Recognizing Warning Signs of Diabetic Foot That Can Lead to Amputation and How to Care for Yourself

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

Because“foot ulcers”are a serious concern for diabetes patients. If neglected, they can lead to severe infections and even loss of limbs. We summarize key points about common foot abnormalities and basic self-care advice from doctors for long-term hygiene.

Warning signs: common foot problems in diabetes patients

Diabetes patients have a high risk of foot abnormalities directly contributing to chronic wounds, which can be divided into three main categories:

1. Changes in the skin

• Dry skin: Caused by autonomic nerve dysfunction controlling sweat glands, leading to reduced sweat production. This results in dry, cracked, flaky, itchy skin that can develop ulcers. Therefore, diabetic patients should moisturize their skin regularly.
• Calluses: Formed by pressure or friction between the skin and shoes or bone protrusions, causing thickened skin. If left untreated, the hardened skin can press on underlying tissues, causing foot ulcers. If calluses develop, gently file them with a fine stone in one direction or use creams to soften the skin. Avoid cutting calluses yourself with sharp tools.

2. Nail abnormalities

• Fungal nail infection: Caused by fungal infection of the nails, which thrives in hot, moist conditions, making nails thick, brittle, and prone to breaking. To prevent this, keep feet dry and wear well-ventilated, properly fitting shoes.
• Ingrown or curled nails: Result from cutting nails too short or curved into the nail bed, or wearing shoes with a narrow toe box. This causes nail edges to press into the skin, leading to painful ingrown nails. Therefore, nails should be cut straight and shoes chosen with a wide, comfortable fit, neither loose nor tight.
• Foot deformities: Caused by various reasons, deformities change how weight is distributed on the foot or increase friction on bone protrusions, leading to calluses or ulcers.
• Bunion deformity: An abnormality of the bone at the base of the big toe, which angles outward while the toe itself angles inward toward the second toe, causing bone protrusions that rub against shoes and form ulcers. Avoid wearing pointed-toe shoes, heels higher than two inches, or shoes that are too tight or small.

3. Foot deformities

• Bunion ( Bunion ): The bone at the base of the big toe deviates outward, causing friction against shoes.
• Charcot foot deformity: Results from peripheral neuropathy causing fragile joints and bones that fracture and deform, forming bony protrusions on the sole. Patients should consult specialists for treatment and custom footwear to prevent ulcers.
• Claw toes: Caused by peripheral nerve damage leading to muscle atrophy and weakness in the foot, resulting in toes that curl and press downward. This shifts weight to the toe tips, increasing ulcer risk. Wearing soft, wide shoes to reduce friction, exercising toes, and consulting specialists for treatment and custom footwear are recommended.

The 10 Commandments: self-care guidelines for diabetic foot

Consistent daily foot care is vital to prevent limb loss. The guidelines are as follows:

1. Foot hygiene: Clean feet with mild soap and water after bathing, morning and evening daily, and whenever feet are dirty. Dry feet and between toes immediately 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 soles if needed. If self-inspection is not possible, a caregiver should assist.

3. Skin care: After bathing and drying feet, apply lotion or urea cream lightly to maintain skin moisture. Avoid applying lotion between toes to prevent moisture accumulation, fungal infections, and skin breakdown that can lead to ulcers.

4. Nail care: Use sharp nail clippers and trim nails when soft, such as after bathing. Proper trimming involves:

• Cutting nails straight across to match nail width, avoiding trimming too short or curving into nail beds, which can cause ingrown nails.
• Filing nails and edges to smooth sharpness, filing in one direction only to prevent skin irritation.

5. Wearing socks: Choose socks made of natural fibers that are clean, soft, and breathable to reduce foot moisture. Avoid tight socks or nylon materials, watch for pressure from seams or knots, and change socks daily.

There are five more important foot care tips to follow next week.

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