Care and prevention of diabetic foot ulcer (DFU)

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What are diabetes problems?

Diabetes is a disease which causes a high concentration of glucose or sugar in the blood. The body gets energy by making glucose the food we eat. The body produces insulin so glucose can use it. When suffering from diabetes, there is a problem with insulin, and glucose therefore remains in the blood.

Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. You can do a lot to prevent or slow down diabetes problems.

This information is about feet and skin problems caused by diabetes, and things you can do each day and during each year to stay healthy and prevent diabetes problems.

 

A healthy foot

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Healthy feet are strong and agile. They allow you to walk, and run supporting your body’s weight. Bones and joints of the foot absorb the pressure of body’s weight. Skin and fat of the feet are the first barriers for preventing entry of infections into the foot, from where they can reach the rest of the body. Usually, if we hurt a foot or if there is an infection, the first thing we feel is pain. Pain alerts us to the possibility of a dangerous situation. Once we feel pain we know the affected area to be cured, and we take care not to hurt it again. The body also fight the infection with special cells that can kill germs that produce it. These cells reach the site of infection via the blood. Blood vessels also carry oxygen and nutrients necessary for the tissues of the feet.

 

How can diabetes hurt my feet?

High blood glucose from diabetes causes two problems that can hurt your feet:

  1. Nerve damage. One problem is damage to nerves in your legs and feet. With damaged nerves, you might not feel pain, heat, or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can lead to a sore or an infection.
  2. Poor blood flow. The second problem happens when not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheral vascular disease.

 

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Smoking damages blood circulation.

For example, you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor blood flow to your legs and feet prevent fighting the infection. There are cases when an infection source is never cured.

The infection might cause gangrene. If a person has gangrene, the skin and tissue around the sore die. The area becomes black and smelly. To keep gangrene from spreading, a doctor may have to do surgery to cut off a toe, foot, or part of a leg. Cutting off a body part is called an amputation.

 

What are common diabetes foot problems?

Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.

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Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected..
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Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become infected.

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Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. If toenail edges are sharp, smooth them with an emery board. You can also get an ingrown toenail if your shoes are too tight.

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A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.

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Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.

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Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.

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Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.

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Athlete's foot is a fungus that causes itchiness, redness, and cracking of the skin. This cause irritation. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.

All these foot problems can be treated. Talk with your doctor immediately if you have a foot problem. It is also important to know that the skin of the legs and feet lose their ability to defend themselves with very basic mechanisms such as sweat and sebum secretion, since these glands are atrophied. Similarly, in the case of men, the legs’ hair begins to disappear symmetrically and bilaterally. These two issues are indicative of undiscovered diabetes, and are factors that predispose their feet to trauma.

 

What can I do to take care of my feet?

Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.
revisar_pies.jpg Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes. crema.jpg
piedra.jpg File corns and calluses gently with an emery board or pumice stone.Do this after your bath or shower.

 

Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board. cortar_unnas.jpg
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Always wear socks or stockings to avoid blisters. Do not wear socks or knee-high stockings that are too tight below your knee.

Wear shoes that fit well. Shop for shoes at the end of the day when your feet are bigger. Break in shoes slowly. Wear them 1 to 2 hours each day for the first few weeks.

Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.

 

Protect your feet from hot and cold.Wear shoes at the beach or on hot pavement. Apply sunscreen lotion on top of the feet to prevent sunburn. Keep your feet away from radiators and flames. Do not put hot water bottles or heating pads on your feet. If your feet get cold at night, wear socks.

 

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circulacion_activa.jpg Keep activates blood circulation in the feet.Put your feet up when sitting. Move your toes for 5 minutes, two or three times a day. Move your ankles up and down and in and out to improve blood flow to the feet and legs. Do not cross your legs for long periods. Do not wear tight socks or elastic bands or rubber materials or garters around your legs. Do not smoke. Smoking reduces blood flow to the feet. Get help to stop smoking. Work with your health care team to control blood sugar, blood pressure and cholesterol.

 

Be more active. Ask your health care team to plan a daily activity program that is right for you. Walking, dancing, swimming and bicycling are good forms of exercise easy on the feet. Avoid heavy activities for the feet, such as running and jumping. Wear athletic shoes that fit well and provide good support. actividad_fisica.jpg
revision_pies.jpg Consult your podiatrist regularly. Get screened feet by a pediatric surgeon, foot and ankle specialist regularly, who can help prevent complications caused by diabetic foot. Ask to doctor to examine sensitivity of your feet.

 

Advices for using suitable shoes.     

  • Support and ventilate feet.
  • Never use shoes made of vinyl, nor plastic shoes because its lack of mechanical flexibility and ventilation.
  • When buying shoes, be sure that are confortable from the beginning, and have enough space for toes.
  • Do not buy pointed shoes or high heels. They put too much pressure on your toes.

 

What should I do each day to stay healthy with diabetes?

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Follow the healthy eating plan that you and your doctor or dietitian have worked out. Eat vegetables and fruits, as they provide co-factors and vitamins deficit by the disease. Important is the consumption of dietary fiber and plenty of water (not soft drik).

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Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
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Take your medicines as directed.

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Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.

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Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.

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Brush and floss your teeth every day.

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Control your blood pressure and cholesterol.
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Don't smoke.

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