people feel pain in their calves when walking fast, up a hill, or on a
hard surface. This condition is called intermittent claudication
. Stopping to rest for a few moments should end the pain. If you have
these symptoms, you must stop smoking. Work with your health care provider to
get started on a walking program. Some people can be helped with medication to
improve circulation.
Exercise is good for poor circulation. It stimulates blood flow in the legs
and feet. Walk in sturdy, good-fitting, comfortable shoes. Don't walk when you
have open sores.
Amputation
People with diabetes are far more
likely to have a foot or leg amputated than other people. The problem? Many
people with diabetes have artery disease, which reduces blood flow to the feet.
Also, many people with diabetes have nerve disease, which reduces sensation.
Together, these problems make it easy to get ulcers and infections that may lead
to amputation. Most amputations are preventable with regular care and proper
footwear.
For these reasons, take good care of your feet and see
your health care provider right away about foot problems. Ask about prescription
shoes that are covered by Medicare and other insurance. Always follow your
health care provider's advice when caring for ulcers or other foot problems.
One of the biggest threats to your feet is smoking . Smoking affects
small blood vessels. It can cause decreased blood flow to the feet and make
wounds heal slowly. A lot of people with diabetes who need amputations are
smokers.
Prevention
Your
health care provider should perform a complete foot exam at least annually -
more often if you have foot problems.
Remember to take off your socks and shoes while you wait
for your physical examination.
Call or see your health care provider if you have cuts
or breaks in the skin, or have an ingrown nail. Also, tell your health care
provider if your foot changes color, shape, or just feels different (for
example, becomes less sensitive or hurts).
If you have corns or calluses, your health care provider
can trim them for you. Your health care provider can also trim your toenails if
you cannot do so safely.
Because people with diabetes are more prone to foot problems, a foot care
specialist may be on your health care team.
Caring for Your
Feet
There is a lot you can do to prevent serious problems with your
feet. Here's how.
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1. Take care of your diabetes.
- Make healthy lifestyle choices to help keep your blood glucose
(sugar), blood pressure, and cholesterol close to normal. Doing so may
help prevent or delay diabetes-related foot problems as well as eye and
kidney disease.
- Work with your health care team to make a diabetes plan that fits your
lifestyle. The team may include your doctor, a diabetes educator, a nurse,
a dietitian, a foot care doctor called a podiatrist (pah-DI-ah-trist), and
other specialists. This team will help you to:
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2. Check your feet every day.
- You may have serious foot problems, but feel no pain. Check your feet
for cuts, sores, red spots, swelling, and infected toenails. Find a time
(evening is best) to check your feet each day. Make checking your feet
part of your every day routine.
- If you have trouble bending over to see your feet, use a plastic
mirror to help. You also can ask a family member or caregiver to help you.
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3. Wash your feet every day.
- Wash your feet in warm, not hot, water. Do not soak your feet, because
your skin will get dry.
- Before bathing or showering, test the water to make sure it is not too
hot. You can use a thermometer (90° to 95° F is safe) or your elbow.
- Dry your feet well. Be sure to dry between your toes. Use talcum
powder or cornstarch to keep the skin between your toes dry.
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4. Keep the skin soft and smooth.
- Rub a thin coat of skin lotion, cream, or petroleum jelly on the tops
and bottoms of your feet.
- Do not put lotion or cream between your toes, because this might cause
an infection.
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5. Smooth corns and calluses gently.
- If you have corns and calluses, check with your doctor or foot care
specialist about the best way to care for them.
- If your doctor tells you to, use a pumice stone to smooth corns and
calluses after bathing or showering. A pumice stone is a type of rock used
to smooth the skin. Rub gently, only in one direction, to avoid tearing
the skin.
- Do not cut corns and calluses. Don't use razor blades, corn plasters,
or liquid corn and callus removers -- they can damage your skin.
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6. Trim your toenails each week or when needed.
- Trim your toenails with clippers after you wash and dry your feet.
- Trim toenails straight across and smooth them with an emery board or
nail file.
- Don't cut into the corners of the toenail.
- If you can't see well, if your toenails are thick or yellowed, or if
your nails curve and grow into the skin, have a foot care doctor trim
them.
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7. Wear shoes and socks at all times.
- Wear shoes and socks at all times. Do not walk barefoot -- not even
indoors -- because it is easy to step on something and hurt your feet.
- Always wear socks, stockings, or nylons with your shoes to help avoid
blisters and sores.
- Choose clean, lightly padded socks that fit well. Socks that have no
seams are best.
- Check the insides of your shoes before you put them on to be sure the
lining is smooth and that there are no objects in them.
- Wear shoes that fit well and protect your feet.
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8. Protect your feet from hot and cold.
- Wear shoes at the beach or on hot pavement.
- Put sunscreen on the top of your feet to prevent sunburn.
- Keep your feet away from radiators and open fires.
- Do not put hot water bottles or heating pads on your feet.
- Wear socks at night if your feet get cold. Lined boots are good in
winter to keep your feet warm.
- Check your feet often in cold weather to avoid frostbite.
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9. Keep the blood flowing to your feet.
- Put your feet up when you are sitting.
- Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles
up and down and in and out to improve blood flow in your feet and legs.
- Don't cross your legs for long periods of time.
- Don't wear tight socks, elastic or rubber bands, or garters around
your legs.
- Don't smoke. Smoking reduces blood flow to your feet. Ask for help to
stop smoking.
- Work with your health care team to control your A1C (blood glucose),
blood pressure and cholesterol.
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10. Be more active.
- Ask your doctor to help you plan a daily activity program that is
right for you.
- Walking, dancing, swimming, and bicycling are good forms of exercise
that are easy on the feet.
- Avoid activities that are hard on the feet, such as running and
jumping.
- Always include a short warm-up and cool-down period.
- Wear athletic shoes that fit well and that provide good support.
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11. Be sure to ask your doctor to
- Check the sense of feeling and pulses in your feet at least once a
year.
- Tell you if you are likely to have serious foot problems. If you have
serious foot problems, your feet should be checked at every visit to your
doctor.
- Show you how to care for your feet.
- Refer you to a foot care doctor if needed.
- Decide if special shoes would help your feet stay healthy.
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12. Get started now.
- Begin taking good care of your feet today.
- Set a time every day to check your feet.
- Note the date of your next visit to the doctor.
- Set a date for buying the things you need to take care of your feet:
nail clippers, pumice stone, emery board, skin lotion, talcum powder,
plastic mirror, socks, athletic shoes, and slippers.
- Most important, stick with your foot care program .... and give
yourself a special treat such as a new pair of lightly padded socks with
no seams. You deserve it!
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These care tips are from
NIH Publication No. 01-4285
October 2001
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Looking for more information on foot care? Visit the
BFS Reading
Room and find volumes of books written specifically for Diabetics.
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Or contact these offices:
American Association of Diabetes Educators
Web site: www.aadenet.org
1-800-TEAM-UP-4
American Diabetes Association
Web site: www.diabetes.org
1-800-DIABETES
American Podiatric Medical Association
Web site: www.apma.org
1-800-FOOTCARE
Centers for Disease Control and Prevention
Division of Diabetes Translation
Web site: www.cdc.gov/diabetes
1-877-232-3422
Juvenile Diabetes Research Foundation International
Web site: www.jdrf.org
1-800-533-CURE
National Diabetes Education Program
Web site: www.ndep.nih.gov
1-800-438-5383
National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse (NDIC)
Web site: www.niddk.nih.gov
1-800-860-8747

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