Common foot problems in diabetics

Nov 22, 2015 News

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By Dr. Kumar Sukhraj
Dear readers, I am pleased to present via this media, some common foot lesions that a diabetic can experience. Your feet are at risk, because diabetes can cause damage to the nerves and the blood supply. This damage is more likely if:
·    You have had diabetes for a long time
·    Your blood glucose levels have been too high for an extended period
·    You smoke
·    You are inactive.
Below is a list of foot problems that anyone can get. However for people with diabetes these common foot problems can possibly lead to infection and serious complications, such as amputation (surgical removal of a limb).
1.    SMELLY FEET (ATHLETE’S FOOT). Many people may experience itching, redness, and cracking of the feet due to a fungal infection. Germs can enter through the cracks in your skin and cause an infection. Uncontrolled infections can lead to ulcers, abscesses etc. Ask your doctor to recommend a medication for athlete’s foot.
2.    FUNGAL INFECTION OF NAILS. Nails may become discoloured (yellowish-brown or opaque), thick and brittle, and may separate from the rest of the nail bed. In some cases, the nail may crumble. The dark, moist, and warm environment while wearing shoes can promote fungal growth. Also any injury to the nail can put you at risk for a fungal infection. Fungal nail infections are difficult to treat. Medications applied directly to the nail are available, but they might only help a small number of fungal nail problems. Oral medications (pills) may need to be prescribed by your doctor. Treatment also may include periodic removal of the damaged nail tissue.
3.    CALLUSES.  Building up of hard skin, usually on the underside of the foot. This is cause by uneven distribution of weight on the bottom of the forefoot or heel. Calluses also can be caused by improperly fitting shoes or by a skin abnormality. Keep in mind that some degree of callus formation on the sole of the foot is normal. Proper care is necessary if you have a callus. For excessive calluses, debridement (removal) is necessary. Use cushioned pads and insoles in your shoes. Medications also may be prescribed to soften calluses. DO NOT try to cut the callus or remove it with a sharp object.
4.    CORNS. Build-up of hard skin near a bony area of a toe or between toes. Corns may be the result of pressure from shoes that rub against the toes or cause friction between the toes. Proper care is necessary if you have a corn. Do not use over-the-counter remedies to dissolve corns. DO NOT try to cut the corn or remove it with a sharp object.
5.    BLISTERS. Blisters can form when your shoes constantly rub against the same spot on your foot. Wearing shoes that do not fit properly or wearing shoes without socks can cause blisters, which can become infected. When treating blisters, it’s important not to “pop” (break) them. The skin covering the blister helps protect it from infection.
6.    BUNIONS. A bunion forms when your big toe angles in toward the second toe. Often, the spot where your big toe joins the rest of the foot becomes red. This area also may begin to stick out and become hard. Bunions can form on one or both feet. They may run in the family, but most often are caused by wearing high-heeled shoes with narrow toes. These shoes put pressure on the big toe, pushing it toward the second toe. The use of felt or foam padding on the foot may help protect the bunion from irritation. A device also may be used to separate the big and second toes. If the bunion causes severe pain and/or deformity, surgery to realign the toes may be necessary.
7.    DRY SKIN. Dry skin can crack, which can allow germs to enter. Use moisturizing soaps and lotions to help keep your skin moist and soft.
8.    FOOT ULCERS. Break in the skin or a deep sore, which can become infected. Foot ulcers can result from minor scrapes, cuts that heal slowly or from the rubbing of shoes that do not fit well. Early intervention is important in treatment. Ask your doctor for advice on how to best care for your wound
9.    HAMMERTOES. A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also be cause by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems, such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating them. In severe cases, surgery to straighten the toe may be necessary.
10.    INGROWN TOENAILS. Ingrown toenails occur when the edges of the nail grow into the skin. They cause pressure and pain along the nail edges. The edge of the nail may cut into the skin, causing redness, swelling, pain, drainage, and infection. The most common cause of ingrown toenails is pressure from shoes. Other causes include improperly trimmed nails, crowding of the toes and repeated trauma to the feet from activities such as running, walking, or doing aerobics. Keeping your toenails properly trimmed is the best way to prevent ingrown toenails. If you have a persistent problem or if you have a nail infection, you may need a doctor’s care.
11.    PLANTAR WARTS. Plantar warts look like calluses on the ball of the foot or on the heel. They may appear to have small pinholes or tiny black spots in the centre. The warts are usually painful and may develop singly or in clusters. Plantar warts are caused by a virus that infects the outer layer of skin on the soles of the feet. DO NOT use over-the-counter medications to dissolve the warts. If you are not sure if you have a plantar wart or a callus, let your doctor decide.
12.    FIXED JOINTS. Some patients may experience no movement in the ankle joint or the joints of the large toe.
13.    BURNING, STINGING AND BITING, SENSATION TO FEET. This is referred to as neuropathic pains. Patient sometimes experience sleepless nights as a result of this problem. Consult your doctor when experiencing this.
14.    CHANGES IN SKIN COLOUR. Dark discoloration, leather like appearance of the skin, and loss of hair in the lower extremities is possible due to peripheral vascular disease. Many may also experience cold and clammy feet with swelling (edema).

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For all diabetic patients it is important to do a 60-second screening test that will help to screen the foot for any of the above mentioned foot problems. There are two types of risk to feet, high risk and low risk. Knowing the risk and taking care of your feet can prevent serious problems even amputation. If you have diabetes, contact your doctor if you are experiencing any of the above mentioned problems:
Please feel free to send an email to [email protected]  or call 6228032 for further enquiry and discussion on the topic. Patient education plays an important role in the diagnosis and management of diabetes and any other illness. Please look forward for a continuation of the discussion on diabetes in the next publication.

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