First, the bad news . . . Diabetics are at a much greater risk for foot complications than the general population. Diabetes has the potential to cause devastating effects on the feet. Diabetics have a 40 times greater chance of losing a limb as a result of infection or circulatory problems than a non-diabetic person.
And, now the good news . . . Diabetics can make a difference in their health by following some simple rules and taking good care of their overall health and their feet. In addition to controlling blood sugar, a healthy diet, exercise and regular medical check-ups, proper care of the feet and regular foot exams can significantly reduce the chances of suffering unwanted diabetic foot complications.

1. Poor Circulation. Diabetes may affect the circulation, causing narrowing of small blood vessels in the feet and lower legs. When circulation is decreased, cuts, scratches or abrasions may heal very slowly or, sometimes not at all. Sores open the skin that don't heal, called skin ulcers, make infection more likely. A regular exercise program is beneficial in helping maintain circulation to the lower legs.

2. Nerve Damage. Nerve damage, or neuropathy, caused by diabetes, can lead to varying degrees of loss of feeling in the feet. Sometimes, diabetic neuropathy may be painful causing burning or shooting pain in the feet and legs, often at night. More often loss of feeling occurs. Loss of feeling may be severe enough that stepping on a piece of glass or developing a blister may not cause pain. Even when neuropathy is mild it often causes people with diabetes to underestimate or ignore their foot problems.

3. Susceptibility to Infection. Diabetics, in general, are more susceptible to infection that non-diabetics. the white blood cells that fight infection don't function as effectively when blood sugar levels are higher than normal. This means that infection may be able to develop and spread more quickly when an opening in the skin occurs.

If you or someone you love has diabetes, it is possible to significantly reduce the chance of developing severe diabetic foot complications with regular exercise and by taking some simple precautions: Diabetics who perform frequent foot inspections and are educated about potential foot problems associated with their diabetes have one-third fewer hospital admissions for foot problems. The number of diabetes-related foot or lower leg amputations can be reduced by one-half through regular exams and proper foot care.

Good Diabetic Foot Care Habits Good foot care habits take very little time and can pay off tremendously in helping diabetics prevent sever foot problems. These include taking certain precautions and inspecting the feet every day. 1. If you inspect your feet daily, you will be able to notice any change or abnormality very soon after it occurs. Look for ingrown toenails, warts, sores, discoloration, swelling, or anything out of the ordinary for your feet. If you notice a change or something unusual, see your physician at once. 2. Check between the toes and on the tops and soles of both feet. Look for blisters, cuts, scratches or cracks. Be aware of corns or calluses so that you will know if they change in appearance. If you do notice a change, seek medical attention. No concern is too minor for a check-up. 3. Trim your toenails when necessary by cutting them straight across, hen filing off any sharp corners with a nail file. If you are unable to trim your nails without difficulty, have it done professionally by a podiatrist. 4. Diabetic neuropathy can sometimes affect sweat glands and cause dry skin, leading to cracks in the skin. Use a moisturizing lotion daily to keep your skin soft. Do not use lotion between the toes, though, as this area should remain dry. 5. Never walk barefoot. Sorry, but the risks from abrasions and cuts is too great when balanced with the joy of free toes! 6. Make sure your shoes fit well and provide plenty of toe room. Wear new shoes for a short break-in period for the first few times. Examine your feet after each wearing to identify any pressure points. If a particular pair of shoes are uncomfortable or tend to cause hot spots, don't wear them.

Dr. Turcic
currently practices in the Department of Podiatric Medicine,
Kaiser Permanente, Portland, Oregon.

Reproduction without written permission prohibited.