Your feet take a beating: Over the course of a single day, the average American walks about 5,000 steps. So it goes without saying that your feet need regular care to keep pounding the pavement—and that goes double for anyone who has diabetes.
Why does diabetes put feet at risk? High blood-sugar levels damage nerves in the legs. About 60 percent of people who develop ulcers have nerve damage, or neuropathy, which can numb feet and keep you from noticing cuts, bruises and abnormal pressures on the foot. Neuropathy also deactivates sweat glands, drying skin and making it prone to cracking and infection.
Diabetes can also narrow arteries supplying blood to the legs. The resulting poor circulation slows the healing of wounds. Unrecognized or slowly healing wounds can quickly enlarge and become infected, requiring intensive treatment and, in some cases, amputation.
“Losing feeling in the feet makes it easier to injure yourself without being aware of it, which can lead to infections and ulcers,” says Raul J. Guzman, M.D., staff physician at Joslin Diabetes Center and instructor of medicine at Harvard Medical School in Boston. “Without proper care, infection of the bone or nearby tissue, systemic infection or gangrene may occur.”
Smart steps to healthy feet
The Society for Vascular Surgery, the American Podiatric Medical Association and the Society for Vascular Medicine recently collaborated to develop a clinical practice guideline called “The Managementof Diabetic Foot,” which appeared in the February 2016 Journal of Vascular Surgery. While the guideline is aimed at clinicians, it offers some good advice that people with diabetes should heed, too.
Below are some best foot-care practices featured in the guideline that focus on preventing and treating foot ulcers:
- Have your feet checked by your provider annually. Your doctor will assess your foot health, test for peripheral neuropathy and help you understand the best way to care for your feet. If you’re at high risk for amputation—for example, you have significant neuropathy, a foot deformity, a history of foot ulcers or a previous amputation—your doctor may recommend custom therapeutic footwear.
- Get an ankle-brachial index (ABI) test beginning at age 50. An ABI test compares the blood pressure measured at your ankle with the blood pressure measured at your arm to assess your risk for peripheralartery disease (PAD), a narrowing of the arteries that deliver blood to the extremities, most often affecting the legs.
- Don’t wait to see your doctor if you develop a new foot ulcer. Patients are typically unable to judge a wound’s severity. Open wounds may require imaging or other tests to assess for bone or tissue problems and infection. Your doctor may request that you visit more regularly—every one to four weeks—to monitor healing progression. Your ulcer should be reduced in size by about 10 to 15 percent a week. Your doctor may perform debridement (removal of dead, damaged or infected tissue) to help you heal faster.
- If you develop an open sore on your sole, keep weight off your foot as much as possible. A plantar diabetic foot ulcer won’t heal when subjected to pressure generated by standing or walking. You can keep weight off your foot—called offloading—by wearing a nonremovable total contact cast (TCC). From the outside, a TCC resembles a plaster cast you’d wear if you broke a bone, although it’s applied differently and changed every one or two weeks. Another option is to wear a nonremovable fixed-ankle walking boot.
- If you develop an ulcer elsewhere on your foot, you should keep pressure off the area. The guideline suggests wearing a surgical sandal, a heel-relief shoe or other footwear that relieves pressure on the ulcer.
- If your wound doesn’t improve enough after a month, you may need adjunctive wound therapy. Adjunctive therapy is added to primary therapy to speed healing and can include hyperbaric oxygen therapy, negative pressure wound therapy or skin substitutes, known as biologics, that are placed over the wound.
- If you have PAD and develop a foot ulcer, you may need revascularization. The guideline suggests that patients with PAD undergo revascularization, which involves either bypass surgery or endovascular therapy such as balloon angioplasty or stenting, to improve blood flow.
“It’s important for anyone with diabetes to see a doctor any time a foot irritation doesn’t improve within a day, or at the first sign of broken skin,” says Neda Laiteerapong, M.D., assistant professor at theUniversity of Chicago Medicine. “Local infection and damage to skin and muscle can occur rapidly.”
This article was adapted from Health After 50.