Taking good care of your feet is important for all of us, but for people with diabetes it requires special attention. Health reporter Catherine Milford explains.
It’s easy for us to take our feet for granted. Hidden away from view for most of the time, we tend to pay them little mind until something happens to them. But for people with diabetes, protecting and caring for your feet is vital.
Foot problems are a common complication in people with types 1 and 2 diabetes, and it’s not unusual for problems to go unnoticed until they have developed quite far. Blood vessels and nerves can get damaged as a result of long-term high blood sugar levels, meaning pain and soreness can go unnoticed. As a result, approximately five per cent of people with diabetes eventually require amputation of a toe or foot.
“Foot issues affect those with both diabetes types, as problems happen in response to blood sugar levels,” explains podiatrist Lauren Earl. “If your blood sugar levels are elevated, or if you’ve had the disease for more than 15 years, you’re more likely to develop foot complications.”
Foot trouble can range from fungal infections, such as athlete’s foot, calluses, bunions, pressure spots and ulcers, through to very serious issues such as infection, poor circulation and gangrene which, in some cases, can result in amputation. But far from being inevitable for diabetics, in most cases, problems can be prevented simply by managing blood sugar levels and ensuring your feet are cared for.
“Foot care is important for both type 1 and 2 diabetes, but there are some good general health guidelines to help you manage it,” according to dietitian Brad Brosnan.
“Diabetes is the result of the body not creating enough insulin to keep blood glucose [sugar] levels in normal range.
“Type 1 diabetes isn’t preventable, but it can be managed with medication, healthy food choices and regular exercise. In type 2 diabetes, either the body doesn’t produce enough insulin or the body’s cells don’t recognise the insulin it does have. The end result is the same as with type 1, high levels of glucose in the blood.”
Eat for your feet
Put simply, poor nutrition can mean poor blood sugar levels, which, if not adequately managed by medical means, may lead to foot complications. If your diet is healthy, you’re less likely to develop complications.
“If you’ve been diagnosed with type 1 or type 2 diabetes, the first step is to get a clinical assessment of your nutrition intake and lifestyle habits, as everyone has different needs when it comes to managing their own lifestyle and diet,” Mr Brosnan advises. “It’s important to remember, though, that enjoying a healthy eating plan doesn’t mean cutting out entire food groups or making one or two changes. Both diabetes types should look at their overall diet and managing daily blood sugars within their personal target range.”
- Eat plenty of coloured vegetables; veges should take up half your plate at meal times.
- Swap refined foods for whole grains, such as brown rice or grainy bread, while watching portion sizes – no more than ¼ of the plate.
- Aim for ¼ plate of protein such as legumes, fish, seafood, eggs, poultry or red meat (fat removed).
- Enjoy some reduced-fat or low-fat milk products.
- Drink plain water.
- Limit sugary, high-carb and processed foods such as lollies, biscuits, potato chips, white bread and chocolate.
Step it up with the right footwear
To give your feet the best chance, make sure you wear the correct footwear. Shoes should fit well and feel snug but not tight. Choose cotton socks that fit loosely and change them daily.
“It’s important to have a supportive shoe that has structure to it,” Ms Earl explains. “This means a shoe with a firm heel counter [the little cup at the back of the shoe that holds your heel in place], a stiff shank [the supportive structure under the arch of the foot that runs between the insole and outsole] and a flexible forefoot. It’s a good idea to get your footwear fitted by a specialist store that will match your foot type with the shoe you need.”
Top tips for foot health
- Wash feet daily in lukewarm water using mild soap. Dry feet thoroughly, taking care to dry between the toes.
- Moisturise your feet well after washing.
- Don’t smoke. Smoking worsens heart and vascular problems and can reduce circulation to the feet.
- Eat a healthy diet and exercise regularly to maintain a healthy weight. This is important for people with both types 1 and 2 diabetes, however, it’s especially important for people with type 2 diabetes, who may also have high blood pressure and a poor lipid (blood fat) profile.
- Check your feet daily. Look for skin breaks, blisters, swelling or redness, including between and underneath toes, where damage may be hidden.
- People who have had type 1 diabetes for at least five years are advised to have an annual diabetic foot check up. People with type 2 diabetes need annual checks by a doctor, podiatrist or diabetes nurse. Seek professional advice immediately if you see any changes to your normal feet.
- Have toenails cut every six to eight weeks by a podiatrist or professional.
- Ensure any corns or calluses are seen by a podiatrist.
Foot issues to watch for
- Dry patches, or patches of thickened skin, on your feet
- Changes in toenails, including fungal infections
- Any cuts and sores that take a particularly long time to heal
- Numbness or tingling sensations in your feet.
Article sources and references
- Bus SA. 2008. Foot structure and footwear prescription in diabetes mellitus. Diabetes/Metabolism Research and Reviews 24:S90-5https://www.ncbi.nlm.nih.gov/pubmed/18386782
- Diabetes New Zealand. Understanding type 2 diabetes, diabetes.org.nz Accessed May 2018https://www.diabetes.org.nz/
- Mayfield JA et al. (1998). Preventive foot care in people with diabetes. Diabetes Care 21:2161-77https://www.ncbi.nlm.nih.gov/pubmed/9839111
- McCulloch DK. 2017. Patient education: Foot care in diabetes mellitus (Beyond the Basics). UpToDate, uptodate.com Accessed May 2018https://www.uptodate.com/contents/foot-care-in-diabetes-mellitus-beyond-the-basics
- McGill M et al. 2005. Which diabetic patients should receive podiatry care? An objective analysis. Internal Medicine Journal 35:451-6https://www.ncbi.nlm.nih.gov/pubmed/16176466
- Singh N et al. 2005. Preventing foot ulcers in patients with diabetes. JAMA 293:217-8https://www.ncbi.nlm.nih.gov/pubmed/15644549