Prevention & CARE OF THE FEET
Many disastrous complications, repeated surgery, prolonged hospitalization; consequent economic hardships and loss of limb or even life can be prevented by proper care of the feet. Care of the feet is of supreme importance to a diabetic. It should be a continuous process. Paying nominal attention to the feet when a complication sets in is of no value.
CARE OF THE FEET
Cleanliness of Skin
The feet should be washed daily with tepid water and good quality, mild toilet soap and dried carefully. The feet should not be soaked in warm, soapy water. Soaking of the feet makes the skin soft and more susceptible to infection. The temperature of water should be tested by the elbow. While drying, the feet should not be rubbed but blotted with a soft towel. The toes must not be parted forcibly. Moisture between the toes encourages fungus infection and should be avoided.
Moist Skin
Some persons perspire a lot. Talcum power should be sprinkled if the feet are moist. The talcum powder should not cake between the toes.
Dry skin
A dry skin may give rise to cracks in the skin. Coconut oil or lanolin or cream or moisturising lotion should be applied if skin is very dry. The cream or the lotion should not be applied in between the toes.
Footwear
A diabetic should never walk barefoot. Contrary to a popular belief, walking barefoot on sand or grass has no beneficial effect in diabetes. On the contrary, this practice is dangerous. The chappals or the shoes should fit properly. Too tight a shoe cramps the foot and hampers the circulation. A loose shoe, on the other hand, encourages formation of corns. The shoe should have a straight inner border. Lace up shoes with soft uppers should be used. A lace up shoe holds the heel firmly in place and prevents its sliding forward. There should be at least half an inch clearance between the tips of the toes and the tip of the shoe. The heel should be low, broad and comfortable and there should be a heel counter. The shoe should not be laced tightly. A new shoe should be worn out by wearing it for a couple of hours every day. The inside of the shoes should be inspected for foreign bodies like nails, rough edges, or any flaw. Sandals with thongs between the toes should not be worn. If the toes overlap, separate them with a little cottonwool or a small piece of gauze. Special shoes should be worn if there is a deformity of the foot, for example, claw foot. Two pairs of shoes should be used.
Socks and stockings
Clean and well fitting socks or stockings, made of cotton and without an elastic top, should be used. Socks should be changed daily and more often if there is an excessive sweating of the feet. The socks should be free of holes and if mended, should not have an uneven area. Garters should not be worn.
Nails
A diabetic should be very careful in cutting nails. Nails should be cut away from the skin, straight across with a nail cutter but never with a knife. Another way is to file the nails with a diamond type file (emery boards). Never file the nails shorter than the tips of the toes. The nails should be shaped according to the contours of the toes and the adjoining toes. Never cut comers of the nail back into the nail groove. A sharp instrument should not be used to clean the free edge of the nail or the nail fold. It is difficult, at times, to cut hard nails. Such nails become soft after a bath and can be cut with ease. Nails should be cut by another person, if the diabetic has poor eyesight, unsteady or stiff hands or cannot bend forwards.
Corns and calluses
Corns and calluses should not be cut. The foot should be soaked in warm (not hot) soapy water for a little while; the com can then be rubbed off with a gauze or a towel. Corns and calluses should not be removed by patent medicines. Curling and stretching the toes, twenty times a day, prevent the formation of corns under the balls of the feet. While walking, the step should be finished on the toes and not on the balls of the feet.
Rest periods
Persons over sixty should have daily rest periods, with the shoes removed. A diabetic should keep off his/her feet, five minutes every
hour, if he/she suffered from a severe foot infection and for fifteen minutes every hour, in case of an amputation.
First aid treatment of injuries of the feet
Even minor cuts should be covered with a sterile gauze and bandaged. If sterile gauze is not available, clean, dry gauze, soaked in surgical spirit, can be used. Adhesive tapes should not be applied directly on the skin without the gauze covering the wound. Strong antiseptics like tincture of iodine should not be used. A hot poultice should never be applied on the foot. A blister should not be pricked but should be allowed to dry and should be covered with a dressing. If a blister bursts, an antiseptic cream should be applied.
Inspection of the feet
Inspect the feet daily for corn, calluses, pressure points, blisters, cracks in the skin or a discolouration of skin. Some other member of the family should inspect the feet if the patient cannot do it himself. A diabetic should report to a doctor immediately, if a foot has become cold, red or blue or there is pain, swelling, throbbing, itching of the foot or a discharge from the foot.
A diabetic should not
- Put feet in very cold or very hot water.
- Sit close to a heater or a fire.
- Sit at one place with legs crossed for a long time.
- Walk in a crowd where the feet can be trampled upon.
- Walk about if there is an infection of the foot.
- Warm the foot if it has become cold.