Education Material for Health Care Professionals: Newsletter Version
THE FEET AND DIABETES
Don't try to be your own doctor
Many of the patients we see with serious foot problems seem to have brought it upon themselves by trying to indulge in self doctoring. Some patients when they see a corn or a callus are tempted to take a knife or some other sharp object and try and remove them. Such self-inflicted wounds are often painless and may not be noticed until serious infection has supervened. One should never use any commercial preparation which are available in the market for treating calluses and corns including corn pads and adhesives. In fact, it would be worthwhile to avoid applying any medication to the skin unless it is under medical supervision. Most of the medicines available for applying to the skin may turn out to be too strong for diabetic skin. Strong medicines burn the skin. Patients often use medicines like mercurochrome to treat mild infection or injuries. This is not only too strong but is usually ineffective. The colour of such medications tends to mask the redness that may be the only sign of spreading infection in the absence of any pain sensation.
The best socks to wear are soft cotton ones. These do tend to absorb moisture but this may end up as an advantage in our country where one tends perspire a lot. The socks should not have tight elastic top as this may interfere with the blood circulation to the feet. It may be better, under the circumstances, to allow the top of the socks to be loose even if they have a tendency to roll down a little.
This is one of the most important areas in preventing trauma to the feet, Unfortunately, this is an area where one comes across the most obstinacy. People having diabetes should never walk barefoot. I am against the use of even chappals ( sandals) for use by a diabetic. These really afford no protection against trauma. Unfortunately, many patients refuse to change over from wearing these chappals inspite of all persuation, saying that the use of shoes is not only uncomfortable but goes against their traditional dress style. In such cases, one compromise would be to insist that the chappals should be stitched and not have any nails in them. It is obvious that these patients would need to be extra careful about any injuries that they may get.
Women also rebel against the use of shoes, but this is an argument that does not hold good especially in urban areas where excellent shoes for women are routinely available. Another argument that is used is that the shoes that the doctor feels are good for the feet are not fashionable enough. This may be true in many cases as unfortunately, the arbiters of fashion do not take into consideration the skin condition of a diabetic. At the same time decent looking shoes are available for women which may not be in the height of fashion but are nevertheless quite good looking and suitable for wearing by a diabetic.
Let us now come to the type of shoes that should be worn. They should be made of soft leather rather than of any other synthetic material.
Buy shoes at the end of the day, when the foot is usually at its largest (because of swelling). Shoes will be more accurately and safely sized at that time. All shoes should be sized while the patient is standing since the foot increases in length and width when it is bearing weight. Shoes should be approximately one-half inch longer than the longest digit when sized while the patient is standing.
They should be big enough to accommodate the foot spaciously, especially the front part which should not bunch up the toes.
The “break” of the shoe, should correspond to the widest part of the patient´s foot (typically at the metatarsophalangeal joints). Heel-to-ball length is as different from person to person as is heel-to toe length and should be taken into account when sizing shoes.