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 Diabetics and Denial

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 How Can Diabetes Affect My Feet?

For people with diabetes, having too much glucose (sugar) in their blood for a long time can cause some serious complications.  Last week we talked about the sexual complications associated with diabetes.    This week we will talk about another very important, often overlooked, but sometimes debilitating complication.  Diabetic foot problems.  

One of the crucial components in the management of Diabetes is Foot Care, but sadly it is an area that is being neglected, and much harm has been done by the treatment of  foot ailments by people who have no professional knowledge of Foot Care, thus frequently causing undue suffering to the patient.

Diabetes can cause two main problems that can affect your feet.    Diabetics can get Diabetic neuropathy and Peripheral vascular disease

Diabetic neuropathy is when uncontrolled diabetes has damaged your nerves. If you have damaged nerves in your legs and feet, you might not feel heat, cold, or pain.

If you do not feel a cut or sore on your foot because of neuropathy, the cut could get worse and become infected. The muscles of the foot may not function properly because the nerves that make the muscles work are damaged. This could cause the foot to not align properly and create too much pressure in one area of the foot. It is estimated that more than ten percent of diabetics will develop foot ulcers.

This number will be higher for those people who live in third world countries and do a lot of walking, for long distances. These foot ulcers occur because of nerve damage and peripheral vascular disease.

Peripheral vascular disease  is a circulation disorder that affects blood vessels away from the heart and cause poor blood flow in the arms and legs.  Without good blood flow, it takes longer for a sore or cut to heal.   If you have an infection that will not heal because of poor blood flow, you are at risk for developing ulcers or gangrene (the death of tissue due to a lack of blood).

A small cut on a toe once sent an diabetic acquaintance of mine to the emergency room. Most people would have just slapped a Band-Aid on the "injury" and forgotten about it. But most people don't have diabetes.

She sometimes joked that somebody could cut off her  toes, and she would never feel it.. Worse, the disease had harmed her circulation, so that the blood flow to her feet had slowed to a trickle. As a result, even the most trivial sores would be slow to heal.

It took the trip to the emergency room and intravenous antibiotics to save her foot. I know some of you listening may have had this experience or know someone else who did.

Unlike people with normal blood sugar, diabetics need to examine their feet daily for the slightest injury. Since diabetes can cause neuropathy -- nerve death or damage -- a small cut could go undetected and lead to serious infection.  Diabetic foot infections are the leading cause of diabetic limb amputation.

 2: What are diabetes-related foot problems?

My friend still walks on two feet, but many people with diabetes aren't so fortunate. Every year, about 80,000 diabetics lose a leg, foot, or toes.

And in almost every case, this catastrophic injury had very humble beginnings. Foot problems such as:

Athlete's foot: is a fungus that causes itching, redness and cracking. Germs can enter through the cracks in your skin and cause an infection. Medicines

that kill the fungus are used to treat athlete's foot. These medicines may be pills and/or creams applied directly to the problem area. Ask your doctor to recommend a medication for athlete's foot.

Fungal infection of nails: Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick and brittle, and may separate from the rest of the nail. In some cases, the nail may crumble. The dark, moist and warm environment of shoes can promote fungal growth. In addition, an injury to the nail can put you at risk for a fungal infection. Fungal nail infections are difficult to treat. Medications applied directly to the nail are available, but they only help a small number of fungal nail problems. Oral medications (pills) may need to be prescribed by your doctor. Treatment also may include periodic removal of the damaged nail tissue.

Calluses:  A callus is a build-up of hard skin, usually on the underside of the foot. Calluses are caused by an uneven distribution of weight, generally on the bottom of the forefoot or heel. Calluses also can be caused by improperly fitting shoes or by a skin abnormality. Keep in mind that some degree of callus formation on the sole of the foot is normal. Proper care is necessary if you have a callus. After your bath or shower, use a pumice stone to gently remove the build-up of tissue. Use cushioned pads and insoles in your shoes. Medications also may be prescribed to soften calluses. DO NOT try to cut the callus or remove it with a sharp object.

Corns: A corn is a build-up of hard skin near a bony area of a toe or between toes. Corns may be the result of pressure from shoes that rub against the toes or cause friction between the toes. Proper care is necessary if you have a corn. After your bath or shower, use a pumice stone to gently remove the build-up of tissue. Do not use over-the-counter remedies to dissolve corns. DO NOT try to cut the corn or remove it with a sharp object.

Blisters: can form when your shoes rub the same spot on your foot. Wearing shoes that do not fit properly or wearing shoes without socks can cause blisters, which can become infected. When treating blisters, it's important not to "pop" them. The skin covering the blister helps protect it from infection. Use an antibacterial cream and clean, soft bandages to help protect the skin and prevent infection.

Bunions: A bunion forms when your big toe angles in toward the second toe. Often, the spot where your big toe joins the rest of the foot becomes red and callused. This area also may begin to stick out and become hard. Bunions can form on one or both feet. They may run in the family, but most often are caused by wearing high-heeled shoes with narrow toes. These shoes put pressure on the big toe, pushing it toward the second toe. The use of felt or foam padding on the foot may help protect the bunion from irritation. A device also may be used to separate the big and second toes. If the bunion causes severe pain and/or deformity, surgery to realign the toes may be necessary.

Severely Dry skin: Dry skin can crack, which can allow germs to enter. Use moisturizing soaps and lotions to help keep your skin moist and soft. :

Foot ulcers: A foot ulcer is a break in the skin or a deep sore, which can become infected. Foot ulcers can result from minor scrapes, cuts that heal slowly or from the rubbing of shoes that do not fit well. Early intervention is important in treatment.

Hammertoes: A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also be cause by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems, such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating them. In severe cases, surgery to straighten the toe may be necessary.

Ingrown toenails: Ingrown toenails occur when the edges of the nail grow into the skin. They cause pressure and pain along the nail edges. The edge of the nail may cut into the skin, causing redness, swelling, pain, drainage and infection. The most common cause of ingrown toenails is pressure from shoes. Keeping your toenails properly trimmed is the best way to prevent ingrown toenails.

And Plantar warts:  look like calluses on the ball of the foot or on the heel. They may appear to have small pinholes or tiny black spots in the center. The warts are usually painful and may develop singly or in clusters. Plantar warts are caused by a virus that infects the outer layer of skin on the soles of the feet. DO NOT use over-the-counter medications to dissolve the wart. If you are not sure if you have a plantar wart or a callus, let your doctor decide.

If diabetes has already dulled the sensations and slowed down circulation in your feet, just about any break in the skin can turn into a dangerous, festering wound. It may start with a callus, a small blister, a corn, a cut, or a scrape. Often, these seemingly trivial problems turn into open sores or ulcers.

The human foot teems with bacteria and fungi, and the ulcers can quickly become infected. And when the blood supply is very low, the immune system can't send its normal reinforcements. If not treated with antibiotics, the infection can spread to the soft tissue of the foot and, eventually, to the bone. At that point, amputation may be the only option.

3: Can These Foot Problems Be Prevented?  If so, what can you do to prevent foot problems?

Can These Foot Problems Be Prevented? Certainly.  By taking a few extra precautions, people with diabetes can prevent infections and save their feet.

Proper foot care can help prevent these common foot problems and/or treat them before they cause serious complications.

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 Here are some tips for good foot care and for protecting your feet:

1.     Take care of yourself and your diabetes. Follow your health care provider's advice regarding nutritionexercise, and medication. Keep your blood glucose level within the range recommended by your doctor.

2.     Wash your feet in warm water every day, using a mild soap. Do not soak your feet. Test the water with a finger to make sure it's not too hot. Don't soak your feet, though, because soaking may dry the skin. Dry your feet well, especially between the toes.

3.     Check your feet every day for sores, blisters, redness, calluses, or any of the other problems listed above. If you have poor blood flow, it is especially important to do a daily foot check.

4.     If the skin on your feet is dry, keep it moist by applying lotion after you wash and dry your feet. Do not put lotion between your toes. Your doctor can tell you which type of lotion is best to use.

5.     Gently smooth corns and calluses with an emery board or pumice stone, only after your doctor says it's ok to do so. Do this after your bath or shower, when your skin is soft. Move the emery board in only one direction.

6.     Check your toenails at least once a week. Trim your toenails with a nail clipper straight across. Do not round off the corners of toenails or cut down on the sides of the nails. After clipping, smooth the toenails with an emery board.

7.     Always wear closed-toed shoes or slippers. Do not wear sandals and do not walk barefoot, even around the house.

8.     Always wear socks or stockings. Wear socks or stockings that fit your feet well and have soft elastic.

9.     Wear shoes that fit well. Buy shoes made of canvas or leather and break them in slowly. Extra wide shoes are also available in specialty stores that will allow for more room for the foot for people with foot deformities.

10.    Protect your feet from heat and cold. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.

11.    Keep the blood flowing to your feet. Put your feet up when sitting, wiggle your toes and move your ankles several times a day, and don't cross your legs for long periods of time.

12.    If you smoke, QUITs. Smoking can make blood flow problems worse. 

Smoking hampers blood flow, and 90 percent of diabetics who lose a foot are smokers.

13.   If you have a foot problem that gets worse or won't heal, contact your doctor for advice and treatment. 

14:  Make sure your diabetes doctor examines your feet during each check-up. An annual foot exam should be performed which should include an inspection of the skin.  Taking off your shoes and socks before the exam will help remind both of you about the foot inspection. He or she may check for redness or warm of the skin. The exam will also be to check for pulses and temperature of your feet and an assessment of sensation to the foot.

(Be sure to see the doctor for a diabetes checkup regularly - at least two to four times a year, depending on your condition.)

As a diabetic, you should try to see your podiatrist (foot doctor) every two to three months for check-ups, even if you don't have any foot problems.

People with diabetes can ward off nerve damage and circulation problems by keeping their blood sugar under control.  

If diabetes has already slowed your circulation and numbed your extremities, you need to give your feet special attention. When you lose sensation you tend to ignore that part of your body. But diabetics can't take their feet for granted."

Have the doctor check your feet at every visit.

At home, inspect your feet at least once every day. If you have difficulty inspecting your feet by yourself, enlist the help of a family member, a friend  or a neighbor.

Contact your doctor if you experience any of the following problems:


         Changes in skin color.

·         Changes in skin temperature.

·         Swelling in the foot or ankle.

·         Pain in the legs.

·         Open sores on the feet that are slow to heal or are draining.

·         Ingrown toenails or toenails infected with fungus.

·         Corns or calluses.

·         Dry cracks in the skin, especially around the heel.

·         Unusual and/or persistent foot odor

5:  What are some other tips?

Here are some other tips for protecting your feet:   

• Shoes should fit properly, with ample room. Avoid high heels or shoes with pointed toes that put too much pressure on the feet.

• Inspect your shoes for pebbles or anything else that can damage your skin.

• Never use heating pads, electric blankets, or hot water bottles that can -9---burn your feet.

• Keep the blood flowing to your feet. When you sit, wiggle your toes for five minutes, two or three times a day. Move your ankles in and out and up and down to improve blood flow.

• Don't cross your legs.

• Never wear tight socks, garters, or any type of elastic bands around your feet. Eat a healthy diet suitable for your condition. 

Keep monitoring your blood sugar conscientiously and take your medications as ordered by your doctor.

• Get your blood flowing with walking, swimming, yoga, biking, dancing, and other low-impact activities. Remember exercise is good for diabetics, but try to avoid high-impact exercise like running and jumping.


Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.

Please take care of your feet.  Diabetic neuropathy or Peripheral vascular disease does not have to stall your strides if you take care and check your feet regularly.  Please enlist the help of your family, a friend or neighbor to help you check your feet if you cannot do it yourself.  You tell them everything else, so why not ask for their assistance in something that matters so much?

Taking this problem seriously can prevent amputation of a digit, foot or leg.  If you are not diabetic and have a friend or family member who is, please help them to be proactive in their care.  Now might be a good time for you to show how much you really love and care for them.  Remember, they need to get regular foot checks by the doctor even if they don't think it's necessary.!


This information is not intended to be a substitute for professional medical advice.  The information is general in nature and may be helpful to some people with diabetes related foot problems, but not to others, depending upon your personal medical needs.  

As with everything, you must practice due diligence and should always consult with your personal doctor or certified diabetes educator prior to changing any part of your diabetes care.  These health professionals are in the best position to evaluate what is appropriate for your specific diabetic needs.  NEVER disregards professional medical advice, or delay in seeking it because of anything you read here. 

1 Corinthians 6:19-20  "Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body."

May God Cover you with his Grace and Loving Kindness.  Take heed and get the help that you need so that you can live a healthy, productive, and content life. 



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