The Do's and Dont's of Foot Care
Basic steps can help keep wounds at bay
A dLife reader asks:
My right big toe has a medium size wound on the bottom side that just will not fill in and heal. I have tried all the ointments and creams, dressings, bandages, you name it and nothing works. Meanwhile, I have ruined many a right sock with soaked pus/blood/fluids and my right shoe stinks beyond belief (even with the shoe powders used).
My work requires me to be on my feet for 10-12 hours a day and I do wear good shoes. I keep my blood sugar levels under 100 and test every day, eat the right foods and exercise as much as possible. I have been having foot pains and numbness in both feet now for almost a year and sort of fear the worst is coming... any suggestions???
Joy Pape, RN, BSN, CDE,WOCN,CFCN answers:
Hi Tony. I'm so glad you wrote. I know dLife contacted you as soon as we received your note instructing you to GO TO YOUR DOCTOR RIGHT AWAY! I hope you followed that advice.
This sounds like a good time to start with the basics of diabetes foot care. As with most complications of diabetes, KNOWLEDGE is the prevention and treatment. Knowing what to do and doing it can help you prevent foot problems and keep your feet for a lifetime.
If you have diabetes, there are a lot of things you can do to prevent problems from developing in your feet. , Dr. Richard Bernstein MD in his book Dr. Bernstein's Diabetes Solution, Revised and Updated The Complete Guide to Achieving Normal Blood Sugars recommends the following:
• Never walk barefoot, either indoors or out.
• Purchase shoes or sneakers late in the day, when foot size is the greatest. Shoes must be comfortable at the first wearing and should not require breaking in. Request shoes with deep, wide toe boxes. Pointed-toe shoes should not be worn, even if the tips are blunted. Some dress shoes are now available with wide, deep shoes and walking shoes are especially accommodating and even have removable insoles so that orthotics (see below) will fit, without making the shoe too tight. If necessary, I prescribe orthopedic or custom oxfords for patients.
• Inspect the insides of your shoes daily for foreign objects, torn lining, protruding nails, or bumps. Have them repaired if you find any of these.
• Don't wear sandals with thongs between the toes.
• Try to alternate at least two different pairs of shoes every few days.
• Ideally your feet should be examined daily for possible injury or signs of excessive rubbing or pressure from shoes(blisters, cracks or other openings in the skin, pink spots, or calluses). Be sure to check your toes. Inspect your soles. If necessary use a mirror or ask another person to check them. Contact your physician immediately if any of these signs are found.
• If the skin of your feet is dry, lubricate the entire foot. Suitable lubricants include olive oil, any vegetable oil, vitamin E oil, emu oil, mink oil, and emulsified lanolin. Many oils and lotions that contain products as major ingredients are available commercially. Do not use petroleum jelly (Vaseline), mineral oil, or baby oil and they are not absorbed by the skin.
• Do not smoke cigarettes. Nicotine can cause closure of the valves that permit blood to enter the small vessels that nourish the skin.
• Keep feet away from heat. Therefore no heating pads, hot water bottles, or electric blankets. Do not place feet near sources of warmth such as radiators or fireplaces. Baths and showers should feel cool-not-not even lukewarm. Temperature should be estimated with your hand or a bath thermometer, not with your feet. Water temperature should be less than 92 degrees F, as even this temperature can cause burns when circulation is impaired. A bath thermometer is suggested.
• Wear warm socks and shoes of adequate size when outside in cold weather. It is wise for all diabetics to have the circulation in their meet measured every few years. If circulation is impaired, do not remain in the cold for more than twenty minutes at a time.
• Do not soak your feet in water for more than 3-4 minutes. This causes macerated skin, which breaks down more easily and doesn't heal well. When bathing or showering, get in, get washed and get out. Don't soak. Beware of rain, swimming pools, and any environment that may wet your feet or your shoes. If you swim regularly for exercise, before getting in the water, rub petroleum jelly (Vaseline) on your feet to protect them from the water. After leaving the water, remove the petroleum jelly with a towel.
• Do not put adhesive tape or other adhesive products like corn plasters in contact with your feet. Fragile skin might be peeled off when the tape is removed. When applying a bandage, tape should not be applied to the skin, but to the bandage only.
• Do not put any medications in contact with your skin that are not prescribed by your physician. Many over-the-counter medications, such as iodine, salicylic acid, and corn-removal agents, are dangerous. Iodine products or hydrogen peroxide should never be applied to wounds.
• If the skin of your feet is dry, your cardiologist should try to avoid medicines called beta blockers for hypertension or heart disease, as these can inhibit perspiration that moistens the feet.
• Do not attempt to file down, remove, or shave calluses or corns. This is dangerous. The toughened skin of a callus is the body's way of protecting against irritation, such as by a shoe that rubs your foot. Filing it off removes that protection, and in my experience, this is the most common initial cause of foot ulcers and resultant amputations. If calluses are present, show them to your physician. Ask her or a podiatrist to arrange for your shoes to be stretched, prescribe special shoes, or prescribe orthotic inserts. Your physician may instruct you in the use of a shoe stretcher or a "ball and ring," both of which can be ordered by a shoe repair shop. By eliminating the pressure on your foot, the callus should resolve over time.
• Do not trim your toenails if you cannot see them clearly. Ask a friend or relative, podiatrist, or your physician to do this for you. If the corners of your nails are pointed, you can file them with an emery board or have someone else trim them.
• If you have thickened toenails, ask your physician to have clippings tested for fungal infection. If infection is present, he should prescribe tincture of fungoid. This solution must be applied twice daily to the nails to be effective. It must be used for about twelve months to effect a cure. It helps to first have thickened nails ground down by a podiatrist, but he/she must be very careful not to damage skin or nail bed.
• Don't wear stockings or socks with elastic bands that are tight enough to cause visible depressions in the skin. Don't use garters. Don't wear socks with holes or that have been darned, have thick seams or are so large that they bunch up.
• Phone your physician immediately if you experience any injury to your foot. I consider ever a minor foot injury to be an emergency. Procrastination can be dangerous.
So Tony, we do hope you followed our advice by going to your health care provider and getting the help you need. We know foot wounds don't usually heal quickly. We hope your wound is healing and you will use preventative measures in the future to help you keep your feet healthy for a lifetime.
When it comes to diabetes and feet, there are no truer words than, "An ounce of prevention is worth a pound of cure."
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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