May 06, 2021 Feet first

You take your feet seriously. How do we know? We reached out to our Facebook community about foot care and you responded, asking about the best strategies and sharing your experiences. Now, it’s our turn. We put together a team of experts to answer your questions. Mariam Botros is a chiropodist (a health-care professional who diagnoses and treats foot problems, including medical and surgical treatment), certified diabetes educator, and CEO at Wounds Canada. Sherry Green is a registered nurse who specializes in wounds, foot care, and research in London, Ont. Dr. John Embil is a physician, a professor in the Faculty of Health Sciences at the University of Manitoba, and co-author of the chapter on foot care in the Diabetes Canada 2018 Guidelines for the Prevention and Management of Diabetes in Canada. We shared Ralph Stoker’s question and Dr. Embil’s answer in How Are Your Feet? but we have lots more for you, including these words of advice from Dr. Embil:

A crack in the skin of your feet is like a scratch in the paint of your car: Just as the scratch allows the metal to oxidize and rust, the crack serves as an entryway for germs.

I’m wondering why soaking your feet and pedicures are discouraged. If your [blood glucose] numbers are good and steady, why is this such a big no-no? – Karen Greiter
 

Botros A pedicure puts you at risk for skin injuries. For instance, the equipment may not be properly sterilized, and many other feet may have touched the tubs in which you soak your own feet. There are a lot of articles about people with diabetes who had to be hospitalized after getting a pedicure. As for soaking your feet, there is no reason to do it, since soaking actually dries out the skin.

I don’t have foot troubles all the time, but some days it’s so bad I can barely walk. I’m not sure what causes it. – Tera Cardinal
 

Embil If you have tingling, aching, or pulsing, the culprit may be painful nerve damage in your limbs, also known as diabetic peripheral neuropathy. Pain in your calf [the back portion of your lower leg] when you walk or raise your feet could mean you have problems with your circulation. The pain in your feet could be related to broken bones, or changes in the shape of your feet, which can happen if you lose sensation in them. Be sure to tell your doctor exactly what kind of pain you have in your feet.

How do I stop my feet from being constantly cold? – Victoria Gibson
 

Embil Your feet may not actually be cold, but they may feel cold to you due to nerve damage. I’ve seen people who think their feet are cold and then burn them on radiators, or with heating pads or boiling water, because they don’t feel the pain. Needless to say, such strategies to warm your feet should be avoided. Wearing thick socks may help, but won’t necessarily get rid of the feeling that your feet are cold. Do bring this to the attention of your health-care provider.

What about a burning sensation, even though my feet are cold? – Carla Gale

Embil Again, this has to do with nerve damage. Your doctor can give you a prescription for medications, including tricyclic antidepressants, gabapentin and pregabalin, that can help relieve the symptoms of nerve damage. If these don’t work, ask for a referral to a pain management specialist.

My feet are cracked and hard. What can I do to make them better? – Amy Pag
 

Green Moisturize every day, ideally after showering or before bedtime. When in bed, wear cotton socks to keep the moisturizer on your skin, unless your feet get uncomfortably hot. Avoid getting the moisturizer between your toes, because excess moisture in that area increases the risk of infections caused by fungus.

What moisturizing foot creams are safe to use? – Julia K. Ivison

Green We usually recommend products with urea, which are well absorbed by the skin. You can also find a product that combines urea for moisturizing and AHA [alpha hydroxy acid] for exfoliation [to remove old dead skin cells on the surface of your skin].

When it comes to your footwear, Green offers this advice: 'f you have diabetes, you can’t buy your shoes at just any store. You need to have your shoes professionally fitted.

Is it true that people with diabetes have poor lower body circulation? – Lisa Sands
 

Green It can certainly happen. Over time, high blood glucose [sugar] levels can affect both the small and large blood vessels. Your doctor can recommend a test called an ankle brachial pressure index [ABPI] to rate the circulation in your lower body.

My arches ache sometimes when I go to bed. Is this due to diabetes? – Lynda Heywood

Botros Not likely. If you have been living with diabetes for many years, this may cause the arches and other structures in your feet to shift, but if the disease has progressed to that point you’re unlikely to feel any pain. Arch strain is more likely to arise from conditions such as plantar fasciitis [a common and painful condition that affects the heel and underside of your foot].

My son’s feet peel. Could this be from him having diabetes? – Jessica Watson

Botros Yes, diabetes may be the cause. Nerve damage can impair the function of the sweat glands, and the loss of lubrication can lead to dryness. I would recommend applying moisturizer to your son’s feet every night. If the dryness is really bad, you can also do this in the morning, but once a day is generally enough.

Sole solutions

Here are some steps you can take to prevent foot problems or ensure they do not get worse:

• Have a health-care professional check your feet at every diabetes visit, which should be four times a year. Also get screened for nerve damage and loss of circulation at least once a year.

• Check your feet every day for any changes or signs of injury. Contact your health-care professional if there are any changes.

• No matter how warm it is, always protect your feet: Wear socks with your shoes, and avoid going barefoot.

• See your doctor or foot specialist as soon as possible if you have any of these symptoms in your legs or feet: swelling, warmth, redness, pain, or changes in foot structure.

• If you have a sore or blister, wash it with warm water, dry it well, cover it with a bandage—and see your healthcare professional immediately.

• See your doctor or foot specialist if you have corns (thick or hard skin on your toes), calluses (thick skin on the bottom of your feet), ingrown toenails, warts, or slivers. Do not try to treat them yourself.

Healthy feet

Foot problems are common in people with diabetes and can lead to serious complications; however, there are many things you can do to keep your feet healthy. 

Here’s a list of other helpful resources:

Foot Care: A Step Toward Good Health
Finding the Proper Shoe Fit
A Step in the Right Direction

PC Health app

Join us on Facebook on May 20 for the Foot Care to Prevent and Manage Diabetic Foot Ulcers webinar.

Did you know?

2021 marks the 100th anniversary of the discovery of insulin. Today, more Canadians have diabetes than ever before. Diabetes or prediabetes affects one in three Canadians. One in two young adults will develop diabetes in their remaining lifetime. We cannot wait another 100 years to End Diabetes. Visit 100 Years of Insulin to learn more, including how you can support those living with or at risk for the disease.

This article appeared in Diabetes Dialogue, Summer 2015.