A contribution to minimise diabetes-related foot complications: The right footwear and footcare

A contribution to minimise diabetes-related foot complications: The right footwear and footcare

Maria José Ferreira, Rita Souto, Patrícia Costa, Joana Soares (CTCP)

The objective of this article is to provide information on diabetes, footwear selection, and diabetic foot care. It aims to introduce diabetics to the risks associated with diabetes-related foot complications, and strategies to prevent such problems through proper footwear selection and foot care practices.

1. Introduction to Diabetes

Diabetes is a disease that affects the way the body regulates blood sugar (glucose) levels. There are several types of diabetes, including type 1 diabetes, type 2 diabetes, gestational temporary diabetes, and other less common forms.

In type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. As a result, the body is unable to produce insulin, a hormone that helps regulate blood sugar. People with type 1 diabetes require administration of insulin to manage their blood sugar levels.

Type 2 diabetes is the most usual form and occurs when the body becomes resistant to the effects of insulin or does not produce enough insulin to maintain normal blood sugar levels. Type 2 diabetes is often associated with age, obesity, physical inactivity, and poor diet, and can be managed namely through lifestyle modifications, and medication if necessary.

Managing diabetes is essential to prevent complications. High blood sugar levels over time can lead to health problems, including heart disease, kidney disease, nerve damage, and eye and foot complications. People with diabetes would benefit from considering the following aspects:

Medical check-ups: Diabetic patients need to do regular check-ups with their healthcare provider to monitor their overall health, review blood sugar levels, and make any necessary adjustments to the treatment plan.

Medication: Diabetic patients may require insulin injections or oral medications to help regulate their blood sugar levels. The specific medication regime depends on the type and severity of diabetes and is determined by a doctor.

Blood sugar monitoring: Regular blood sugar monitoring is fundamental to diabetes management. Diabetic patients can use blood glucose meters to check their blood sugar levels. This information helps them to make decisions about medication, diet and physical activity.

Healthy eating: A balanced diet is essential for managing diabetes. This includes controlling portion sizes and monitoring glucose and carbohydrate intake.

Physical activity: Regular physical activity helps to improve glycaemic control. Recommended exercise and any restrictions should be advised by the healthcare provider.

Proper footwear and foot care: Diabetes can affect the circulation and nerve function of the feet, making them more vulnerable to infection and slow-healing wounds. It is important to look after your feet, including to inspect them regularly, keep them clean and dry and wear the right footwear to prevent foot complications.

It is important that people with diabetes seek the advice of healthcare professionals, such as doctors, educators and nutritionists. 

2. Foot Complications in Diabetes

High blood sugar levels over time can lead to damage nerves and blood vessels in the feet, resulting in various foot complications. These complications can result in decreased sensation, poor wound healing, and increased susceptibility to infections. Also, high blood sugar levels can affect the skin and make it more prone to dryness, cracking, and infections. The more common foot complications include:

Diabetic neuropathy: Refers to nerve damage caused by diabetes. It commonly affects the peripheral nerves, leading to peripheral neuropathy. Symptoms may include loss of sensation in the feet, numbness, tingling, or burning sensations. Neuropathy can make it difficult to detect injuries or irritations, leading to delayed treatment and increased risk of complications.

Diabetic peripheral artery disease (PAD): Diabetes can cause a narrowing or hardening of the blood vessels, leading to reduced blood flow to the feet and legs. PAD can result in poor wound healing, increased risk of infections, and the development of non-healing ulcers.

Foot ulcers: Foot ulcers are open sores or wounds that may occur in individuals with diabetes. They typically develop due to a combination of factors such as neuropathy, poor circulation, and pressure points from ill-fitting shoes or trauma or foot deformities. Foot ulcers can be difficult to heal and can increase the risk of infections, and lead to serious complication.

Charcot Foot: Charcot foot is a serious condition characterised by progressive weakening and deformity of the bones and joints of the foot. It can result from nerve damage and trauma without appropriate intervention. Early detection and treatment are important to avoid irreversible deformity.

Foot complications can limit mobility and daily activities, affecting the quality of life of diabetics. To minimise these risks, patients should prioritise regular foot care, monitor their feet assiduously for any changes or abnormalities, and consult a doctor promptly if any worrying symptoms arise. 

3. Shoes for Diabetics

Wearing appropriate comfortable footwear is recommended for people with diabetes to protect their feet and reduce the risk of foot complications. Footwear for these patients has typically the following characteristics:

Wide, rounded and deep toe box to accommodate fingers and allow for proper toe alignment, minimise pressure on the toes, and prevent friction or rubbing.

Breathable materials such as leather or textile to allow air circulation, perspiration absorption, and prevent excessive sweating, which can contribute to skin irritation or fungal infections.

Seamless interior reduces the risk of friction that can lead to blisters or ulcers. In the inside of the shoe, there are no protruding seams or stitching.

Adjustable closures, such as Velcro straps or laces, to offer a customised and secure fit, accommodating any fluctuations in foot size or swelling.

Adequate cushioning and shock-absorbing properties to help reduce the impact on the feet while walking or standing, providing comfort and protection.

Supportive stability to promote proper foot alignment and reduce the risk of excessive pressure on specific areas.

Soles that are lightweight, durable, promote natural foot movement and help reduce strain or pressure points and slip.

The choice of footwear may vary according to individual circumstances. It is always advisable to consult a healthcare professional or chiropodist. General considerations and guidelines for choosing footwear for diabetics are set out in the following paragraphs:

Proper fit and width: Choose shoes that fit well. Prefer shoes that provide a good comfortable fit without causing pressure points or rubbing against the skin. Avoid pointed shoes that can increase pressure on the toes. Avoid shoes that are too tight or too loose. Shoes that are too tight can cause pressure points and increase the risk of developing sores or ulcers.

Size: Measure both feet and select the size based on the larger foot. Select a size approximately 1 cm longer than foot length. It is recommended to try on shoes later in the day when the feet tend to be slightly larger due to normal swelling.

Extra depth and wide toe box: Shoes with extra depth provide more space for the toes. A wide toe box allows proper toe movement and circulation and helps prevent issues like bunions and hammertoes.

Design and breathable and moisture-wicking materials: Well-designed shoes made with breathable materials, such as leather or specific textiles, allow air circulation and keep the feet dry.

Seamless interior: Shoes with a seamless interior can minimise friction and reduce the risk of skin irritation or ulcers. Ensure that the interior of the shoes prevents foot slipping inside the footwear and is smooth and free from seams or stitching that can cause friction or irritation.

Adjustable closures: Shoes with adjustable fastenings, such as Velcro straps or laces, are preferable for people with diabetes, as they allow a personalised fit and easy adjustment throughout the day.

Insoles, orthotics or inserts: Shoes with removable insoles can be cleaned and dried. The use of custom-made socks, orthoses or orthopaedic insoles, prescribed by healthcare professionals, can provide additional support and cushioning.

Cushioning and support: Shoes with adequate cushioning provide shock absorption and reduce pressure on the feet. Arch support can help maintain proper foot alignment and reduce strain on the arches. Seek professional advice regarding shoes with arch support.

Shock-absorbing bottom: Shoes with shock-absorbing bottom help reduce the impact on the feet while walking or standing, providing added comfort and protection.

Outsoles: Choose shoes with outsoles that provide stability when walking and are slip-resistant to minimise the risk of falling.

Elevation of heel: Foot lift is recommended approximately around 1.5 to 2 cm, maximum 3 to 4 cm.

4. Daily Diabetic Foot Care

People with diabetes are at greater risk of developing foot problems due to reduced blood circulation, nerve neuropathy and/or a weakened immune system. Foot care is an essential aspect for preventing foot complications. Foot care practices for diabetics include:

Daily foot inspections: Inspect both feet and between the toes daily for any signs of redness, blisters, cuts, any breaks, cracks, or sores. If necessary, use a mirror or ask for assistance to check areas that are difficult to see. Promptly report any changes or concerns to your healthcare professional.

Clean and moisturise: Wash your feet daily with slightly warm water and mild soap. Gently dry the feet, paying attention to the spaces between the toes. Apply a moisturising cream or lotion to keep skin hydrated but avoid applying it between the toes to prevent excessive moisture.

Nail Care: Trim your toenails straight after bathing, avoiding cutting them too short. Smooth any sharp edges with a nail file. If you have difficulty trimming your nails or have thickened nails, or have ingrown toenails, consult a professional for assistance.

Protect Your Feet: Avoid walking barefoot, even at home, to minimise the risk of cuts, burns or injuries. Always wear shoes to avoid accidental trauma. Wear clean, dry, seamless socks made from moisture-absorbing natural fibres. Before putting on your shoes, check that there are no foreign bodies inside.

5. Professional Foot Care

It is essential to know when to consult a professional specialised in foot care in order to manage diabetes-related foot complications. Here are a few situations in which it is advisable to consult a healthcare professional:

Any signs of infection: If you notice signs of infection, such as redness, swelling, increased warmth, pain, or drainage from a wound or ulcer, it is important to seek immediate medical attention.

Non-healing wounds or ulcers: If you have a foot ulcer or wound that is not healing or showing signs of improvement within a reasonable timeframe, it is essential to consult a healthcare professional.

Changes in sensation or neuropathic symptoms: If you experience new or worsening symptoms of neuropathy, such as numbness, tingling, burning sensations, or loss of sensation in your feet, it is important to have a professional evaluation.

Foot deformities or structural issues: If you have foot deformities, such as bunions, hammertoes, or Charcot foot, or if you experience chronic foot pain or discomfort, consulting a healthcare professional is recommended. They can provide interventions, such as custom orthotics, footwear modifications, or surgical options, to alleviate pain and improve foot function.

Regular visits to a healthcare professional are essential for people with diabetes, even in the absence of specific foot problems. Professionals can perform comprehensive foot examinations, and provide guidance, contributing to promote optimal foot health.

5. Conclusion:

This article aims to contribute to the prevention of diabetic foot complications by briefly presenting the most common complications, giving general advice on footwear selection and summarising daily foot care practices for diabetics and professionals. By addressing these topics, the article aims to give readers the knowledge they need to make more informed decisions and implement effective foot care practices. However, please note that the information provided in the article does not replace the advice of a healthcare professional.

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