Foot Care for People with Diabetes/Reduced Blood Flow
Individuals with diabetes and other conditions such as peripheral arterial disease (PAD) that limit blood flow to the extremities are at increased risk of foot problems, limb loss and, in severe cases, loss of life.
IPFH suggests that foot care for someone with diabetes or another condition that reduces blood flow to the extremities include the following steps:
- Inspect the person’s feet at least twice daily by looking at them (top and bottom) and feeling them with your hands for any bumps, lumps, sores, lesions or pressure points where sores and ulcers might form.
- Wash the person’s feet at least once daily using lukewarm, not hot, water. Use your elbow to test the water temperature. Dry his/her feet thoroughly, including between the toes.
- Apply lotion only to the tops and bottoms of the feet, but never between the toes, since this can create a moist environment that favors fungal growth.
- Cut the individual’s toenails straight across. Do not let the person cut his/her own nails. If you cannot perform nail care easily, leave the task of cutting toenails to a foot health professional.
- Never cut corns and calluses or use wart removers, corn removers or other chemicals on the person’s feet. Only an appropriate foot health professional should do any procedures involving corns and calluses.
- If the individual you’re caring for has no sensation in the feet (numbness/ neuropathy), be extra cautious. Do not expose the feet to temperature extremes. Make sure there are no sharp objects such as broken glass, nails, or exposed sharp edges on floors or in carpeting. The person should not walk or move around barefoot, even inside the house.
- Ensure that the individual has proper footwear. If he/she is fully or partially mobile, this means properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically tested padded socks can help prevent injuries to the skin/soft tissue of the foot, a major cause of diabetic ulcerations.
Acrylic and acrylic blends have been demonstrated by clinical research to be best for the diabetic foot; made from 100 percent “natural” fibers (cotton, wool and silk) retain moisture and make feet vulnerable to irritation, lesions, athlete’s foot , blisters and other foot conditions.
If the individual is immobile, wheelchair bound or bedridden, he/she should wear shoes and padded socks that do not confine or restrict the feet and that protect the vulnerable heel area from pressure ulcers.
- Check inside shoes daily for sharp points, sharp edges, seams or other rough areas or foreign objects that may lead to cuts, wounds or abrasions.
- Never depend on shoes to “fit better after they’re worn for a while.” Trust the foot health professional who analyzes the individual’s gait and sizes his or her feet. New footwear may “feel” large to the patient, but if they are properly fitted as a system—padded socks, insert/orthotic, shoes—they will provide better protection.
- Make sure the individual does not cross his/her legs for extended periods, as this can reduce blood flow and create pressure points.
- Move the individual or make sure that he/she changes position at least once every two or three hours to avoid tissue damage or pressure sores. Check carefully for signs of tissue damage in the heels of the feet—and also, for overall health, at the base of the buttocks, the upper outer thigh, the lower back and the back of the head. These are the areas where there is greatest risk for pressure sores.
- Encourage and facilitate appropriate physical activity. Check with the person’s doctor for recommendations on exercise and activities. Investigate exercise programs that may be available in your area.