Foot Care for Diabetics
In this section we are going to cover foot care for diabetics as this is a very important subject. Again this knowledge has come from Dr Bernstein’s book The Diabetes Solution and my own personal knowledge and are only a guide and not a medical diagnosis. This Information is available in full in Appendix D of Dr Bernstein’s book The Diabetes Solution and is used by myself as a reference for this section. like I mention in the introduction of this site you need to read The diabetes solution before you start making any changes and have the full support of your diabetes care providers.
As diabetics we are at increasing risk of complications especially in our lower extremities such as our legs, feet and toes. If our blood sugars are left to run high then damage is almost guaranteed to our limbs and feet over time. I have seen first hand the damage that diabetes can play on our legs and feet, my Father before he passed away had struggled with a foot ulcer for almost 2 years. He was a type 2 diabetic and the pain was excruciating and needed some really heavy duty pain killers to help cope with it. He also had to have his foot elevated as much as possible and had to wear an air-boot to relieve the pressure to stop anymore damage to his foot. It doesn’t have to be like this though and with the help of doctor Bernstein we can help many more of our fellow diabetics. We unfortunately didn’t know of Dr Bernstein and his approach to normalise blood sugars at the time of my dads ulcer and he sadly passed away from complications related to T2 Diabetes.
Diabetic Ulcers and Foot Damage
Non Healing “diabetic” ulcers are the major cause of leg, foot and toe amputations in the USA as well as here in the UK. After traumatic injuries such as those occurring from road traffic accidents . These ulcerations do not occur spontaneously; they are always preceded by gradual or sudden injury to the skin by some external factor. Preventing such injuries can prevent their sad consequences. Virtually all diabetics who experience higher than normal blood sugars for more than 5 years will have already started to loose sensitivity in their feet to pain, pressure and temperature. This is because prolonged high blood sugars can injure and and eventually destroy all of the sensory nerves in the feet(sensory neuropathy). Further to this already terrible damage that can happen to our feet the nerves that control the shape of the foot are likewise injured, with a result of deformity that includes “claw” or “hammer” toes, high arch, and prominent heads of metatarsal bones at the bases of the toes on the underside of the foot. The nerves that simulate perspiration in the feet are also affected. This results in the classic dry feet that we see on diabetic feet. Dry skin is more easily damaged and slower to heal than is normal, moist skin, and cracks permit the entry of infectious bacteria.
Damage to Legs From Elevated Blood Sugars
Long term elevated blood sugars also may cause impairment of circulation in the major arteries of the legs, as well as in the minor arteries and small capillary blood vessels that supply the skin of the feet. In order to heal, injured skin can require fifty times the blood flow of normal skin. If this increase in flow in unavailable, the injury will probably deteriorate, becoming gangrenous, and facilitate infection that spreads up the leg. This infection may not respond to antibiotics. Blood circulation to the normal foot can readily increase a hundredfold, if necessary, in order to conduct the heat of warm objects away from the skin. Impaired circulation may make this impossible, and the resultant burn may not even cause pain. A deformed foot with bony prominences (knuckles of toes, tips of toes, heels, and metatarsal heads at soles) may be continually rubbed or pressed by shoes. This foot is frequently unable to perceive the extent of such pressure, or shear, and may not heal readily if injured. It can be burned at relatively low temperatures. Impaired circulation likewise can prevent the warming of cold feet so that prolonged exposure to cold can cause frostbite. The following guidelines are therefore essential for all diabetics, to prevent foot injury and the potentially grave consequences that may ensue.
The List of Things to Do and Don’t Do
- Never walk barefoot, either indoors or out always wear slippers indoors to protect your feet.
- Purchase shoes or trainers late in the day, when foot size is the greatest. Shoes must be comfortable at the first wearing and should not require breaking in. Pointed-toe shoes should not be worn, even if the tips are blunted. Look for shoes with a wide, deep toe box. Some dress shoes are now available in this style. A number of currently available brands of athletic 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 certain of my 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 between your toes. Inspect your soles. If necessary, use a mirror or ask another person to check them. Contact your physician immediately if any of the above signs are found.
- If the skin of your feet is dry, lubricate the entire foot. Suitable lubricants include coconut oil, olive oil, any vegetable oil, vitamin E oil, emu oil, mink oil, and emulsified lanolin. Many oils and lotions that contain these products as major ingredients are available commercially. Do not use petroleum jelly (Vaseline), mineral oil, or baby oil, as 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 even lukewarm. Temperature should be estimated with your hand or a bath thermometer, not with your feet. Water temperature should be less than 92 ° 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 feet measured every few years. If circulation is impaired, do not remain in the cold for more than 20 minutes at a time. Do not soak your feet in water for more than 3–4 minutes, even if so instructed by a physician. 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, apply petroleum jelly (Vaseline) to 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.
The above list is from Dr Bernstein’s Book The Diabetes Solution and is taken from Appendix D on Foot Care. As mentioned do not try this method to normalise your blood sugars without reading this book and having the full support of your diabetes care providers.