Foot problems associated with diabetes

Diabetes (suikerziekte) is a condition in which the body can no longer maintain a balanced blood sugar level because it produces too little of the hormone insulin. This is because insulin regulates blood sugar levels. The body often no longer responds properly to insulin or stops producing it altogether. Diabetes can be caused by a variety of factors. The longer you have diabetes, the greater the risk of complications arising, including in the feet and legs.

The progression of diabetes varies from person to person. However, there are certain symptoms affecting the feet that we see in many people with diabetes:

• Reduced/no sensation in the feet: Diabetes can damage your nerves (neuropathy). This can lead to a loss of sensation in your feet without you realising it. You will then not feel any pain if, for example, you take a foot bath that is too hot, have a small stone in your shoe or step on a sharp object. This can lead to unnoticed wounds that are difficult to heal (even under calluses).
• Reduced blood flow: If you have diabetes, you are at high risk of reduced blood flow to and from your feet. This results in a reduced supply of oxygen and nutrients to your feet. The skin becomes thin, making it more prone to damage, and wounds heal slowly or not at all. It is therefore important to prevent the development of wounds and pressure sores.
• Postural abnormalities of the feet: When certain nerves fail, the small muscles of the foot function less effectively. Dominance of the larger foot muscles causes a change in the position of the feet, including the curling of the toes. This causes pressure points which can lead to excessive calluses, blisters and

To prevent foot ulcers from developing, it is important to have your feet checked regularly. This is known as a foot screening. Your podiatrist, GP, practice nurse or diabetes nurse carries out this screening. The podiatrist also draws up a personalised treatment plan in which various examinations and treatments are tailored to your feet.

• Check your feet daily for red patches, blisters, cracks or wounds. A wound should usually heal within seven days. If this is not the case, or if you know that the blood circulation in your legs is poor, there are signs of an infection, the wound is deep or is getting bigger by the day, please contact your GP or podiatrist immediately.

• Install the Diabetes Foot Check app on your mobile phone or tablet. This app helps you with your daily foot checks. The app is available to download free of charge for patients of RondOm Podotherapists from the App Store and Play Store under the name Diabetes Voetencheck. Ask your podiatrist for more information.

• Wash your feet with or without mild soap to prevent your skin from drying out. Dry your feet thoroughly, including between the toes. It is helpful to use a thin towel for this.

• Apply cream (or ointment if you have dry skin) to your feet every evening to prevent the skin from drying out. Do not apply it between your toes, as the skin there can quickly become softened.

• Never take a foot bath! Not even a Biotex/soda foot bath for wounds, etc. This softens the skin, making it even more vulnerable to wounds and infections.

• As diabetes patients need to take extra care of their feet, it is advisable , and do not try to cut difficult-to-trim nails yourself. It is better to consult a (medical) chiropodist specialising in diabetes or a podiatrist for this.

• Wearing good shoes reduces the risk of foot problems. Do you also find it difficult to find the right shoes? Seek advice from a podiatrist or visit www.dediabetesschoen.nl.

• Shake your shoes out thoroughly before putting them on to check there are no small stones inside. This is to prevent you from sustaining injuries.

• Never walk barefoot or in socks alone. Always wear shoes or slippers (with a fastening such as laces or Velcro) to protect your feet. The sole of a shoe or slipper protects your feet from sharp objects such as stones and glass, and from dirt on the floor. Wearing flip-flops is not recommended; this can cause pressure sores or blisters between your toes, which may result in wounds.

• Do not wear socks or tights with thick seams. These can cause pressure marks. Seamless socks are available. It is best not to wear tights, as these can cause friction and do not protect your skin.

• Make sure your shoes fit properly. Ensure there is sufficient space for your toes in terms of length, width and height. Toes and toenails can easily become pinched, which can lead to pressure sores and wounds.

• Feet often get bigger and wider as you get older: so always have your foot size measured! Always try on both shoes in the shop; it is normal for one foot to be longer than the other.

• More advice on shoes.