Why do diabetics develop foot problems more often than others?
The disease process of diabetes itself affects feet in many ways.

1. Diabetes leads to nerve damage ( neuropathy) causing a loss of sensation to touch, pain and temperature. Hence, you can never rely on pain to indicate when you're injured. Nerve damage also leads to an absence of sweating causing dry skin in feet, which cracks and develops fissures, which can easily get infected. If you are a diabetic with numbness, a tingling sensation of feet or burning pain in the night, muscle cramps, coldness of feet or altered sensation over the lower limbs; then you have already developed neuropathic effects of diabetes. Neuropathic feet can easily develop foot complications in the presence of trauma without your knowledge.
   
    

2. Diabetes affects blood vessels supplying the lower limbs by gradually blocking them and decreasing blood flow, so that fewer nutrients reach the legs for nourishment and less oxygen to breathe. This condition in legs is known as peripheral vascular disease or PVD and it is so commonly seen in diabetics, so much so that any patient who presents with PVD or foot ulcer should be screened for diabetes.
   
    

3. Diabetics are more prone to secondary infections of traumatized skin and tissues and fight poorly against bacteria causing infections. Therefore, it doesn't take a long time for a warm spot on the leg to become a spreading cellulitis involving the whole leg leading to an amputation!
    

What are the foot complications of diabetes?
Patients can have varying foot conditions.
There can be patients with a high- risk foot due to the above conditions but with no ulcers at the time of presentation. There can be diabetics with superficial foot ulcers, which are skin deep. Some can have deeper ulcers with infections that do not reach bone. When the infection reaches the bone it is called osteomyelitis and it is then very difficult to treat.

Localised gangrene of the foot (death of one part of the foot) and spreading gangrene are limb- threatening conditions resulting from neglected foot ulcers with super added infection. Due to nerve damage, poor blood supply and frequent infections your feet get traumatized repeatedly leading to deformities.

How to take care of your feet if you are a diabetic
 

• Self-inspection of feet is the most important thing to do. All diabetics should inspect their feet daily.
  Look for,
                   Areas of blisters, cuts, cracks, calluses, corns, scratches
                   Colour changes
                   Swelling
                   Change of temperature like a warm area
                   Look between toes for evidence of fungal infections
                   Check for ingrown toenails
  
   

• If you have developed any of the above conditions, it's better to seek medical advice as soon as possible. It may be unwise to wait for your next clinic date to get treatment.
  Inspect feet in good light and use a mirror to see the soles. If your eyesight is poor or if you are too obese to see your feet, get some one else to check your feet every day.
  
   

• Wash your feet at least once a day and dry carefully. When washing feet never use hot water as it could be too warm for you and your feet may not feel it. Whenever it is necessary to use warm water, check the temperature with your hand or elbow before putting your feet in. Do not use chemical agents to clean your feet. Mild soap would be sufficient. Dry your feet with a soft cloth paying special attention to areas in between toes. You can apply some moisturizing cream or an ointment afterwards.
  
   

• Cut your toe nails straight across. Do not cut the corners of nails or ingrown toe- nails. If you are unable to do it on your own, always get help. It's easier to cut nails after a shower or a bath, as the nails are softer.
   

• Never self treat corns, calluses and blisters. Improper treatment could lead to a limb threatening condition in a diabetic patient. Always avoid over the counter medications and 'home surgery'.
   

• Try to avoid walking bare foot. The only time a diabetic is allowed to be bare foot is either in bed or in the shower. If you have numbness or tingling of feet always wear shoes or slippers even indoors to avoid getting injured unknowingly. Avoid walking bare foot on the beach or on a heated pool terrace.
   

• Be very careful with your foot- wear and socks. Select comfortable, well fitting shoes with enough space for toes in their natural resting position. Always buy shoes in the afternoon, as it is known that feet swell towards the latter part of the day. Break new shoes gradually to avoid shoe cuts. Check the inside of shoes for any sharp objects, torn edges or a ragged lining which can be rough on your skin. Use cotton socks which are not too tight and check for any discharge when removing them for the first signs of possible foot ulcer, blisters.
  
  Custom-made shoes, insoles and devices can be constructed for diabetics with pressure sores in order to redistribute pressure and weight.
   

• Exercising your feet is a good idea for most diabetics as it improves the general circulation of feet and improves the general health of the patient by helping to control blood sugar
   

• Avoid crossing legs as it can affect an already reduced blood circulation of the feet. It can exert pressure on nerves too.
   

• Stop smoking!! Diabetes and smoking is a dangerous combination, which can not only cost your limb but also your life. Smoking enhances clogging of blood vessels and further impedes blood supply to your feet.

If you have diabetes, try to avoid possible injuries like sprains and fractures in the foot and ankle because being a diabetic, healing will take what it seems like forever. The prolonged bed rest period and reduced physical activity would affect your blood sugar control and general health adversely.

Who can help you to look after your feet?

When you are a diabetic your feet become more important than your face. Show your feet to the doctor at each visit. Make sure you remove your socks at a clinical examination so that your doctor can see your feet.
The field of foot care is known as 'podiatry' and the professionals in the field are known as podiatrists. They are experts in treating corns, calluses, toenails, bunions, heel spurs as well as ankle and foot injuries, deformities and infections. Podiatrists prescribe medicines, guide on physiotherapy, treat fractures and perform other surgeries of the foot. They can correct deformities and design corrective insoles, plaster casts and custom-made shoes.

With the increasing diabetic population in Sri Lanka, the need for trained podiatrists is overwhelming. After all, every diabetic should meet a podiatrist at some point of time and it's better not be with a serious foot complication.

So take care of your feet. Never think that your feet are normal if you have diabetes. You are born with only one perfect pair and nothing on earth can give you an equally good spare if you neglect looking after it.