It’s easy to take your feet and legs for granted but paying these hard-working body parts some attention is worth the trouble. Having diabetes puts you at risk of foot and leg woes due to blood glucose-related changes in the nervous system and circulation. Here’s how to avoid some of the common problems.
1. Ingrown toenails: Cutting into the corners of your toenails can leave a nail spike, which may grow into the skin, causing pain, swelling and infection, so always trim nails straight across. “If you have any signs of infection, avoid ‘bathroom surgery’ and instead see a podiatrist, who has the right tools to remove the infected nail,” advises Dr Tegan Barthelson, senior podiatrist at Sydney’s South East Podiatry.
2. Fungal infections: Two types of common fungal infections that can affect your feet are athlete’s foot, which causes redness, itching, peeling and blisters, and fungal nail infections that can cause thickened or painful nails. “Sometimes you can come into contact with a fungus that thrives inside your shoes, as it loves warm, moist conditions,” says Diabetic Living podiatrist Danielle Veldhoen. It responds well to over-the-counter creams, but in severe cases, antifungal tablets may be needed. “For fungal nail infections, daily application of tea tree oil can help,” adds Barthelson.
3. Bunions: While we think of bunions as bony growths, they are due to a change in the angle of the metatarsal bones of your foot. They are largely hereditary, but tight, narrow footwear can exacerbate them. “Depending on the severity of your bunions, pressure-relieving insoles and footwear modification is where to start. If it’s cosmetically important, you could consider surgery,” says Barthelson.
4. Slow-healing wounds: Cuts and abrasions may take longer to heal in people with diabetes due to reduced blood flow to the feet and legs. Clean wounds with warm, salty water and apply antiseptic and a sticking plaster. “Watch daily for signs of redness or infection and see your doctor if you need antibiotics,” says Barthelson. Sometimes peripheral arterial disease (poor circulation due to narrowed blood vessels) may be a factor. “A vascular surgeon will be able to assess the blood flow in the legs and whether it can be improved by surgery,” adds Matthew Malone, Head of Department for Podiatric Medicine at Liverpool Hospital, Sydney.
5. Plantar fasciitis: Caused by a strain of the ligament that supports the foot arch, symptoms of plantar fasciitis are heel pain and swelling. Having high arches or flat feet, being overweight, spending a lot of time on your feet and poor footwear are risk factors. “It requires a combination of treatments such as anti-inflammatories, rest, ice, compression, massage and improved footwear,” advises Veldhoen.
6. Corns and calluses: Caused by poorly-fitting shoes, corns and calluses are hard, thickened areas of skin that can turn into pressure sores if left untreated. “See your podiatrist, who has sterile instruments to painlessly remove corns and calluses, and can tell you how to prevent them,” advises Barthelson. “Self-treatment with corn pads or razor blades is a big no-no as this can lead to infection.”
7. Swollen feet and ankles: There are numerous issues that may cause swollen feet and ankles, from gravitational oedema (where fluid drops to your ankles when you stand), to medications that cause fluid retention, to arthritis or potentially your heart not pumping as well as it should. “Staying fit and active will help reduce some of the swelling, but the first port of call is your GP,” says Malone.
8. Varicose veins: They can be a cosmetic issue for some people, but they can also be painful and, in some cases, are linked with the development of ulcers, which is a concern for people with diabetes. “Treatment depends on which vein is causing the trouble, and may involve surgery, endovenous ablation (where a laser probe blocks off any abnormal veins), or sclerotherapy, which is injection treatment of the veins,” explains Professor Robert Fitridge, Professor of Vascular Surgery at the University of Adelaide and Head of Vascular Surgery at the Queen Elizabeth Hospital.
9. Peripheral neuropathy: Chronically high blood sugar can damage nerves, leading to a loss of sensation, numbness or pain in the legs and feet (called peripheral neuropathy). Pins and needles in the feet, pain in the legs at night and numb toes are warning signs, as is dry, dehydrated skin. “Unfortunately, damage to nerves is largely irreversible, so the only treatment is having good blood glucose management to prevent further damage,” says Malone. Checking feet daily is crucial so that any cuts and sores that may not be felt don’t go undetected.
10. Sciatica: This can be felt as pain or numbness along the sciatic nerve, which branches from the lower back through the hips, buttocks and down the legs. Sciatica typically affects one side of the body and can be due to a herniated disc, bone spur or narrowing of the spine, compressing the nerve. “If pain is the main symptom, usually bed rest and anti-inflammatories will help, but if there’s power loss, that’s an urgent problem and usually requires an MRI to see if there’s a disc rupture or prolapse,” says Fitridge.
11. Deep vein thrombosis (DVT): DVT refers to a blood clot in the veins of the leg, and symptoms can include pain, tenderness and swelling. “Certain operations can put you at risk of DVT, such as abdominal, pelvic or leg procedures,” says Fitridge. It can also occur in people who’ve been sedentary for long periods or after a long-haul flight. “It’s treated with blood thinning medications,” explains Fitridge. Seek medical help immediately to reduce the risk of the clot breaking free and causing a pulmonary embolism.
12. Puffiness and swelling: Puffy legs can be due to a number of factors, and it’s best to see your GP. “Some people need compression stockings, but it’s important to see a health professional before you buy off the shelf as you don’t want to restrict the blood low further,” advises Malone.
13. Muscle aches and pains: Occasional aches and pains are common and may benefit from gentle stretching and magnesium supplements. But if you get cramping, particularly in the calves when you’re walking (called intermittent claudication), it may indicate insufficient blood flow, potentially due to peripheral artery disease. “We use an ultrasound to assess blood flow in the feet, and if an abnormality is detected, we’d refer you to a vascular specialist – a stent is then often the main treatment,” says Barthelson.
YOUR DAILY FOOT-CARE ACTION PLAN
If you have diabetes, you need to be vigilant about your feet. These simple foot-care rituals can help prevent complications:
- Keep ‘em clean: Wash your feet daily and dry thoroughly between the toes.
- Inspect daily: If you can’t reach your feet, use a mirror or ask a family member or friend to help you. “Look for cuts, redness, swelling, abrasions or anything that looks abnormal,” says Barthelson. If you find anything of concern, see your podiatrist or GP.
- Moisturise daily: Your feet will appreciate a regular massage with a product such as Plunkett’s NS-8 Leg Care Cream or NS-8 Heel Balm Complex. Rub it in well. To help avoid fungal infections, don’t apply the cream between your toes.
- Shoe check: Look and feel inside your shoes daily for things like pebbles or torn insoles that could lead to corns, calluses, blisters or even ulceration. Choosing comfortable, well-fitting shoes is important. “A sports store can measure your feet properly and offer a range of runners and diabetic-friendly, seam-free shoes,” advises Barthelson.
Be sure to have a foot assessment performed by a member of your healthcare team at least once a year.
By Bonnie Bayley