Ask the Pharmacist

Q) When I was diagnosed with diabetes, my doctor told me I had better take care of my feet. What did she mean by that?

A) While diabetes is a disease that is, at its most basic, an issue with too much sugar circulating within the blood, it is the long term consequences of what this excessive sugar does to our body that makes this such a potentially debilitating condition.

We term these consequences as “complications” and they can involve virtually all parts of our body including the heart, our nervous system, our eyes and our kidneys. In tending to all of these vital organs and tissues, sometimes the feet are somewhat forgotten which can be a massive mistake given how frequently problems can arise on a diabetic’s foot.

For instance, diabetic foot ulcers (sores) occur in 6.3% of diabetics annually. The unfortunate reality of these ulcers is that half of them eventually become infected and require antibiotics as well as time consuming and expensive wound care. What’s worse, 20% of those with moderate to severe infections will wind up needing an amputation to be performed.

In 2017 in the United States, (you know, the country that is less good at basketball…) $176B was spent on diabetes care. A full 1/3 of this staggering total was spent on problems related to the lower extremities. I’ll use one last number to help illustrate just how serious foot care should be taken in the diabetic population. That number is 47% (give or take a %). This represents the five-year mortality rate for those who incur a neuropathic ulcer or an amputation.

To put that rate into perspective, that is more than triple the 5 year death rate from prostate cancer and more than double that of breast cancer. So the next question that needs to be answered is just what should diabetics do about their feet?

Well, the first step is to schedule regular foot inspections with a qualified health care provider. Studies have shown that ongoing foot exams can reduce the risk of amputation by 45-85% making this a highly impactful and no-brainer type solution. Not only should you have a professional look at your feet periodically but all diabetics should inspect their own feet daily looking for cuts, redness, areas of swelling, blisters or nail problems. For those of us with old backs and stomachs not quite as trim as they once were, a magnifying hand mirror can make inspecting the bottom of your feet a far easier task.

Visual foot inspections are critical for two reasons. One, diabetes can take away the ability of your nerves to transmit pain to your brain. This is called neuropathy. As such, you may not be able to feel a tissue problem until it has gotten out of hand. Secondly, diabetes tends to reduce the flow of blood to the feet (it makes the blood vessels of the foot and leg narrower and harder) making it more difficult to fight off an infection or heal an injury.

Foot problems that many of us can self-treat should usually be treated by a professional before they get serious and lead to possible antibiotics or even surgery. Never use the various Dr. Scholl’s type corn or callous pads as they can cause serious skin damage due to the poor circulation in the foot. Minor cuts and scratches can be self-treated by cleaning them with a mild soap and water and covering the area with a bandage type product that is suitable for sensitive skin.

When it comes to bathing the feet, wash them daily but use only lukewarm water and never hot water. Be gentle with washing them. Use a soft wash cloth or even a sponge and dry them by patting or blotting rather than rubbing them. Make sure that the skin in between the toes is dry as well before putting on socks.

Diabetics tend to have dry feet because the nerves that control the oil and moisture in your foot are frequently damaged by the elevated blood sugars. Dry skin is both irritating and has a greater risk of tearing so use a moisturizer daily to keep the skin from cracking. However, do not apply this in between the toes as it could lead to a fungal infection.

Wear clean and dry socks rather than walk around in bare feet, even within your house. The socks will protect your skin from minor scratches which can quickly get out of hand. Some people wear diabetic socks. Good ones (which not all are) are made of materials that have superior abilities to wick away moisture, are fitted, padded, warm (which increases blood flow) and non-binding. The elastic is eliminated which reduces the constriction on the foot allowing for better circulation. As well, the seams are taken out as these can rub against the skin causing blisters or sores.

For those who suffer from cold feet at night, wear the socks to bed and never use a heating pad or a hot water bottle. Keep your feet warm and dry so wear proper footwear during the winter or a rain storm. For those with sweaty feet, an antiperspirant can be applied to the soles of the feet to help keep them dry. Cut nails carefully, or get someone else to trim them. Cut toe nails straight across and file the edges. Do not cut them too short as you run the risk of an ingrown toenail.

Most of all, keep your blood sugars under control. The better your “numbers” are, the less nerve and circulation issues your feet will suffer from. It’s the old “an ounce of prevention…” adage at work once again.