Nerve damage. With damaged nerves, you might not feel pain, heat, or cold in your legs or feet. A sore or cut on the foot may get worse because there is no pain sensation. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can keep sores and infections hidden until they become serious.
Poor blood flow. You may also have circulation problems. Poor blood flow makes it hard to fight off infection. Decreased blood flow can also be painful. This problem is called peripheral vascular disease, also called PVD. Lack of good blood flow to the legs means not enough energy can be delivered to the muscles when exercising. PVD can lead to extreme pain when walking. Smoking can make these blood flow problems much worse.
Infection risk. A variety of problems with diabetes lead to an increase in the risk of infection. (An article about the risk of infection with diabetes is included in this newsletter). Nerve damage, poor blood flow, and high infection risk can work together to cause foot problems.. For example, you may get a blister from shoes that do not fit well. You do not feel the pain from the blister because there is nerve damage in the foot. Next, the blister could get infected. If blood glucose is high, the extra glucose feeds the bacteria, which grows and causes the infection to get worse.
Poor blood flow to the legs and feet can slow down healing. Once in a while a bad infection will not heal. The infection might cause gangrene, a condition that causes the skin and tissue around the sore to change color and die. To keep gangrene from spreading, a doctor may have to do surgery to remove the affected area.
To prevent foot problems you should:
- Wash your feet every day with lukewarm (not hot) water and mild soap.
- Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror or have someone else check them for you.
- If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
- Cut your toenails once a week or when needed. It is easier to cut toenails when they are soft from washing. Cut them to the shape of your toe and not too short. File the edges with an emery board. If your toenails have become too thick to cut with nail clippers, a podiatrist is recommended.
- Always wear slippers or shoes to protect your feet from injuries.
- Always wear socks or stockings to avoid blisters.
- Wear shoes that fit well.
- Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.
- Tell your doctor right away about any foot problems; and seek a podiatrist when there are problems with your feet.
Bremo carries a line of shoes especially designed for people with foot problems. These stylish shoes come in many styles, widths, and sizes. Our trained shoe fitter can help you find the right shoes for you
Michelle Herbert Thomas, PharmD, CDE
Clinical Director, Richmond Apothecaries Incorporated
