Diabetic Foot Care

Diabetics are more likely to have foot problems.
If these problems worsen they can lead to complications and even infections.

It is important to recognize and treat any foot problems so that complications do not occur.

Diabetic patients can have nerve damage in their feet. This is known as diabetic neuropathy.
The patient may experience numbness and tingling in their feet.

The diabetic patient with neuropathy may have a lack of sensation in their feet.
This type of patient may not experience pain the way that someone without neuropathy would experience pain.

The diabetic patient may not feel a cut, or blister.

Numbness may change the normal balance of walking and standing.
Poor weight distribution can even lead to fractures.

Pressure points can lead to ulcerations and blisters.

The diabetic patient may also have a deficiency in their circulation. The diabetic with both a wound and poor circulation could develop an infection or even gangrene.

This type of event could possibly lead to a partial amputation of the foot.

When the diabetic has nerve damage and circulation problems it is important to notice changes in the feet to prevent any complications.



Prevention:
Control of glucose levels

Regular visits to the primary care doctor

Inspecting the feet regularly:

Look between toes

Check for any cracks, blisters, scrapes, or ulcers

Look at the bottom of the feet (use a mirror if needed)

Wear protective shoe gear

Preventing any injury to the feet

Wash your feet with mild soap and water (Do not use hot water)

Dry carefully between the toes

If you note any lesions or any signs of infection notify your podiatrist immediately

See the podiatrist regularly for foot care

Never try to trim calluses yourself

Wear good fitting shoes

Avoid tight shoes and high heels

Wear clean socks and change them daily

Do not walk barefoot

Make sure there is nothing in your shoes before putting them on

Apply proper sun screen



When foot problems are found early proper treatment can take place. Notify your podiatrist immediately. Early treatment and care of a minor problem may prevent a major problem such as a serious infection.



Foot problems can be prevented through good glucose control, daily foot care, and regular inspection.

Diabetic Education

General Education for Diabetics:

Avoid any at home care for nails and calluses

Avoid constrictive bandages

Avoid open toed or opened back shoes

Be careful with adhesives and tape on the diabetic insensate foot

Buy shoes at the end of the day when the feet are the largest

Check the bath temperature before submerging the feet

Diabetics with impaired vision need someone to inspect there feet daily

Do not use chemical substances for removing corns or calluses

Dry the feet and between the toes thoroughly after showers

Inspect the feet and toes daily for any lesions

Inspect the shoes for objects before placing on feet

Never walk barefooted

Professional nail care at a podiatry office with regular visits

Protect the feet from sunburn

The use of a high toe box to accommodate hammertoes

The use of an insert to accommodate any lesions

The use of shoes with a wide toe box with extra depth

The use of water based lotion daily without moistening between the toes

Wear a shoe with an appropriate fit to avoid friction which can cause blisters

Tinea Pedis

Is a fungal infection of the skin that causes scaling, flaking, and itch of affected areas. It is also known as Ring Worm or Athlete's foot.

Symptoms
The symptoms of athlete's foot or tinea pedis typically include itching and burning of the feet.

The skin may peel or crack with or without any associated pain.

Commonly the rash is localized to the soles of the feet.

Sometimes the flaking skin may spread to the sides and tops of the feet in a moccasin distribution.


The digital interspases may have some moisture, peeling, redness and flaking as well.



Types of Tinea Pedis


T rubrum is the most common cause for tinea pedis.

Trichophyton mentagrophytes, and Epidermophyton floccosum are other causative organisms.




Vesicular tinea pedis-
Usually caused by T mentagrophytes.
This type is characterized by painful, pruritic vesicles most often on the instep.






Interdigital tinea pedis-Usually caused by T rubrum seen more in hot/ humid environments
This type is characterized by redness, maceration, fissuring, and scaling between toes. It is also associated with itching




Chronic hyperkeratotic tinea pedis-usually caused by T rubrum.
This type is characterized by chronic redness on the bottom of the foot or sides with scaling.




Risk Factors

• A hot, humid, tropical environment
• Prolonged use of footwear
• Hyperhydrosis- Sweating
• Certain people may have a genetic predisposition to the infection

Work Up

In suspected tinea pedis a KOH (potassium hydroxide) staining may be ordered by the doctor for fungal detection by obtaining a sample of the flaking skin

Fungal culture- may be performed to confirm the diagnosis of tinea pedis. A culture can be used to identify the fungal species.



Treatment

Tinea pedis can be treated with topical or oral antifungals. Some topical medications are over the counter. Topical agents are generally used for 1-6 weeks


Examples of Topical Medication

Topical Imidazoles

• Clotrimazole 1% (Lotrimin)
• Econazole 1% cream (Spectazole)
• Ketoconazole 1% cream (Nizoral)

Topical Pyridones

• Ciclopirox 1% cream (Loprox)

Topical Allylamines

• Naftifine 1% cream (Naftin)
• Terbinafine (Lamisil)

Oral Antifungals

Considered in patients with extensive chronic hyperkeratotic or inflammatory/vesicular tinea pedis

• Terbinafine (Lamisil)
• Itraconazole (Sporanox)

Prevention

• Keeping your feet clean and dry
• Avoiding prolonged moist environments
• Disinfecting old shoes
• Periodic use of anti fungal foot powder in the shoes

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