Watch for Danger Signs of Diabetic Foot—Ignoring It Could Lead to Amputation, Plus Self-Care Tips

Check the warning signs of "diabetic foot," a common issue among diabetes patients, including dry skin, ingrown nails, and foot deformities, along with recommendations.The “10 Commandments”for self-care of the feet to prevent amputation.

Because“Foot wounds”are a serious concern for diabetes patients. If left untreated, they can lead to severe infections that might result in limb loss. We summarize key points about common foot abnormalities and basic self-care tips recommended by doctors for long-term hygiene.

Warning signs: Common foot problems in diabetes patients

Diabetes patients are at high risk of foot abnormalities that directly contribute to chronic wounds, which can be divided into three main categories as follows.

1. Changes in the skin

• Dry skin: Caused by dysfunction of the autonomic nervous system that controls sweat glands, leading to reduced sweat production. This results in dry, cracked, scaly skin with itching, which can cause wounds. Therefore, diabetics should regularly apply moisturizing cream to maintain skin hydration.
• Thickened skin (callus): Caused by pressure or friction between the skin and shoes or bone prominences, leading to skin thickening. If the callus becomes too thick, it can press the underlying tissue and cause foot wounds. If calluses develop, gently file the feet with a fine stone in one direction or apply creams to soften the skin. Avoid cutting calluses yourself with knives or sharp objects.

2. Nail abnormalities

• Nail fungal infection: Caused by fungal infection in the nail area, fungi thrive in warm, moist environments, making nails thick, brittle, and prone to breaking. Therefore, it is important to keep feet dry and wear well-ventilated, properly fitting shoes.
• Ingrown or curved nails: Caused by cutting nails too short or rounding them into the nail folds, or wearing shoes with a narrow toe box. This causes the nail edges to press into the skin, leading to painful ingrown nails. Thus, nails should be cut straight, andshoes with a wide toe boxthat fit the foot well—not too loose or tight—should be worn.
• Foot deformities: Have various causes. Deformed feet alter weight distribution or increase friction on bone prominences, leading to calluses or wounds easily.
• Bunion deformity (hallux valgus): An abnormality where the bone at the base of the big toe deviates outward while the tip bends inward toward the second toe, causing bone prominences to rub against shoes and form wounds. Therefore, avoid pointed shoes, heels higher than 2 inches, or shoes that are too tight or small.

3. Foot deformities

• Hallux valgus ( Bunion ): The bone at the base of the big toe deviates outward, causing friction with shoes.
• Charcot foot deformity: Results from peripheral neuropathy causing fragile joints and bones that can fracture and deform, creating bony prominences on the sole. Patients should consult specialists for treatment and receive custom-fitted shoes to prevent wounds.
• Claw toes: Caused by peripheral nerve degeneration leading to muscle wasting and weakness in the foot, resulting in bent toes that press down. This increases pressure on the toe tips and can cause wounds. Therefore, wear soft, wide shoes to reduce friction, exercise the toes, and consult specialists for treatment and proper shoe fitting.

The 10 Commandments: Self-care foot guidelines for diabetes patients

Consistent daily foot care is essential to prevent limb loss, with these recommended practices.

1. Foot cleaning: Clean feet with mild soap and water after bathing, morning and evening daily, and whenever dirty. Dry feet and between toes promptly to prevent moisture buildup.

2. Daily self-inspection: Check for abnormalities such as swelling, redness, warmth, thickened skin, or blisters on the heels, soles, nails, and between toes on both feet. Use a mirror to view the soles if needed. If unable to inspect alone, have a caregiver assist.

3. Skin care: After drying feet post-bath, apply lotion or urea cream lightly all over to maintain moisture, but avoid lotion between the toes to prevent fungal infection, skin breakdown, and wounds.

4. Nail care: Use sharp nail clippers. Cut nails when soft, such as after bathing. Cut nails straight to match nail width, avoiding cutting too short or rounding edges deeply to prevent ingrown nails.

• File nails and edges to smooth sharp points in one direction only, avoiding back-and-forth motions to prevent skin irritation.
• 5. Wearing socks:

Choose socks made of natural fibers that are clean, soft, breathable, and reduce foot moisture. Avoid tight socks or those made of nylon. Be mindful of seams or knots that might press on the skin. Change socks daily. More helpful foot care tips will be shared next week.

Source: Nursing Department, Ramathibodi Hospital, Faculty of Medicine, Ramathibodi Hospital, Mahidol University