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Diabetics are prone to many types of difficulties. The feet are a particular source of potential problems related to the complications of the disease process. Over time, increased blood sugar levels cause numerous problems to the blood vessels. Sugar-based substances line the walls of the small blood vessels and cause them to thicken and leak. Fatty deposits clog the arteries (atherosclerosis), reducing circulation and causing hardening of the arteries as well.

It is this poor circulation to the legs that can cause many potential and severe problems. When the circulation to the legs is decreased, the foot is at greater risk for injury and infection.

Diabetic neuropathy, damage to the nerves, is a second threat. When the nerves of the feet become damaged and the ability to feel pain, heat and cold, are diminished. This increases the chance of injury secondary to loss of feeling. Foot injuries may occur and go unnoticed until the foot becomes infected or skin break down has occurred.

It is important for diabetics to inspect their feet daily. Ordinary problems can lead to serious complications. About one of every five hospitalizations for diabetics involves foot problems. Any changes in the foot should be relayed to your health care provider immediately. This should include changes in color or temperature, any loss of feeling or sensation, tingling, burning or pain should be noted. If injuries are sustained, they should be watched closely for signs of infection or slow healing.

Sometimes the skin of the feet becomes very dry and can crack and peel. Usually when this happens the nerves that control sweating have been damaged or no longer work. When the skin peels and cracks it leaves the foot open for increased chance of infection. Diabetics should dry their feet very well after bathing, being sure to dry between the toes really well. Moisture can be added by using a thin coat of salve, i.e., plain petroleum jelly or substances such as unscented oils or lotions. Never put lotions or creams between the toes, extra moisture in dark, moist places can lead to infections.

Calluses should be treated immediately. Diabetics tend to develop calluses faster and more often than others. If left untrimmed and treated, callouses will harden and thicken, they may even turn into open ulcers in time. Using a pumice stone daily will help keep calluses under control, afterwards using a little lotion of the area is recommended. Check with your doctor if you have a callus.

Foot ulcers are very dangerous for the diabetic. Any skin break down or open area should be checked by your health care provider. The most common areas for ulcers to begin are the bottom of the big toe or the ball of the foot. At times ulcerations will occur on the sides of the feet, which is usually associated with ill fitting foot wear. It is very important for diabetics to check or have someone check their feet daily. A reddened area can quickly break down, a small ulceration may go undetected because of loss of feeling in the feet. Infections that occur in any foot ulceration can lead to the loss of a limb.

The treatment of a foot ulcer is determined by your health care provider. The main thing to remember is to stay off your feet. Ulcers will become larger and you can force infection deeper into the foot by walking on it. A person may be required to wear a special cast, have a culture done so that an antibiotic can be prescribed, or x-rays may be needed.

Here are some tips for caring for your feet for those who are diabetic.

• Avoid cutting off circulation to the feet. Don't wear garters or constricting hose.

• Keep your blood sugar under control.

• Inspect your feet daily. Look for cuts, scrapes, calluses, swelling, blisters or open areas and red areas. If you can't get help to check your feet, use a mirror.

• Wash your feet daily, dry well between the toes. Do not use lotion or oils between the toes.

• Avoid using heating pads, hot water bottles or electric blankets. You can burn your feet or other areas without knowing it. If your feet are cold, wear extra socks.

• Always test water temperature with your hand before putting your feet into it.

• Consult your physician before using any treatments of chemicals on warts, calluses, etc. Many over the counter products are too harsh for diabetics.

• Consider talking to your health care provider about special foot wear if you have reddened areas or decreased sensation. Always check inside your shoes before wearing them, making sure there are no sharp objects, nails, pebbles or that the shoe lining is not rough or torn.

• Don't walk barefoot.

• Don't smoke.

• Choose socks without seams or lumps in them. Don't wear mended socks, pull your socks on gently and make sure they are not too tight. Padded athletic socks are good, and they protect the feet while walking.

• See your health care provider if any signs of problems occur. You should have your feet checked by your physician at least once a year.