Diabetes Mellitus — Signs, Symptoms & Treatment

For the person with diabetes who has not yet developed foot complications, there are warning signs you should look out for and point out to your podiatrist or your family physician. Warning signs include:

• Color changes of the skin
• Elevation of skin temperature
• Swelling of the foot or ankle
• Pain in the legs, either at rest or while walking
• Open sores, with or without drainage, that are slow to heal
• Ingrown and fungus-infected toenails
• Corns or calluses with bleeding within the skin
• Dry fissures (cracks) in the skin, especially around the heel

There is a sizable list of “do’s and don’ts” when it comes to preventing ulcerations. Shoes are at the top of the list. Poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Foot shape and size may change over the years; peripheral neuropathy contributes to change. Everyone, particularly those with diabetes, should be fitted by experienced shoe fitters for every new pair of shoes. New shoes should be comfortable at the time they’re purchased — they should not require a break-in period — but it is a good idea to wear them for only short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for the toes to wiggle freely, and be cushioned and sturdy. Athletic footwear may fit the bill nicely. It’s a good idea to change shoes during the day to relieve pressure areas. Avoid high heels and shoes with pointed toes. Never wear shoes with open toes or heels, including sandals — especially those with straps between the first two toes. Shake shoes out and feel inside them for rough stitching or foreign objects, such as small pebbles. Never go without socks. Diabetics who have difficulty finding shoes that fit should ask their podiatrist to prescribe corrective shoes or refer them to a shoe specialist (an orthotist). For those eligible, Medicare provides coverage for extra depth shoes, specially molded shoes, and inserts for those with advanced cases of diabetes.

• Wash feet daily, using mild soap and lukewarm water. Those with diabetes should always test bath water temperature with a thermometer or the elbow, since the feet may be unable to detect scalding temperatures. Dry feet carefully with a soft towel, especially between the toes, and dust them with talcum powder. If the skin is dry, use a small amount of moisturizing cream daily, but avoid getting it between the toes.
• Feet and toes should be inspected daily for cuts, bruises, and sores or other changes that are less obvious. If self-inspection is hampered by age or other factors, use a mirror or get the assistance of another person.
• Wear thick, soft socks, and avoid mended socks or those with seams, which could cause blisters or other skin injuries. Never go barefoot, even inside your own home, and especially out of doors on unfamiliar terrain, such as the beach or grassy areas.
• Quit smoking. Tobacco can contribute to circulatory problems, and should be stopped. The consumption of alcohol should also be moderated.
• Exercise is important. Walk as frequently as possible; it’s the best overall conditioner for the feet.
• Observance of good dietary habits is important. People with diabetes are commonly overweight. This approximately doubles the risk of complications they may face.
• For cold feet at night, wear loose socks. Don’t use heating pads, hot water bottles, or other external heat sources.
• Don’t use garters or elastics to hold up stockings.
• Cut toenails straight across, or if in doubt, see a podiatrist. If you are diabetic and have Medicare, your Medicare benefits very often cover the treatment of your toenail problems.
• Never try to cut calluses with a razor blade — or anything else — without professional guidance, and never use commercial preparations to remove corns or warts, as they contain chemicals that can burn the skin.

The podiatrist is a foot care specialist with skills in recognizing and treating diabetic foot conditions. Because diabetes is a systemic disease affecting many organs of the body, ideal case management requires a team approach, involving the podiatrist as well as the family physician, several medical specialists, and a dietitian.

Your podiatrist, as an integral part of the treatment team, has documented success in the prevention of amputations. Diabetes is one of the most serious conditions treated by podiatric physicians, whose training stresses salvage of the foot rather than amputation. A comprehensive approach to prevention of complications must include good glucose control, adherence to diet, an exercise program, proper medication and hygiene, and regular foot care. Those who follow the medical team’s advice have a good chance of preventing or delaying the complications of the disease and living normal lives. Furthermore, with such a regimen as groundwork, it is estimated that more than half of the lower extremity amputations among people with diabetes could be prevented.