Diabetic Neuropathies

Complications /Information to beware of/General tips:

Foot advice 

• Advising patients to check their feet daily;
• Advising patients to apply moisturising cream to dry areas but not between the toes;
• Advising patients to choose footwear that accommodates the shape and size of the foot to prevent rubbing or shearing;
• Advising patients never to walk barefoot (to prevent standing on anything that could traumatise or injure the foot);
• Advising patients to seek early advice as soon as a foot problem is identified (the National Diabetic Foot Care Audit demonstrates that this leads to shorter healing times and reduces the likelihood of amputation);
• Asking the patient if they have had a recent foot check as part of their annual assessment and, if they have not, advising them to have one, as well as how to perform daily foot checks themselves.

Daily foot checks and footwear advice

• Check feet daily;
  • For patients with reduced mobility or flexibility, using a mirror can be helpful to check the foot for changes. Alternatively, asking a friend or relative can be beneficial;
• Be aware of loss of sensation;
• Look for changes in the shape of the foot;
• Look for discolouration of the foot;
• Do not use corn removing plasters or blades;
• Look after toenails and ensure these are cut straight across;
• Wear shoes that fit properly;
• Examine shoes for sharp objects or stones before putting them on and replace ruffled innersole linings;
• Avoid socks, stockings or tights with wrinkles or prominent seams, or socks with holes or darned areas;
• Garters and stockings or socks with elastic tops should be avoided because they may restrict the circulation;
• Attend annual foot reviews.

The Pharmaceutical Journal,
The diabetic foot;
Online:DOI:10.1211/PJ.2017.20203299

General tips

Hot baths and massage

• Some diabetics cannot tell if their skin feels hot or cold sensations (peripheral neuropathy) and may burn their skin leading to skin infection and/or a serious muscle breakdown called rhabdomyolysis.
• Hot baths can increase blood flow and may reduce blood glucose levels in one’s blood due to an increase in insulin levels produced by ones body.
• Massages are fine if one has no poor circulation, it is not fine if one has poorly controlled or advanced  diabetes and/or is prone to muscle breakdown this can lead  to numbness, heart problems and/or kidney failure  as well as a  serious muscle breakdown called rhabdomyolysis.
• Avoid massaging areas when one has insulin injected as the pressure in the area may influence the way their body absorbs the shot and their alter their intake.
• Excessive heat can can cause your heart to beat faster which may be of concern if one has an underlying heart issue/cardiovascular issue.

Foot care Patient Advice (especially diabetics or with poor foot circulation)

• Look at feet each day. If you are not able to check if someone else can, particularly if you have reduced sensation in feet.
• If you get a cut, bruises, redness, blister bleeding; please see your medical doctor, in the meantime cover it up with a clean dry dressing.
• If you have dry skin, use a moisturising cream or oil but do not use between toes (one may have athletes foot or be at risk).
• Cut your nails along curvature with toe nail clippers, not straight across. Do not damage your skin.
• Wash feet regularly everyday in warm soapy (anti-bacterial soap) and/or salty (antiseptic) water especially between toes and ‘pat dry’ thoroughly.
• Try to avoid foot burns:
  • Check bath temperature with hand before you put your feet in.
  • Keep your feet away from hot objects e.g. hot water bottles, electric blankets, close to fire, hearers
  • Avoid slip on shoes
  • Avoid top flat shoes, pointy shoes (have broad front with room for toes, sandals and flip flops that cause rubbing).
  • Always feel inside shoes for stones or rough edges before you put them on.
  • Always wear comfortable low heel shoes/trainers, (heels too low can strain the foot arch, cause sore and cracked heels)
  • Make sure they fit well (comfortable fastening, liner and buckles to prevent rubbing otherwise can get blisters). Take into account any corns, bunions, awkward shape. (If have no choice, consider specially fitted shoes to take account of bunions, corns deformities)
  • When buying new shoes, wear your usual socks.
  • Gradually break in new shoes.
• Always wear comfortable socks (not too tight) with footwear. Socks protect you from a rubbing shoe.
• Do not walk bare foot anywhere. One may damage their feet.
• Rotate ones ankles move feet up and down and do regular feet exercise to improve suppleness and blood circulation.

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice