Foot wounds must not be ignored by those of us with diabetes as there are very serious consequences if foot wounds do not heal properly.

A wound which does not heal properly and is left exposed

may form a foot ulcer
which further raises the risk of an infection occurring.

Indeed, if a wound becomes infected,

amputation
is a very real prospect if medical attention is not received quickly, as a

result of severe complications like gangrene

Gangrene

Gangrene is a serious medical condition that comes in two type, known as “wet” and “dry” gangrene. They are caused by bacterial infections or pre-existing health-issues respectively. Unfortunately, diabetics are at risk of both types.

Gangrene is caused by a lack of blood flow to a certain part of the body, and so diabetes can cause “dry” gangrene by destroying blood vessels. Diabetics can also be at risk of the infections that destroy blood vessels or block off blood flow due to swelling because they have a weakened immune system.

• See here for more information on
  
  gangrene, what to do and how to prevent it

Signs of foot wounds

Foot wounds are any break in the skin and therefore include any of the following that causes skin to be lost or open out:

• Cuts
• Grazes
• Blisters
• Cracked skin
• Loss of skin following a corn or callus
• In grown toenails pressing against the surrounding skin

If you notice any signs of wounding, or any of the above signs that can lead to wounds, make an appointment to see your GP.

If a wound has gone unnoticed or heals slowly, the affected area may grow larger and become a foot ulcer. Having a foot ulcer increases the risk of infection so it’s important to

notify your GP
or podiatrist as soon as possible.

Symptoms of infection

The following symptoms at the site of the wound may indicate that the foot has become infected:

• Swelling
• Reddening of white skin, darkening of brown or black skin
• You may experience increasing amount of pain
• Skin feels warm to the touch
• The appearance of pus

Infection may be accompanied by other symptoms including:

• Having a high temperature
• Swollen glands
• Feeling lethargic and unwell

If you notice these signs arrange to see your GP or health team with a day and if this is not possible, visit your A&E (Accident and Emergency).

Causes

Cuts, grazes and blisters are more likely to occur if you don’t wear comfortable fitting footwear or if you walk around bare foot.

Damage can also occur from activities including:

• Dropping objects on your feet
• Stubbing your feet
• Being trod on
• Burns or scalding from hot water or heaters
• Accidents when clipping toenails

People with diabetes need to extra careful because diabetes can affect the sensory nerves in the feet which can mean suffering wounds without noticing.

If wounds are not well protected, there’s a greater risk of infection and another key factor is that

wounds tend to heal more slowly in people with diabetes

Complications

If wounds do not heal properly, the wounds may form an ulcer where the surface of the skin breaks down over an area of the skin leaving the tissue underneath exposed.

It’s important that foot ulcers are treated immediately as infection can set in which can significantly raise the risk of amputation if it causes gangrene or spreads to infect the bone.

Treatment

If you develop a wound, it’s important to:

• Clean the wound in a bowl or warm but not hot water.
• Cover the wound with a sterile wound dressing or bandage to prevent any infection getting in.
• Clean the wound and change the dressing or bandage each day.
• Ensure you do not aggravate the wound and limit how much your walk on it.
• Notify your health team, who will be to advise you on any other treatment or precautions you should take.

Let your doctor know if there is, or could be, an object in the wound, such as a splinter or piece of debris such as glass or metal.

Treatment for infected wounds

If the wound has become infected you need to seek medical help immediately. An infected wound can be treated with antibiotics but people with diabetes may often require additional care to help ensure the wound heals properly.

If you cannot see your GP or a member of your health team within a day, go to your nearest A&E (Accident and Emergency).

Preventing wounds and infections

You can help to minimise the risk of wounds occurring by wearing

comfortable, well-fitting shoes
which will help to reduce the chances of developing blisters, calluses or other foot problems such as hammer toes.

Avoid walking around bare foot to prevent the risk of cuts, burns or grazes occurring. Remember that

if you have nerve damage (neuropathy), you may not feel pain should a foot injury occur.

Check your feet each day for signs of damage or any changes in feeling or appearance in your feet. If you notice something different, notify your doctor. Don’t wait to see if things get better as this can sometimes lead to getting the treatment you need too late.

• 
  See our guide to foot symptoms for further information

Try to maintain

good control of blood glucose levels
as well as this will help any wounds you’ve suffered to heal more quickly.

Checking your feet is an important way to reduce the chances of developing a serious foot problem.

It’s important that those of us with diabetes regularly check our feet as nerve damage and reduced circulation, caused by diabetes, can mean having reduced awareness of pain (neuropathy) and

slower healing

Checking feet daily means that any signs of damage can be addressed at the earliest stage and therefore before a problem poses any serious risk to health.

Your own foot checks should be carried out

in addition to

the

foot examinations you should receive at least once a year
from your health team.

How often should I check my feet?

It’s important to check your feet daily for signs of damage.

Don’t be put off checking your feet if nothing seems to change.

That’s a good sign and remember that by checking your feet daily, you’re giving your feet the best chance of healing should any damage or change in your feet occur in future.

What if I can’t check my own feet?

Some of us may find checking feet harder than others. If you are unable to fully check your feet, arrange for someone to help you check your feet.

Note that if you require help from someone to check your feet and help with other aspects of your diabetes,

you may qualify to receive state benefits

Damage

Look out for any general signs of damage that include:

• Cuts
• Grazes
• Sores
• Bruises
• Blisters
• Burns
• Missing skin

Other signs of change

Look out also for other changes such as:

• Changes in colour – eg whitening, reddening, yellowing, darkening or paling of skin
• Changes in shape – either in one particular area or if the whole foot becomes swollen
• Any unusual change in odour of your feet
• Fungal growth
• Dry or hard skin
• Skin that is warm or hot to the touch
• Cold feet, particularly if they are also paler than they should be

Soles of the feet

The soles of the feet may be awkward for some of us to check but it’s an important part of our feet so does need checking each day. You may find it helps to set up a mirror to help check the soles of your feet. When checking the soles of your feet, look out for the general signs of damage and changes and also:

• Calluses
• Plantar warts (verrucas)
• 
  Foot ulcers

Tops of the feet and toes

• Corns
• Calluses
• Bunions – a condition where the big toe starts to point towards the neighbouring toes
• Any loss of hair on your feet, ankles or toes
• Shiny, smooth skin
• Changes in shape of the toes – any evidence of one or more toes becoming clawed

Toenails

• Discoloured nails
• Brittle nails
• Broken toenails
• Thinning nails
• Thickening of the nails
• Ingrown toenails

Heels

• Calluses
• Dry, cracked skin
• Foot ulcers

Check for sensitivity of your feet

When checking your feet, it is also useful to check the sensitivity of your feet. Briefly and gently tap your toes with your finger and see whether you can feel the touch of your finger with your toes. Do not use any sharp or hot objects to test for sensation in your feet. If you notice reduced sensitivity in your toes, notify your doctor.

Numbness or

reduced sensitivity in the feet is a common symptom of sensory neuropathy, which can make it harder, or impossible, to feel when damage to the foot occurs.

Diabetes often means that there is a greater risk of a foot condition becoming serious so it’s important to

let your doctor know if you have symptoms of any of the foot conditions
in this guide.

It’s important not to dismiss a foot problem as mild as each of the problems listed has the potential to be serious when diabetes is present.

When contacting your doctor about any of these conditions, ensure the health team, including receptionist know that you have diabetes.

Causes of diabetic foot problems

There are a range of different foot complications which may each have different causes but there are some causes that are common to a number of foot problems.

Poorly fitting shoes can lead to rubbing of skin causing blisters and corns and shoes that don’t leave enough room for all the toes may increase the chance of bunions or hammer toes occurring.

Walking barefoot raises the risk of suffering a foot wound or,

particularly in hot weather, burns.

Having neuropathy
can significantly increase the risk of a foot condition occurring as you may not sense when your feet are becoming aggravated or damaged.

Having poor blood circulation can also lead to a number of foot problems.

Preventing foot problems

There are a number of ways you can reduce the chances of developing a foot problem, which include:

• 
  Wearing shoes that fit well
• Avoiding walking bare foot
• Keeping feet clean
• Keeping feet moisturised
• 
  Importantly – checking your feet for signs of damage on a daily basis

Athlete’s foot (tinea pedis)

A fungal infection of the foot characterised by a rash between the toes which

may be itchy and cause dry, flaky skin

Athlete’s foot can lead to fungal infection of the toenails and may cause skin on your feet to crack which can lead to infection and therefore can be a serious problem for those of us with diabetes.

Blisters

Often caused by rubbing of skin against shoes, blisters are when fluid builds up under the top layers of skin. Burst blisters carry a risk of infection so do not attempt to burst a blister.

Bunions (hallux valgus)

A bunion is said to occur if your big toe points towards the neighbouring toes of that foot. This can cause the big toe to rest on one or more of the other toes and push the bone leading to the big toe (this bone is called the first metatarsal) to stick out.

The cause of bunions is not so well understood but family history is believed to be a strong factor and badly fitting shoes may worsen the problem. Treatments include measures to relieve problematic symptoms such as painkillers, insoles or bunion pads, or surgery may be recommended if the bunion may lead to further, more serious problems.

Calluses

Calluses are tough areas of skin which build up as a protective reaction to your skin in that area receiving regular rubbing or pressure. Calluses can form on the feet for a number of reasons including:

• Wearing badly fitting shoes
• Regularly wearing high hells

If calluses build up, this can increase the risk of the skin breaking down and forming foot ulcers. Treatment may either involve reducing pressure on the foot, such as with the use of therapeutic insoles, or with surgery. Home treatment to remove the hard skin should not be attempted.

Charcot foot

Charcot foot is a condition that can affect the foot and/or ankle
if someone has a form of nerve damage called motor neuropathy. This form of neuropathy prevents the nerves from being able to adequately control muscles in the feet which can lead to bones in the foot and ankle not being properly supported by these muscles. This can lead to bone fractures and dislocation.

Complicating the issue of Charcot foot is that neuropathy means that people with the condition may not feel pain when fractures or dislocation occurs. This one of many reasons why it is important to regularly check your feet for any changes in appearance or signs of damage.

Corns

Corns are circles of hard skin that can commonly form on the tops or sides of shoes from wearing high heels or as a result of another condition such as a bunion or hammertoes.

As with calluses, removal of corns should only be done by a doctor or podiatrist.

Dry skin

Dry skin on the feet can become a danger as it may lead to the skin cracking which then invites infection to occur.

If your skin is dry, moisturisers can help to keep the skin hydrated and prevent cracking. Notify your doctor if your skin becomes dry or cracked.

Foot ulcers

Foot ulcers are areas where skin has broken down leaving the tissue underneath exposed. Foot ulcers are more common in people with neuropathy (nerve damage) or reduced circulation in their feet as both of these conditions impair the body’s ability to heal.

Foot ulcers can easily become infected if they are not protected and allowed to heal so it is both important to check your feet regularly and to notify your doctor immediately if a foot ulcer has developed.

• 
  Read more on foot ulcers

Fungal nail infections

Fungal nail infections may occur as a result of athlete’s foot or the nail becoming infected with the yeast, candida. Fungal nail infections may be noticed by changes in colour of the nail, such as turning white, yellow, green, brown or black. The nail may become thicker and can cause the nail to become brittle, leading to pieces of nail breaking off.

Nail infections can lead to skin infections (cellulitis) and even bone infections (osteomyelitis) in some cases. These can quickly become a serious threat to health. It is therefore important that you arrange for nail infections to be seen by a doctor or podiatrist as soon as you notice any changes in the condition of your nails.

Gout

Gout is not a foot condition as such, however, it is a condition that can commonly affect feet. Gout occurs if there is a build up of uric acid in the blood.

Symptoms of gout include pain in joints,

which may often occur in the joints of the big toe, swelling and shiny pink or red coloured skin (in white people) or shiny darker skin (in people with brown or black skin).

Gout may lead to complications including foot problems if it causes the skin on the foot to break.

Hammer toes and mallet toes

Hammer toe and mallet toe are conditions whereby the toes become bent into unusual shapes with the toes pointing downwards. Hammer toe and mallet toe may be caused by toes being pressed against the end of shoes or if muscles and tendons in the toe become shorter and tighter.

You doctor or podiatrist can recommend the best treatment to solve the problem or to help relieve pain or discomfort.

Ingrown toenails (onychocryptosis).

Ingrown toenails are when the nail starts to grow into skin tissue. Ingrown toenails can be painful and also dangerous as it can lead to wounds and the chance of infection.

Ingrown toenails may develop for a number of reasons from incorrect cutting of toenails to too tight fitting shoes to nail injuries. You doctor will be able to advise on or carry out the best treatment to prevent foot injury occurring.

Plantar fasciitis

Plantar fasciitis is inflammation of the plantar fascia, a band of tissue runs along the sole of the foot. If damage occurs, which can be sudden damage or damage that builds up over time, this can cause the inflammation which can cause heel pain.

This condition is more common in people that are overweight.

The pain of plantar fasciitis may be felt as a stabbing pain that is usually at its most painful at the start of mornings.

reatment may involve rest, specific stretches or anti-inflammatory drugs such as Ibuprofen.

Corticosteroid injections
or surgery may be required in some cases. If you have heel pain, contact your doctor who will be able to advise on the best treatment.

Plantar warts (verrucas)

Plantar warts, commonly known as verrucas, are viral infections caused by the human papilloma virus (HPV). Plantar warts are noticeable as small lumps with a rough surface. Warts are infectious and can be passed by skin to skin contact and sometimes by through contact with surfaces. For example, verrucas may commonly be passed from person to person via swimming pool surfaces if the person with a verruca does not wear a protective plastic sock.

People with diabetes are not advised to self-treat verrucas. Sometimes plantar warts disappear without the need for treatment, but if the wart persists or begins to bleed, multiply or otherwise change appearance, you need to notify your doctor who will be able to advise or carry out the appropriate treatment.

The general rule for people with diabetes is to notify your doctor if you notice any change in feeling or appearance in your feet.

This page provides information on the range of symptoms that can indicate a wide variety of

diabetic foot problems

Foot problems can quickly become serious so it’s important to check your feet daily for signs of damage or change in addition to attending foot examinations.

Signs of foot damage

• 
  Wounds – cuts, burns, grazes or blisters
• 
  Pain in the feet
• 
  Prickly tingly feelings
• 
  Burning sensation
• 
  Warm or hot feet
• 
  Cold feet
• 
  Numbness
• 
  Swelling
• 
  Dry and cracked skin
• 
  Firm spots on the feet
• 
  Warts and fungus
• 
  Changes in colour
• 
  Changes in shape of the foot
• 
  Changes in toenails
• 
  Changes in smell

Wounds – cuts, burns, grazes or blisters

It’s important to take action on any wounds, such as cuts, burns, grazes or blisters. Make sure your feet are kept clea, cover the area of damage with a plaster that allows the area to breathe and ensure the area is not rubbed or made worse.

It’s important to let your doctor know at the earliest opportunity so he or she can advise on the best care advice for you.

Contact your doctor, out of hours service or NHS direct if you

notice pus or any sign of infection in your feet

Pain

Pain may occur as a result of damage, such as a wound, blister or broken bone but can also occur for other reasons including neuropathic pain (nerve pain). In some cases, such as with nerve pain, the feeling of pain may be present despite no other outward changes.

A number of people with diabetes report intense pain when the skin on their feet or legs come into contact with material such as bed linen. A burning sensation, which can present difficulty when getting to sleep is also relatively common.

These symptoms in people with diabetes tend to be dysesthesia, a type of neuropathic pain

It is important to tell your doctor if you experience pains in your feet.

Prickly, tingly feeling – unusual sensations in the feet

A tingly feeling like pins and needles could be a result of a number of causes. It can be from a temporary block in circulation, such as if you have been resting too much body weight on one part of your leg. However, it

could be the result of neuropathy or advancing circulation problems
if the sensation is regular and can’t otherwise be explained.

If you are experiencing these sensations for no good reason, speak to your doctor. You should also mention whether you have any other symptoms in your feet such as numbness in your feet, any changes of colour of your feet and if you experience any difficulty with the muscles in your feet or legs.

Burning sensation and very sensitive to touch

A number of people with diabetes report intense pain when the skin on their feet or legs come into contact with material such as bed linen. A burning sensation, which can present difficulty when getting to sleep is also relatively common.

These symptoms could be dysesthesia which can result from neuropathy, a common complication of diabetes caused by damage to the nerves.

Warm feet

Warm feet can result from a variety of causes, some of which may be harmless but it is important that those of us with diabetes not to ignore any symptoms.

Warmer than usual feet may be related to the temperature of your environment but could be a sign of complications or another condition, particularly if other symptoms are present.

If your feet, or just one foot, are feeling warm, check your feet for signs of any damage, swelling or changes in colour. If you cannot check your feet yourself, ask someone else to help you.

In some cases you may notice a swelling that is hot to the touch. This could be caused by a number of reasons and could include any of the following:

• Cellulitis – bacterial infection
• Gout
• A sprained ankle or broken bone in the foot
• 
  Charcot foot
• 
  Kidney disease
• Blisters or calluses
• Insect bites

If you experience warm feet either without good reason or if you have any other signs, it’s important to contact your doctor.

Cold feet

If you have feet that are cold to the touch that is not explained by the temperature of the environment, and is accompanied by a weak pulse,

it could present a sign of circulation problems
This is even more likely to be the case if you’ve noticed a loss of hair on your feet or toes.

Speak with your doctor if you experience cold feet for no good reason or if you notice any other changes in the appearance in your feet.

Numbness

If your feet are numb, and not just temporarily, it could be a sign of diabetic neuropathy which is nerve damage that can occur as a result of diabetes. If the damage affects our sensory nerves, this can cause a loss of feeling and our feet is the most likely part of the body to first be affected.

If you have lost sensation in your feet it’s very important to be aware of this and not risk damage to your feet that may occur without you feeling it. Notify your doctor if you noticed your feet have become numb for any extended length of time and make sure you check your feet every day for any signs of foot damages or changes.

Swelling

Swelling can occur for a number of reasons, with some of these being dangerous signs.

Causes of swelling in the feet include oedema (water retention), broken bones, sprains, gout and infection but there other possible causes too. If you notice your feet have swelled, it’s important to contact your doctor who will be able to assess the cause.

Dry or cracked skin

Dry skin is relatively common but a condition that shouldn’t be dismissed. People with diabetes are at

increased risk of dry skin
as a result of neuropathy as damaged nerves don’t deliver the signal that the feet need hydration.

If you develop dry skin, notify your doctor who can help your skin to be appropriately treated and therefore reduce the risk of complications developing which may include dermatitis or infection, which can be serious.

Firm spots on your feet

Areas of firm or raised areas of skin may be signs of corns, calluses or bunions. These may often be a

sign of ill fitting footwear which could lead to other problems
developing. The conditions can also raise the risk of foot damage and infection occurring.

Warts and fungus

Plantar warts (verrucas) and fungus need to be treated correctly to prevent an increased risk of foot infection. Fungal infection such as athlete’s foot can cause additional problems such as cracked skin and thick, hard to cut toenails which may lead to more serious complications.

If you develop warts or a fungal infection, speak to your doctor who can assess the problem and advise on treatment.

Changes in colour

Be aware of any unexpected changes of colour in your feet. Changes in the colour of your feet may be a sign that damage has, or is, taken place. Look out for changes of colour such as reddening, yellowing, paling or bluing of the skin, darkening of the skin, any areas that have become black or green coloured.

Changes in colour of your feet, including appearances of bruises, can sometimes indicate a serious medical issue so it’s important to notify your doctor if you notice any such changes.

Change of shape of your feet

Some conditions may cause a change of shape to your feet. Some causes include Charcot foot, a condition that is more common in people with diabetes and results from cracked, broken or dislocated bones in the foot or ankle.

Look out for any changes in your toes as well. If any of your toes start to point downwards or at another unusual angle, it could be a sign of a condition called hammer toes.

A change of shape in your feet can often indicate a potentially serious problem and therefore needs to be mentioned to your doctor.

Changes in toenails

Toenails may also indicate problems. Brittle or slow growing toenails could indicate peripheral arterial disease, thickening or a change in colour of toenails may indicate a fungal infection and in grown toenails can lead to more serious health issues.

When you check your feet, ensure you inspect your toenails as well and notify your doctor of any significant changes.

Changes in smell of your feet

Changes in smell of your feet may also be a sign of problems. If your feet start to develop a foul smell, it’s important to check for any other signs and to notify your doctor of the change in smell you’ve noticed so your doctor can assess further.

There’s a range of treatments available for treating the

different foot complications that can commonly affect people
with diabetes.

A number of the following treatments are those that need to be carried out by healthcare professionals. Consult your GP if you have any signs of foot damage and your health team should arrange an appointment and/or treatment.

Amputation

Amputation is the last resort
when it comes to treatment of foot problems but a last resort that may be required if foot problems progress to a severe level.

This is more likely if foot problems are not treated quickly enough which is why it is important to notify your doctor of any sings of damage or change in the condition of your feet.

Antibiotics

Antibiotics are used to fight bacterial infections and

may be required for people with non-healing foot ulcers

Antibiotics may be given intravenously or orally depending on a number of factors.

Debridement

Debridement involves removing necrotic (dead), damaged or infected tissue from a wound, which can improve cleanliness of the wound and promote healing.

Debridement may carried out by a number of methods including:

• Autolytic debridement – which encourages the body to use its own enzymes to debride the wound
• Enzymatic debridement – use of chemical enzymes, such as topical, or proteolytic enzymes
• Mechanical debridement – allowing dressings to go from moist to dry and then removing the dressing along with dead or infected tissue that has stuck to the dressing
• Surgical debridement – use of sharp surgical instruments, such as scalpels, to remove dead and infected tissue
• Larval therapy – use of fly larvae (maggots) to clean away dead tissue

Dressings

There are a number of dressings available for diabetic wound care including:

• Alginate dressings
• Foam dressings
• Gauze dressings
• Hydrogel dressings
• Hydrocolloid dressings

Dressings serve a number of purposes in the wound healing process.

They help to protect the wound from outside infection, speed up clotting and the growth of new skin cells.

Regular removal of old dressings and replacement with new, clean dressings helps with debridement
(to remove dead and infected tissue from the wound).

Hyperbaric oxygen (HBO) treatment

HBO treatment involves placing a wounded foot and leg within an environment of pure oxygen delivered at high pressure. Wounds need oxygen to heal and research has shown that a pure oxygen environment can help to speed to speed up the wound healing process.

Sessions in the chamber may vary from 30 to 120 minutes. After the treatment the pressure is gradually decreased to reduce the chance of symptoms such as light headedness or nausea.

Larval therapy (maggot therapy)

Larval therapy involves introducing live, disinfected maggots directly into the wound. The maggots begin digesting the dead and infected tissue, helping to leave wound clean.

You may make you feel squeamish but the method is effective at precisely removing dead tissue whilst leaving healthy tissue intact and can help to improve the success of healing.

Orthoses

Foot orthoses are devices which are designed to provide support to limbs and/or relieve pressure. Examples of different orthoses are ankle braces, which help to control movement of muscles and specialist foam or gel insoles, which help to relieve and spread out pressure on the sole of the foot.

Plaster casts

Plaster casts are a solid casing made out of bandages and plaster of Paris (or sometimes an alternative hard substance).

Plaster casts are used to help broken bones heal by keeping the bones from moving. Plaster casts may be used in people with Charcot foot to

help fractured or broken bones

Surgery

Surgery may be carried out to treat a number of foot problems ranging from corn or verruca removal through to more involved surgery such as to

treat Charcot foot, hammer toes or bunions.

Surgery, particularly more involved surgery, may be carried out under a local or general anaesthetic.

Total contact casts

A total contact cast is a fibreglass shell that can resemble a plaster cast. Total contact casts may be used to help the healing of foot ulcers unless severe ischaemia (severe lack of blood flow to the foot) or

peripheral arterial disease is present
Total contact casts may also be used for treatment of other foot problems including Charcot foot.

A total contact cast covers the whole foot and is designed to fit tightly to prevent rubbing of the skin. The cast has a foam layer under the foot and is designed to keep pressure off the ulcer when walking or standing.

People with diabetes will be aware of the importance of

foot care
and footwear choice is a factor that should not be overlooked.

When it comes to choosing the best shoes, it’s important to have shoes that fit well and allow pressure to be distributed evenly over the foot.

These days there is also specialised footwear available such as extra wide or extra deep footwear and

prescription
footwear to deal with certain foot care needs.

Importance of shoes that fit well

It is important to choose shoes that fit well. Your footwear should be long and wide enough but not too loose either.

If your shoes are too short, there’s a greater risk of developing problems including hammer toes, blisters, corns and damaged nails. Hammer toes can occur if your toes are forced to bend inside your shoes, which, over time, can lead to tendons and muscles in the foot being affected and this can lead to deformation of the foot.

Corns and damaged toes can occur if your toes do not have some room for movement and therefore rub against the end of your shoe. Blisters can occur either on or around the toes or at the heel if shoes are too tight.

If shoes are not wide enough, your feet can be pressed and rub against the sides of the shoe which can lead to corns, calluses, blisters or bunions forming.

Any form of damage or change to the skin or shape of the foot can lead on to loss of surface skin and wounds and foot ulcers forming.

Note that if you have

neuropathy, you may not be able to feel whether your shoes are uncomfortable or if they are causing damage. It’s important therefore that you check your feet daily for any signs of damages or change.

Getting the right fit

To ensure you get shoes that fit well, it’s recommended to have your feet measured and the shoes properly fitted.

It’s better to visit a shoe shop and try the shoes on before you buy. Don’t be tempted to just try on one shoe as most people’s feet tend to be at least slightly differently sized.

It’s advisable to wear shoes at home for relatively short periods of time, say 20 minutes.

Check that your feet do not show any signs of poor fitting such as redness or any marks on your skin. If your shoes show signs of not being the right shape or fit, and you have not worn your shoes outside, you may be able to return the shoes and pick a better fitting pair.

If you have uncertainties about the fit of a new or existing pair of shoes, you may wish to arrange an appointment with a

podiatrist

Picking a good shoe

Natural materials, such as leather, tend to be the best material for footwear as it provides good support and reduces sweating. It is advisable to avoid wearing high heeled shoes where possible as this can cause parts of the foot to withstand an inappropriately high amount of pressure.

Pick shoes which match the shape of your foot and avoid shoes that do not, such as shoes with pointed ends.

As with the fit of shoes, your podiatrist can advise you on the shape, material and types of shoes you wear.

Checking your feet

It’s important to check your feet daily for any signs of wear or rubbing caused by your shoes. It’s also important to look for any other signs of damage or changes in appearance of your feet at the same time.

• Read more on
  
  checking your feet

Specialist foot wear

There are a number of different types of specialist shoes and footwear which may be available commercially or, in specific cases, on prescription.

Note that if you are buying specialist footwear, such as extra deep or extra wide footwear, by mail order or from the internet, it’s important that the shoes fit well. As with non-specialist footwear, it’s useful to try the shoes on for short periods in the home and/or check the fit with a podiatrist before beginning to wear the shoes outside.

This way, if there are any problems with the footwear, you may be able to return them.

Orthoses (shoe inserts)

Shoe inserts are cushioned in soles which help to spread out and relieve pressure on the base of the foot. Shoe inserts may use foam or gel to reduce pressure on the sole of the foot.

Extra deep shoes

Extra deep shoes provide more space within the shoe and are a good pick if you experience red marks or signs of pressing on the top of your feet.

Extra deep shoes may also be useful if you are using shoe inserts, which therefore slightly raise the level of your feet inside your shoes.

Extra wide footwear

Extra wide shoes may be needed for a number of reasons including if you experience swollen feet, bunions or have naturally wider feet.

A good number of shoe suppliers provide wide fitting shoes these days, allowing you to pick

wider fitting shoes for sports, formal or casual wear.

Prescription footwear

If you have specific footwear needs, such as need specialist footwear to enable healing to take place, you may be provided with footwear on prescription.

It’s possible that your prescription footwear may not be a perfect fit and, if this is the case, it’s important to contact your podiatrist or orthotist to notify them of any issues you have with your prescription shoes.

Diabetic socks are socks aimed at people with diabetes. Quite often, diabetic socks are designed without seams in order to reduce the chance of blistering.

In addition, diabetic socks may also be designed to control moisture in order to reduce risk of fungal infection or with cushioning to prevent foot

ulcers
Good

skin care
and foot care is essential. Foot ulcers affect as many as 10% of people with diabetes.

Ideal socks for people with diabetes

The ideal socks for people with diabetes will have the following features:

• Non-elasticated cuffs
• No prominent seams
• Keep in warmth (particularly for winter use)
• Allow feet to breathe and sweat to dry out (particularly for summer use)

Keeping feet warm

Keeping feet warm can help to improve blood circulation which is beneficial for the skin and the health of nerves in the feet. Socks play an important role in keeping feet warm and some socks may be designed specifically to keep feet warmer and to improve circulation.

If your feet are regularly cold, you may benefit from wearing 2 pairs of socks at a time, or socks over stockings. Note that it’s better not to wear 2 pairs of socks if they cause shoes to fit too tightly.

What are diabetic socks?

As with diabetic food, there are no strict guidelines as when the term diabetic can be used with regard to socks which means that it’s better to look at the merits of the sock rather than rely on the label ‘diabetic’ as a measure of suitability.

Reflexa Diabetic Socks

Reflexa’s Diabetic Socks can help you prevent complications of diabetic foot as they contain a new synthetic yarn called Celliant.

Celliant has been


clinically proven to relieve pain, promote quicker wound healing, improve sleep quality, heighten athletic performance and help to regulate body temperature.

These revolutionary fibres are woven into the sock to help increase blood oxygen levels while retaining heat to keep feet warm.

They also feature a flat toe seam (i.e. are seam-free) and do not feature binding.

Skinnies Socks

Skinnies socks are classified as a class 1 medical device Skinnies Therapeutic Socks has specialist composite yarn used to absorb some moisture while helping retention of emollients and creams to effectively hydrate the skin.

Its properties are such that it also removes any allergenic elements of its construction away from contact with your skin while keeping the foot safe and clean.

Skinnies Therapeutic socks are 86% Viscose, 11% Nylon & 3% Elastane and do not restrict blood flow, relieve tired feet and aching legs and give protection for your toes. Featuring a low powered stretch, with no actual compression of the foot, they do stay in place despite having seam-free technology.

This removes the risk of blisters and calluses and the sock also has no tight rib on the top edge.

Silver Socks

Do you suffer with cold feet? If so silver socks could be a dream come true, as they have been proven to help keep the feet warm.

They are a specialist medical product made with safe and natural pure silver, which minimises heat loss by actively reflecting the body’s energy back to the skin. Silver has one of lowest radiant heat loss rates and therefore keeps warmth longer. The socks have been adapted to include added benefits for diabetics.

The diabetic silver socks have extra technical soft tops and a low compression effect, which is created by the silver and not by pressure from elastane or rubber. They are therefore ideal for those with either a diabetic condition with thin diabetic skin or for people with bad surface varicose veins, which may have become swollen or itchy when using conventional socks.

Silver Knit Comfort Socks

Silver Knit Comfort Socks


are made in the USA and included Teflon-reinforced yarn which is used in the heel and toe areas which reduces friction against the skin as well as maximizing the durability of the sock.

The flat toe seam (also described as ‘seam-free’) makes for extra comfort – no seams, no chafing!

They’re called Silver Knit as they utilise anti-microbial Silver Knit thread that can reduce foot odour. The socks also have a knit-top that stays up without binding or leaving marks.

Will diabetic socks prevent me from getting diabetic foot?

Whilst a good choice of socks doesn’t guarantee that you won’t get

diabetic foot
complications, it can help to reduce the risks.

Choosing shoes that fit well, keeping blood glucose levels under control and

ensuring you check your feet for signs of damage
or changes will each also help to improve your chances of avoiding foot complications.

Foot care amongst diabetics is incredibly important as foot related complications are more common for those of us with diabetes.

Foot ulcers for example, which affect as many as

1 out of 10 people

with diabetes, can all to easily develop from blisters and small

wounds
to posing a threat of amputation.

Even
small ulcers on the foot can represent a serious risk: they may heal extremely
slowly and need rigorous treatment to cure.

Ulcers can develop into serious lower body infections, with the possibility
of amputation at an advanced stage.

Caring for your feet

Caring for your feet as a diabetic should not be difficult, and should be a prime consideration.

This section details complications that may affect the diabetic foot, and some methods and information about care.

Why is foot care important?

The presence of high blood glucose levels over a long period of time may result in a condition called

diabetic neuropathy
(damage to the nerves) or loss of circulation in the extremities of the body.

If the nerves in your feet or legs are damaged, your feet can lose sensation and become numb.

It is relatively common for people with diabetes to not feel foot problems until they have developed, therefore it is key to ensure you have

regular foot examinations

Diabetic foot complications include:

• 
  Foot ulcers
  – open wounds on the foot
• 
  Charcot foot
  – deformation of the foot
• 
  Amputation

Caring for your feet

Foot care involves reducing damage from occurring to your feet and regularly checking your feet for any signs of damage.

Damage to your feet can be reduced by avoiding walking barefoot, wearing correctly fitting footwear and keeping your feet clean and in good condition.
Check your feet every day for any signs of damage.

Checking your feet

You should regularly examine your own feet for signs of damage. This is all the more important if you are suffering from

poor circulation
and numbness. If you have trouble checking your own feet, you may need to ask someone to help you check them.

Look out for any of the following signs of foot damage:

• Cuts
• Bruising
• Swelling
• Grazes
• Sores
• Changes in colour
• Ulceration
• Hard skin

Also be aware of any cracking from

dry skin
as this could develop into an ulcer over time.

Foot examinations on the NHS

It is important that you receive a regular check-up from a health professional at least once each year. If you have signs of neuropathy and/or poor blood circulation, you may need to have a foot examination more often.

At a foot examination, your feet will be checked for:

• Signs of neuropathy or development of neuropathy
• Blood circulation
• Any signs of damage

Read more on

foot examinations

Manage your diabetes

Controlling your diabetes
with an appropriate treatment regimen, healthy diet and lifestyle, and regular exercise will help to reduce the chances of suffering from foot complications.

Products for the diabetic foot

Several companies make specific products for the diabetic foot.  Calluses must be removed regularly by a podiatrist or other specialist. The wound should be cleaned and dressed, protected by the bandage but allowed to breathe.

In more severe cases, it may be necessary to wear an orthowedge: a special shoe designed to alleviate pressure on the front of the foot.

Further treatment may include the application of a contact cast, heavily padded inside to reduce pressure on the foot.

Skin care is an important factor for people with diabetes. Skin conditions can be more likely amongst diabetics, and reduced sensitivity of nerves and circulation can often make it harder to spot emerging skin problems.

The skin on our feet need particular attention as the presence of

diabetic neuropathy
can sometimes lead to skin issues not being identified until an advanced stage, when they can cause serious problems.

Why are diabetics more prone to skin problems?

People with diabetes may experience greater loss of fluid from the body due to high blood glucose levels, which can cause dry skin on the legs, elbows, feet and other areas of the body.

If dry skin becomes cracked, germs can get into these areas and cause infection, meaning that taking care of the skin is essential.

If not checked regularly, even minor skin care problems can evolve into serious diabetes complications, such as

diabetic foot ulcers
and even

amputation

Keeping the skin, particularly of your feet, in good condition should be a priority for people with diabetes.

What skin problems particularly affect people with diabetes?

As well as dry and cracked skin, a number of specific skin problems are closely linked to diabetes.

Necrobiosis Lipoidica Diabeticorum (NLD)

Necrobiosis Lipoidica Diabeticorum
(NLD) affects the shins and occurs gradually. It is a patch of plaque that can range in colour from yellow to purple.

The skin in this area can get thin and ulcerate. When it heals, NLD can leave a brownish scar. The causes of NLD are unknown, but it affects more people with type 1 diabetes.

Diabetic Dermopathy

Diabetic Dermopathy is also a common skin problem for people with diabetes. Sometimes known as shin spots, this condition leaves round, raised lesions that can turn into
ulcers

Bullosis Diabeticorum

Bullosis Diabeticorum are small-large nodules underneath the skin, similar to subcutaneous blisters. Again, the cause is unknown.

Acanthosis Nigricans

Acanthosis Nigricans, more common amongst Hispanic people and African Americans, causes brown and black lesions under the skin.

Tips for diabetic skin care

Skin care for people with diabetes is really no different to that which is required by those who don’t have diabetes. However, a few extra skin care tips can help ensure and maintain healthy skin.

• Wash with a mild, neutral soap and make sure that as well as rinsing you also dry yourself. This may include drying between your toes, under your arms, and anywhere else that water can hide.
• Use a
  moisturising lotion
  to keep you skin soft and moist. This type of cream is widely available and can make a huge difference.
• 
  Keeping hydrated
  can help with keeping your skin moist and healthy.
• Wear loose-fitting underwear made from 100% cotton – this allows a healthy through flow of air.
• Consider wearing special socks and shoes if you have neuropathy and are worried about skin care of your feet.
• Keep a close eye on any dry or red spots on your skin, and be ready to act by ontacting your healthcare professional sooner rather than later.
• Keep an extra close eye on any areas affected by neuropathy and make sure to seek professional advice at an early stage.
• Seek medical advice if you have persistent dry skin as this can lead to infections, which can quickly develop into serious complications.

If your skin problems worsen over time, see a doctor immediately.