FOOT CARE IN DIABETES MELLITUS

By Sam Maondu

Diabetic neuropathy is one of the microvascular complications of diabetes mellitus. Occurrence of diabetic complications has a direct relationship to the severity of hyperglycemia and also duration in which one has been diabetic.
Occurrence of blood vessel complications like atherosclerosis is also a primary cause of foot problems in diabetes mellitus.

Presentation of neuropathy.

• Loss of sensation in the feet and arms described as 'glove and stocking' in pattern.
• Muscle wasting of the feet and sometimes arms due to loss of nerve function.
• There could also be loss of fine coordination in walking.
• One may lack visual clues.
• Patient may have pain of the lower limbs. May also complain not being able to withstand the pressure of the beddings.
• Combination of decreased or lack of sensation and diminished blood supply to the lower limbs increases the risk of developing diabetic foot. One big challenge with diabetic foot lies with non-healing diabetic ulcer.
• Care of feet in diabetics is imperative and health care provider should educate the patient on foot care to avoid complications.

Diabetic patients should:

• Not walk bare footed.
• Always put on comfortable and well fitting shoes.
• Always use socks or stockings for more foot comfort. They should be seamless and not mended.
• Keep feet clean by washing feet daily with mild soap and moderately warm water.
• Do not use sandals with thongs in between the toes. In other words avoid open shoes.
• Daily feet inspection to check for blisters, small wounds and seek urgent medical attention.
• When cleaning feet avoid soaking them in water.
• Nails should be cut across and free edge of the nail should not be allowed to overgrow.
• Use aqueous creams to apply on the feet and in between the toes.

The DON'TS

• Do not walk bare footed.
• Do not use socks or stockings with seams or mended.
• Do not wear shoes without socks or stockings.
• Do not cut dry skin lesions.
• Do not apply heat to the feet.

References:
Foot care -Diabetes handbook. Avenue Healthcare with partnership with Comprehensive Diabetes Centre. 2013.

Complications of Diabetes Mellitus -textbook of Medicine 2004. By John Axford and Chris O'Calkaghan. Page 778