Diabetic foot: the basic rules of hygiene and prevention

Cura del piede diabetico

Among the many complications of diabetes, those concerning the feet are very important. The risks of foot injuries are very frequent: each wound, even the slightest, can cause serious consequences. It is important to know that more than 75% of these injuries could be safely avoided with thorough hygiene and simple preventive measures.

Diabetes and Foot Care

In fact, the feet of those with diabetes need very special treatment: even an injury that seems entirely insignificant must be treated with the utmost care in order to avoid serious complications.

It is fundamental to comply with certain hygiene and prevention rules. In particular, diabetics should know that the risks increase:

  • if they have been diabetic for a long time
  • are older
  • have blood circulation problems
  • have poor perception of heat and pain.

The loss or absence of normal sensitivity is the main cause of most diabetic foot problems. The best cure for diabetic foot is prevention. Constant vigilance is therefore essential.

Checking the foot and prevention

Check your feet once a day using a mirror or, if necessary, someone’s help. It is very important to check your feet if you notice that you are becoming less sensitive. You must carefully inspect the skin, the nails and the area between the toes. Check for fissures, blisters, red dots, cuts and/or ulcers, checking that there is no excessive moisture between the toes.

How to proceed: sit comfortably near a light in order to have optimal vision (under a lamp or near a window); if you have vision problems, cannot bend or cannot see every part of the foot, ask another person to examine them.

WARNING: never use a mirror to inspect the sole of your foot, as if it breaks you could cut yourself.

What you could find:

injuries between the toes due to fungal infections facilitated by the maceration of calluses: this is an excess of callosity on the sole of the foot which compresses the skin, making it more fragile and facilitating the development and proliferation of germs.

calluses: they can form due to rubbing with the shoes, on the toes or between the toes themselves; in any case it is good to look for the cause of their cracking formation: they are skin lesions that occur on areas of greater callosity. WARNING: an excess of callosity always has a cause. The most frequent causes are incorrect support of the foot and defects in footwear; always check the inside with your hand.

Take care of your nails

Cut your nails into linear margins, without inserting the scissors into the corners. File the nails once a day in order to reduce how frequently you have to cut them. Consult your Podologist if your nails are very thick or hard to cut. Too long, too short or badly cut nails can injure you and cause infections. Always file your nails with a file at least once a week (they are softer after washing your feet).  Remember that if you must use scissors, use those with rounded tips. If you cannot see well or are uncomfortable cutting them, ask another person for help. The nails should not be shorter than the tips of the toes. If your nails become brittle, change colour or thicken, consult your doctor immediately.

Choose footwear well

You must choose your footwear carefully, as the type of shoe you wear is incredibly important in preventing foot complications. The shoes must be sufficiently comfortable to provide suitable space to the toes, especially if they are deformed; your feet must be comfortable, your toes should not be compressed and should not touch the tip of the shoe.  
Avoid footwear made of synthetic materials that do not allow normal foot perspiration. Leather and skins are the most suitable materials because they adapt to the shape of the foot quite well. Normal shoes on the market are generally suitable, but before buying them diabetics must also respect some special precautions: try on the shoes you intend to buy in the evening (when the foot is more swollen), and when trying them on make sure you wear socks that fit your foot and the type of shoe you want to buy. Light socks, pantyhose or microfibre for normal city shoes and thicker cotton socks for sports shoes.  

Characteristics of a good shoe: it must be soft, light and leather, with a sole in non-slip material that is not too thick to let you feel a certain amount of contact with the ground. The heel should be 2/2.5 cm tall for men, and 3/5 cm for women (heels which are too high or too low make walking difficult and unbalanced).

Wear footwear correctly

Carefully examine the shoes before wearing them to check for foreign bodies (e.g. pebbles, poorly-made seams, etc.). Changing shoes during the day reduces the risk of injury. Do not use excessively rigid insoles in shoes, as they could put dangerous pressures on the sole of the foot. It is a good rule to wear new shoes for no more than an hour at a time, frequently checking the condition of the feet. The tip should not be too tight nor too wide.

The shoe is of good quality if: when horizontally placed on the ground the heel adheres to it, when twisting the foot the arch does not bend and if bending the tip, only the relative area of the toes actually bends.

IMPORTANT: – change socks every day – do not wear mended stockings, as they can cause excessive chafing.

… and again:
check the inside of your shoes daily and clean them regularly.  It is better to change shoes every two days, so that they rest one day every two.

It is important to periodically check how worn the heel is. It is advisable to avoid sandals which don’t protect the toes. But above all, avoid wearing rubber shoes which make transpiration difficult and favour sweating and the formation of fungal infections.

Pay attention to deformations or irregular wear of the soles; these are often caused by walking problems. Never walk barefoot on the beach! Remember that salt water and sand are particularly aggressive on the skin, so rinse and dry your feet frequently.

Pay attention to rocks and sea urchins, always wear plastic sandals, even while bathing. Remember that your feet must always have a shoe that protects them from foreign bodies and being struck.

What to do

If you have dry skin, avoid letting your skin become overly dry: gently massage your feet with a thin layer of neutral ointment (lanolin or vaseline). Avoid particular ointments. Do not use creams or ointments in the area between the toes.
If you have calluses, rub them gently with a pumice stone. Do not use talc or aggressive powders, which in the long run facilitate skin maceration.
In case of excessive sweating, wash your feet several times a day and dry them well, especially between your toes.  
Always change your socks every day.
Use appropriate socks depending on your footwear. There has been footwear on the market for some years now that lets the foot breathe thanks to a particular perforated sole. Avoid using spray or paste deodorants. If you have cold feet use wool socks, and wear them even when you go to bed. Use slippers or padded shoes with fur or fleece. Avoid heating your feet with electric heating pads, heaters, radiators or hot water bags. The sensitivity of your foot can lessen and you can risk burning yourself without even realising it when using a heat source. Furthermore, if your circulation is insufficient, the heat produced will stimulate the need for oxygen, but since the arteries are not able to increase blood flow, the tissues of the foot are exposed to suffering that can trigger a dangerous process of gangrene.

If you have wounds, injuries and calluses, always use a mild soap to wash your feet.  If you have injuries or wounds, disinfect them locally (mercury chromium) and cover them with dry sterile gauze fixed with a porous paper tape. If the wound does not improve in 2-3 days, contact your doctor.
Never use local creams or antibiotics, as they could aggravate the wound. Try to discover the cause of calluses, perhaps try changing your shoes.  
Never use razor blades, metal files or corn plasters.
Do not try to soften the calluses with long, hot foot baths.

WASHING. Wash your feet once a day with warm water, using a specific non-aggressive soap. Check the water temperature beforehand using your elbow (a neuropathy-free zone). Carefully and gently dry your feet, dabbing them with a towel without rubbing them.

AVOID BURNS. Never use heating instruments (e.g. electric heating pads, hot water bags). If your feet are particularly cold at night, put on warm socks before going to bed.

PAY CLOSE ATTENTION TO CALLUSES AND CORNS. Do not use medicated patches or chemical corn plasters. Never try to remove them with shaving razor blades, scalpels, etc. Regularly use a specific and delicate emulsion to keep the skin of the feet trophic, elastic and hydrated. Creams, lotions or ointments should not be applied between the toes, as this may result in excessive moisture between them. Corns and calluses must only be removed by podology studios, especially if severe microvascular changes occur.

WEAR APPROPRIATE SOCKS. Never wear stocks with elastic edges and do not use garters. Avoid socks or stockings with embossed seams. Wash and change socks every day. Socks and stockings made of natural and absorbent materials such as wool and cotton are the most suitable.

INFORM. When purchasing new shoes, we suggest informing the footwear shop’s staff about your diabetes. During periodic check-ups, your trusted Podologist should be informed of any event related to the foot that you have noticed, even if of a modest size.