The key to keeping your feet healthy for diabetics is vigilance. An ounce of prevention is worth a pound of cure, has never been more true.
Take these steps to avoid problems.
Control your blood sugar. Work with your doctor and health-care team to keep your blood sugar within the limits your team has set for you. “Keep your A1C level” — the average of your blood glucose levels over three months to below 7% and your daily blood sugar normal. Ask your doctor what to do if your numbers are too high or too low.
Check blood pressure and fat levels. Have your blood pressure checked at every doctor’s visit. The target for most people with diabetes is 140 over 90. Your cholesterol and triglyceride levels — both types of blood fats — should be checked at least once a year. For people with diabetes, the target is below 100 for LDL, or bad cholesterol; HDL, or good cholesterol, levels should be above 40 for women and 50 for men. Triglyceride levels should be below 150.
Quit smoking. Smoking raises the risk of foot complications by narrowing and hardening your blood vessels so that fewer nutrients and insufficient oxygen reach your feet. Smoking also keeps your cholesterol and blood pressure levels up and puts you at greater risk for heart attack, stroke, kidney disease, and amputation.
Get a podiatrist. Before you have a problem, ask your doctor to refer you to a podiatrist, or foot specialist, who is experienced with diabetes. You should see a podiatrist at least once or twice a year.
The podiatrist should check for ulcers between your toes, calluses, bone abnormalities, and the pulse in your feet (a lack of pulse indicates PAD). He or she should also test the sensation in your feet, probably using a 10g monofilament test, which assesses touch and pressure sensation. He or she will press a single strand of fiber against various spots on your foot until you register sensation, noting the point at which the strand bends; this tells the doctor how much pressure you can feel.
Inspect, and re-inspect. Do your own foot inspections daily, check between your toes for redness and skin breaks. For places you can’t see easily, use a mirror or ask someone else to look.” If you find a break in the skin or anything suspicious, see your doctor or podiatrist right away.
Get shoe savvy. Before you put on your shoes, feel inside to make sure there are no stones or other debris. Avoid shoes that are too tight, pointy, or high-heeled, or that have stitching inside that might abrade your foot. Buy shoes at the end of the day when your feet will likely be a bit swollen. A good choice is athletic or walking shoes, which allow air to circulate inside the shoe (unlike vinyl or plastic shoes) and offer flexibility and support. Break new shoes in slowly, wearing them only an hour or two a day for the first couple of weeks.
Don’t go sockless or wear open-toed shoes; buy lightly padded seamless socks. And don’t even think about going barefoot.
Wash your feet daily. Before you immerse your foot, check the water temperature with your hand because your feet may not feel heat. Use warm water, not hot, and don’t soak — it can dry out your skin and lead to cracking. Dry your feet carefully and apply moisturizing cream or baby oil to prevent dryness. Don’t put cream between the toes; the moist conditions can encourage infection.
Taking the time to treat your feet royally — inspecting them daily and protecting them from abrasions — can keep both them and you healthier. Start now, and keep at it: Prevention is a whole lot easier than treatment.