The Critical Importance of Diabetic Foot Care
Diabetes can cause two main problems that affect the feet: peripheral neuropathy (nerve damage) and peripheral artery disease (poor circulation). Neuropathy can cause a loss of feeling, meaning a client might not notice a small cut, blister, or sore. Poor circulation makes it harder for these minor injuries to heal, creating a high risk for infection, ulcers, and in severe cases, amputation. Educating clients on proactive foot care is one of the most effective strategies for preventing these devastating outcomes. While many aspects of care are important, the foundation rests on two core principles: daily, vigilant inspection and consistent, protective footwear.
Pillar 1: Daily Foot Inspection
The number one rule in diabetic foot care is to check the feet every single day. Because neuropathy can eliminate pain as a warning signal, a visual and tactile check is the only reliable way to find potential problems before they escalate.
How to Perform a Daily Foot Check:
- Establish a Routine: Advise the client to link their foot check to a daily activity, like getting dressed in the morning or undressing at night.
- Use Good Lighting: Perform the check in a well-lit room.
- Inspect All Surfaces: Look at the top, bottom, and sides of the feet, as well as the heels and the spaces between the toes.
- Use a Mirror: A non-breakable, long-handled mirror is an essential tool for seeing the bottom of the feet.
- What to Look For: Clients should be taught to look for:
- Cuts, scratches, or sores
- Blisters
- Redness, warmth, or swelling
- Corns or calluses
- Ingrown toenails
- Changes in skin color
- Athlete's foot or other fungal infections between the toes
Any change, no matter how small, should be reported to their healthcare provider immediately. Emphasize that 'waiting to see if it gets better' is a dangerous approach for someone with diabetes.
Pillar 2: Proper Footwear and Never Going Barefoot
The second pillar of diabetic foot care is protecting the feet at all times. This means never walking barefoot—not even indoors—and selecting the right shoes and socks.
Guidelines for Diabetic Footwear:
- Protection is Key: Shoes act as a shield against injury. Walking barefoot dramatically increases the risk of stepping on something sharp, stubbing a toe, or sustaining a minor cut that goes unnoticed.
- Proper Fit: Shoes should be fitted professionally. It's best to shop for shoes at the end of the day when feet are slightly swollen to ensure a comfortable fit. There should be about a half-inch of space between the longest toe and the end of the shoe.
- Shoe Characteristics: Ideal shoes have a wide toe box, a firm heel, and a cushioned sole. They should be made of breathable materials like leather or canvas. Avoid high heels, pointed-toe shoes, and open-toed styles like flip-flops.
- Check Inside Shoes: Before putting on shoes, always check inside with your hand to ensure there are no pebbles, rough seams, or foreign objects.
- The Right Socks: Socks are just as important. Clients should wear clean, dry socks that are well-padded and moisture-wicking. Diabetic socks are a great option as they are seamless and non-constricting, which promotes better circulation.
Footwear Do's and Don'ts Comparison
| Feature | Do | Don't |
|---|---|---|
| Environment | Always wear shoes or slippers, even inside. | Never walk barefoot. |
| Fit | Get measured and ensure a roomy toe box. | Wear tight, narrow, or pointed-toe shoes. |
| Material | Choose breathable materials like leather or mesh. | Choose plastic or vinyl that traps moisture. |
| Style | Opt for closed-toe, supportive shoes with laces or Velcro. | Wear high heels, flip-flops, or open-toed sandals. |
| Socks | Wear seamless, moisture-wicking, padded socks. | Wear tight socks with constricting elastic tops. |
Expanding on Comprehensive Foot Care
While inspection and footwear are the two main points, a holistic teaching plan should include these supporting habits:
- Washing and Drying: Wash feet daily in lukewarm (not hot) water. Test the water temperature with an elbow, not the foot. Dry feet gently and thoroughly, especially between the toes.
- Moisturizing: Apply a thin coat of moisturizer to the tops and bottoms of the feet to prevent dry, cracked skin. Avoid putting lotion between the toes, as this can lead to fungal infections.
- Nail Care: Trim toenails straight across and gently file any sharp edges. If the client has vision problems, thick nails, or poor circulation, nail care should be performed by a podiatrist.
- Professional Care: Encourage regular check-ups with a doctor and at least an annual comprehensive foot exam with a podiatrist. A podiatrist can treat corns and calluses safely and prescribe therapeutic shoes if needed.
Conclusion: A Partnership in Prevention
Teaching a diabetic client about foot care is about empowering them to be an active participant in their own health. By focusing on the two most crucial points—daily inspection and proper footwear—you provide a simple but powerful framework for preventing serious complications. Reinforce that these small, daily actions are their best defense against infection, ulcers, and amputation. For more information, patients can consult resources from the American Diabetes Association.
