Foot Care and Diabetes - Advice from the Experts at Diabetes UK | Gentle Grip

In a recent study conducted by the Gentle Grip team which looked into the behaviours and attitudes of people across the UK regarding their foot health, we learned a few striking truths:

• Around one in six of us claim to be completely unaware that our foot health can affect our overall health
• Only 40% of us are actually properly aware that foot health can affect overall health
• 21% of us will ignore issues or delay seeking treatment for a suspected foot problem

While we know that the nature of ‘foot problems’ can be wide ranging - and that there are many different medical conditions and circumstances that mean foot issues can affect people in different ways - the data from our study does still suggest there's a little bit of a knowledge gap here. Moreover, this might also mean that a certain number of people won't be aware that foot health, and the implementation of appropriate foot care, is particularly important for people living with diabetes.

Gentle Grip is supporting Diabetes UK, the UK's leading diabetes charity, and we are working together to share trusted advice and simple steps to healthier feet. So to help shed some light on everything from some of the foot problems people with diabetes can encounter, to the importance of foot care, what issues to look out for and how best to identify and manage them, we spoke to Natasha Marsland, Senior Clinical Advisor at Diabetes UK, who provided these helpful, expert insights.

Advice from Diabetes UK

GG: Why is foot care especially important for people with diabetes?

“If you live with diabetes, you’re much more likely to develop problems with your feet. This is because if your blood sugar levels, blood pressure and cholesterol are consistently high, it can seriously damage the nerves in your feet and stop them working so you might not feel when you’ve cut your foot or burned yourself. This is known as peripheral neuropathy.

Your blood vessels can also become damaged and can cause problems with blood flow to your feet. If the blood vessels are damaged, known as ischemia, it can take longer or be more difficult for any wounds to heal. This is because blood vessels carry essential nutrients and oxygen round the body, which are needed for wound healing. Damage to your feet creates an opening for bacteria and infection to get in. 

So common foot problems such as a blister or a problem with a toe can turn into a serious foot problem or infection if left untreated, and for some people this can lead to amputations.

But most problems, including amputations, can be prevented. If you take care of your feet, check them regularly, know the signs of a serious foot problem, and understand what action to take if you spot one, you can reduce your risk of developing foot problems.

This is important as a minor foot problem can quickly become serious for people living with diabetes – a blister can get infected quickly, leading to an infection or other serious foot problem, such as a diabetic foot ulcer, which can result in an amputation. The likelihood of this is greater if you’ve been told you have a high risk of getting a foot problem. This usually applies if you have more than one sign of a foot problem, are on kidney dialysis or have previously had an ulcer or amputation. 

So, foot problems should never be ignored and knowing what action you need to take is vital.”

GG: What are the symptoms of diabetes-related foot problems?

A serious foot problem needs urgent attention so it’s important that you can spot any indication of a major issue quickly. Signs of a serious problem include:

• A tingling sensation or numbness
• Burning pain
• A dull ache
• Discharge or smell
• Smooth, shiny skin on your feet
• Hair loss on your legs and feet
• Loss of feeling in your feet or legs
• Swollen feet
• Your feet aren’t sweating
• Cuts, wounds or sores that don’t heal
• Cramp in your calves when resting or walking.
  

If you see any of these changes, seek urgent medical attention and/or contact the diabetic foot team immediately.

If this fails, contact your GP practice, urgent care centres or accident and emergency department and inform them you have a diabetic foot and are at risk of serious foot complications, as you need to be seen urgently. Dress any wound with sterile dry dressing and try to keep weight off the area until seen by a Healthcare Professional.

It is important to flag a foot problem, and alongside this, any flu symptoms could indicate sepsis. Sepsis is a life-threatening reaction to an infection so seek urgent medical advice and call 999 or go to A&E.”

GG: What other checks can people with diabetes do to monitor their feet?

“Because of diabetes, foot problems can get worse very quickly and that’s why it’s important to check your feet every day as part of your essential care to see if diabetes is affecting your feet. 

Getting to know your feet helps you identify any changes quickly and easily. This will help you spot the signs of any problems and prevent serious complications. Here are some approaches to try:

1. Look at your feet before you put your socks on in the morning and before you go to bed.
   
   
2. Touch both of your feet and check their temperature. They should both feel the same and not be cold or hot.
   
   
3. Look at your feet and see if there are any thick, hard areas of skin (calluses), blisters or scabs, or any changes in the shape or colour.
   
   
4. Check in between your toes for any dry or flaky skin. 
   
   
5. Look at your toenails too to make sure they’re not too long and that they’re not digging into the skin. If you find it difficult to reach your feet or if you have poor eyesight, you could try using a mirror on the floor to help you check the bottoms of your feet.
   
   
6. If you struggle to lift your feet up, try using a mirror to check the bottom of your feet. Make sure you’re sitting or lying down if you’re using a mirror. Or you could also ask a family member, friend or carer to help you check. If you notice any changes, see a healthcare professional as soon as possible.

GG: Can the warmer weather we get in spring and summer impact on the foot health of those with diabetes and do you have any advice for those going on summer holidays?

“Some people living with diabetes experience foot swelling in hot weather, which makes their shoes fit tighter and may exert blister-causing pressure on the toes and heels. Avoid wearing new shoes and make sure your footwear isn't too tight, too loose or rubs. Shoes that don’t fit well, even those that feel comfortable, can cause problems or make existing conditions worse.

Check your footwear inside and out before putting them on. Make sure nothing sharp like a small pebble or piece of glass has gone through the sole at the bottom of the shoe. And that nothing has fallen into them. 

Choose socks that are made from breathable, moisture-wicking material, like bamboo, to help manage moisture and avoid socks that are too tight, have holes or thick seams. 

Enjoying the sun is of course one of the things many people look forward to in the summer, but if you have diabetes, the hot weather presents additional challenges you need to consider:

• It is important to avoid walking barefoot even on the beach. The sand can become very hot, and you may burn your feet without realising it so wear well-fitting sandals or shoes. Avoid wearing ‘flip flop’ type footwear as this may cause blisters between your toes.
  
  
• If you go paddling in the sea, wear suitable protective footwear such as plastic shoes or neoprene beach shoes with rubber soles to help protect your feet from the elements.
  
  
• People living with diabetes should moisturise their feet every day using an emollient cream, especially if it has a urea base, to help keep your skin healthy. Emollients are moisturising treatments applied directly to the skin to soothe and hydrate it. You may need to apply extra moisturising cream if your skin gets very dry in hot weather.  You should avoid talcum powder because if it gets clogged up between your toes, it could make them too dry or cause rubbing between the toes that can affect the skin. 
  
  
• You should use sunscreen on your feet to reduce the risk of sunburn.  Sunscreen should have a sun protection factor (SPF) of at least 30 and at least 4- star UVA protection.
  

Continue to check your feet daily and seek medical attention if problems arise.” 

GG: In addition to daily foot checks what other practical steps can people living with diabetes do to look after their feet?

“In addition to your daily foot checks there are a lot of things you can do to look after your feet and to reduce your risk of developing a serious foot problem. 

• If you smoke, ask for help to stop. Smoking makes it harder for blood to flow to your feet. This puts you at even more of a risk of amputation. 
  
  
• Manage your blood sugars, cholesterol and blood pressure. Meeting your targets means it is less likely the nerves and blood vessels in your feet will get damaged. 
  
  
• Washing your feet everyday will help keep them clean and free from infection. Do this with a mix of soap and warm water. Always check the temperature with your wrist or elbow before you put your feet in and avoid soaking your feet, as this makes the skin more susceptible to damage. 
  
  
• Dry your feet thoroughly, especially between the toes, to help prevent fungal infections. Moisturise your feet every day. This will help stop your skin from cracking and getting infected if it’s too dry, but don't put cream between your toes. 
  
  
• Eat a healthy, balanced diet and stay active. Your care team can give you advice about this and Diabetes UK has lots of information on their website.. Before trying any new activity , or if you have had a previous foot problem it’s important you check with your GP first. They can help you decide what’s safe. 
  
  
• Take care when cutting your toenails. Cut your nails straight across, not down the sides, and use an emery board on any corners. Don’t use any sharp tools, like the point of nail scissors, to clean your nails. Ask your care team for help if you are struggling to cut your own nails. 
  
  
• Make sure your footwear fits. If your shoes or socks are too tight or loose, they can rub your feet and cause blisters, which can become serious if you have diabetes. 
  
  
• Don’t use blades, plasters, creams and sprays for removing corns or verrucas as they can damage your skin and cause ulcers. If you need help with corns or other skin problems, speak to a podiatrist.
  

GG: Do you have any other advice or resources for supporting foot health for people living with diabetes?

“You should have a foot check by a healthcare professional at least once a year to make sure you don’t have problems with nerves or blood supply in your feet. This may be once every other year if you live in Scotland and are at low risk of foot problems. 

Keep useful numbers handy and know what to do and who to call - for example your GP, foot specialist or out-of-hours service, if you have a problem with your feet.

You can also find out more about this here: Signs of serious foot problems and foot infections | Diabetes UK

You can also visit www.diabetes.org.uk/check-feet to watch a video about how to check your own feet every day.  

To get specialist information and advice on all aspects of living with diabetes you  can call the Diabetes UK helpline for answers. We also provide support or can just be there for you to talk to someone who knows about diabetes - our helpline number is 0345 123 2399.”

A few other useful resources available include:

Support with healthy eating: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/healthy-eating

Support with exercise: https://www.diabetes.org.uk/living-with-diabetes/exercise

Our free leaflets:

• Z Fold Foot Leaflet Urgent Care Access Card | Free diabetes information - Diabetes UK Shop
• https://shop.diabetes.org.uk/collections/information-for-you/products/diabetes-and-looking-after-your-feet-1
  

How the Gentle Grip range can also Help

Our range of socks are designed to help support and meet the unique needs of individuals living with diabetes. 

They have a variety of features – including cushioned soles, extra-wide construction, breathable fabrics and smooth toe seams – which work to prevent irritation, reduce friction, support better circulation and draw sweat away from the skin to keep feet dry. In other words, they’re engineered for comfort and to help protect against some of the issues people with diabetes can have with their feet.

About Diabetes UK

Diabetes UK is the UK’s leading diabetes charity, and its vision is to create a world where diabetes can do no harm.

For more than 90 years, Diabetes UK’s research has driven many of the biggest breakthroughs in diabetes care – improving millions of lives. The charity also drives change by influencing policy and the NHS, as well as raising awareness and combatting misconceptions about diabetes.

For more information about Diabetes UK, visit www.diabetes.org.uk.