Surviving Covid-19: Diabetic Foot Care

pins and needles diabetic foot tingle

Surviving COVID-19 without my Podiatrist

Diabetic Foot Care

Welcome to the sixth installment of my blog, Surviving COVID-19 without my Podiatrist. Each article provides at home self-help guidance to common foot ailments. The information provided in our blog is not intended as a substitute for a medical diagnosis or care. My intent is to help the reader take care of their feet in these difficult times where access to immediate medical care is limited.

If you have any questions about any of the topics covered, as well as any other subject you would liked addressed, please email me at drreyes@ngfootclinic.com.

Diabetic Foot Care at Home During the Pandemic

The preventive and medical foot care I provide to my diabetic patients ranks as the most rewarding work I do as a podiatrist in terms of improving a patient’s quality of life. According to a 2012 study by the Joslin Diabetes Center at Harvard University, diabetes is the major cause of below the knee amputations in the United States. Patients who have had amputations are 40% percent more likely to suffer cardiovascular complications such as heart attacks and strokes. Therefore,  limb salvage can be a life and death matter for diabetic patients.

 

What is the connection between diabetes and our feet?

Diabetes is considered to be a form of “small vessel disease,” in that it promotes the calcification and obstruction of small vessels, such as the ones we find supplying the eyes, kidneys and yes the bottom of our feet. The previously mentioned study stated that diabetes is the leading cause of blindness and kidney failure in the United States, therefore lifestyle changes and preventive medicine are essential to a diabetic’s very survival.

However, even with the best plan of care, diabetics will gradually have a decrease in the circulation of the peripheral vessels of the feet. This causes hypertrophy, or thickening of toenails, formation of thick calluses due to excessive friction over very atrophied (thin) skin. Furthermore, the poor circulation also causes the decrease of the protective fat pad on the bottom of our feet. This can lead to thick “heel fissures” a type of callus formed around the heel due to this lack of cushioning. This type of callus can deepen and form actual wounds that can become infected and become very painful. The lack of circulation from these small vessels makes it very difficult for wounds, or ulcerations, to heal for these patients, particularly if their sugar isn’t under control. This is because all the tissues in the body are nourished and oxygenated through our circulation.

This same small vessel disease of the diabetic foot can cause a neurological condition known as diabetic neuropathy. Like all tissues,the small peripheral nerves that provide us with sensation in our feet require good circulation in order to live. When the circulation carrying needed oxygen and nutrition decreases, the nerve start to slowly die. The initial symptoms of diabetic neuropathy can range from sharp “pins and needles” sensations, all the way to severe pain. I have had patients compare diabetic neuropathy pain as “a sharp knife being inserted through the bottom of their feet.” The final stage of neuropathy is appropriately called anesthesia. It is a point where the patient has lost almost all sensations on the bottom of their feet. A patient could step on a nail and not feel it at all! This can lead to a serious infection, particularly because of its inability to heal properly. Interestingly, I have had patients who are completely insensitive in this area and yet will experience sharp stabbing pain from time to time.

A visit to the Podiatrist, my hero!

Diabetics must see a podiatrist at least twice a year for a Comprehensive Diabetic Foot Exam (CDFE). During this visit they undergo a vascular, neurological, dermatological and orthopedic evaluation of their feet. The purpose of this evaluation is to diagnose and treat any ongoing condition as well as assess the patient’s risk of limb loss. It is during this evaluation that at risk patients are prescribed molded diabetic shoes and scheduled for routine foot care. During routine foot care calluses, thick and ingrown nails are also reduced by the doctor.

Most at-risk diabetics come in every two months for routine foot care. However, there is nothing routine about them. During each visit any current ailments can be seen and any potential problem can also be detected. For example, I once had a patient that came in for a routine visit complaining of a small “corn” due to a new pair of shoes. Well turns out that underneath the corn was a deep wound going all the way to bone. However because of his neuropathy, he couldn’t feel it! I immediately began a wound care treatment regimen, that included an evaluation by a vascular surgeon. The wound healed and the limb was saved. Routine foot care by podiatrists is perhaps the single most important treatment available in the prevention of amputation.

 

Taking care of your diabetic feet at home during Covid 19

While it isn’t recommended that diabetic patients attempt to shave down calluses or thick nails themselves, there are some basic steps that a patient can do at home in order to keep their feet healthy and prevent complications. Keep in mind, one must immediately seek urgent medical care if the following were to occur: loss of sensation, a discoloration from normal to blue or red digits, a deep open wound or a severe swelling with blistering and purple discoloration of the skin and a fever.  A strict control of one’s sugar is paramount during at home quarantine to avoid turning a simple problem into a serious complication.

Dr. Rick’s Diabetic Foot Home Care Road Map

  1. Inspect your feet daily. The best time to do this is right after you bathe. Take a mirror and place it under
    your each foot in order to inspect the bottom of your feet. Inspect in between your toes, to make sure they are
    dry and are not macerated.
  2. Bathe in lukewarm water, never hot and use a liquid moisturized anti-bacterial soap, such as Dial or
    Aveeno. Avoid harsh bar soaps. They promote xerosis in diabetic skin, a chronic dryness.
  3. Be gentle when bathing your feet use a soft washcloth or sponge. If you have calluses or fissures on the
    bottom of your feet, you can use a moist pumi stone while bathing to gently remove any of the hardened
    callus skin. Only use the pumi stone while your feet are wet. Gently rub the area only two to three times. You can repeat this routine daily after bathing.
  4. After bathing make sure you thoroughly dry your feet, particularly in between your toes. Also apply a moisturizer on the bottom of your feet. I prefer vaseline petroleum jelly. It is very inexpensive in has great
    penetration through callused hard skin.
  5. If you have a painful heel fissure that hasn’t formed a cut or a wound yet, here is a very effective way to
    heal them.

    • Use cooking lard, such as crisco for instance, apply it over the heel and cover the area with plastic saran wrap and then a soft padded cotton sock, before going to sleep. By covering up the foot, it increases the penetration of the oil into the fissure. After 4 to 5 days the fissure will heal usually.
  6. Cut your toenails straight across and file the edges with non metal nail file. Don’t cut your nails too short, as this promotes ingrown toenails. If you notice that there is bulging on the sides of the nail border or redness  due to an ingrowing nail, do not attempt to dig in and remove it. Begin soaking the entire foot with 1⁄2 cup of regular vinegar and enough lukewarm water to cover the foot for 10 minutes every day. After you finish soaking, dry your foot and apply neosporin or bacitracin ointment in the border between the skin and the nail. Cover the toe with a cloth band-aid and try to avoid any closed shoes, but don’t wear flip flops! They offer very bad support for a diabetic’s foot and the strap in between the two first toes can cause forefoot pain and/or ulcerations.
  7. Shake out your shoes and feel the inside of them before wearing them. Keep in mind that your feet may not be able to feel a pebble or other foreign object inside the shoe. Only wear shoes that are either considered diabetic molded shoes or have the seal of approval for diabetic shoewear by the American Podiatric Association (APMA).
  8. Only wear socks made specifically for diabetic patients. These socks are made with extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin.
  9. Never walk barefoot! Enough said!
  10. Use a regular antiperspirant on the soles of your feet if you have to wear closed shoes for long periods of time in a hot or humid environment. It prevents excessive sweating and moisture in your feet.
  11. Keep your feet dry and warm, particularly if you live in an area where it snows. However, do not use warmers in your shoes. They can lead to a burn or an ulceration. You must always have extra dry socks to change into after being out in the snow.
  12. If you suffer from cold feet at night, wear socks to bed. Do not use a heater or hot water bottle.
  13. If you are suffering from neuropathy symptoms and don’t have access to prescription medications such as Lyrica, a new study by the American Diabetes Association has found that using topical over the counter capsaicin cream 2 to three times a day on the affected area of your feet has been very effective in controlling these symptoms.
  14. A study by the Lancet indicated that a daily dose of Vitamin B complex can help improve neuropathy symptoms and damage, in patients who control their blood sugar.I have my patients taking FHA B complex for Diabetics. It is inexpensive, has an excellent purity and is very easy to order online.
  15. If you are a smoker please quit. There is a study in The Journal of Endocrinology that links the use of nicotine with advance small vessel blockage in diabetics. Furthermore, for diabetics on insulin, it has been demonstrated that it inhibits the effectiveness of insulin in lowering blood sugar.

 

I hope this at home road map is of use to you and remember you can be a healthy diabetic as long as you are
proactive in your care. If you have any questions I am always available, drop a comment here, email me, or send me a DM through any of my social media pages.