Diabetic Foot Care

Diabetes can significantly impact foot health, affecting nerves, circulation, and the immune system. This makes individuals with diabetes more susceptible to various nail and skin problems, which can escalate quickly if not managed properly. Careful attention to nail and skin condition is a critical component of diabetic foot care, aimed at preventing serious complications like infections and ulcers. Regular monitoring and professional podiatric care in Singapore are essential for maintaining foot health and overall well-being when living with diabetes.

Daily foot inspection is crucial for diabetics. Be aware of these common signs:

Nail Symptoms:

• Thickening: Nails become unusually thick and difficult to cut.
• Discoloration: Yellowish, brownish, or opaque appearance, often indicating fungal infection (onychomycosis).
• Brittleness: Nails may crumble or split easily.
• Ingrown Toenails (Onychocryptosis): Nail edges grow into the surrounding skin, causing pain, redness, and potential infection.
• Lifting: The nail plate separates from the nail bed.

Skin Symptoms:

• Dryness and Cracking (Xerosis): Especially around the heels, which can create entry points for infection.
• Calluses and Corns: Build-up of hard skin due to pressure or friction, which can hide or lead to underlying ulcers.
• Redness, Warmth, Swelling: Can indicate inflammation, irritation from footwear, or early signs of infection.
• Blisters: Often caused by friction from ill-fitting shoes.
• Cuts, Scratches, or Sores: Any break in the skin needs careful attention due to slower healing.
• Athlete’s Foot (Tinea Pedis): Fungal infection causing itching, redness, scaling, or cracking, often between the toes.

Changes in Sensation:

• Numbness, Tingling, or Burning (Neuropathy): Reduced sensation means injuries might go unnoticed.

Any changes, no matter how small, should be monitored closely and discussed with a podiatrist.

Diabetes contributes to nail and skin problems through several mechanisms:

• Peripheral Neuropathy: Nerve damage reduces sensation (touch, pain, temperature), meaning injuries like cuts, blisters, or pressure sores may not be felt. It can also affect sweat gland function, leading to dry skin.
• Peripheral Artery Disease (PAD): Reduced blood flow to the feet impairs the delivery of oxygen and nutrients needed for skin health and wound healing. Minor injuries can take longer to heal and are more prone to infection.
• Hyperglycemia (High Blood Sugar): Elevated blood sugar levels can weaken the immune system, making infections (like fungal nails or skin infections) more likely. High sugar levels can also damage nerves and blood vessels over time.
• Weakened Immune System: Diabetes can impair the body’s ability to fight off infections.
• Foot Deformities: Conditions like bunions or hammertoes (which can also be related to neuropathy) create pressure points prone to calluses, corns, and ulcers.

• Foot Ulcers: Breaks in the skin, often starting under calluses or at pressure points, that fail to heal due to poor circulation and neuropathy.
• Infections: Bacteria can easily enter through cracks, cuts, blisters, or ingrown nails. Infections can spread rapidly (cellulitis, osteomyelitis - bone infection).
• Gangrene: Tissue death resulting from severe lack of blood flow or untreated infection.
• Amputation: In severe cases where infection or gangrene cannot be controlled, amputation of a toe, foot, or leg may be necessary to save the patient's life.

Regular foot checks by a podiatrist are essential for early detection and prevention. Diagnosis involves:

• Comprehensive Foot Examination: Assessing skin condition (dryness, calluses, temperature, colour), nail health (thickness, colour, shape), foot structure, and footwear.
• Neurological Assessment: Testing sensation using tools like a monofilament to detect loss of protective sensation (LOPS).
• Vascular Assessment: Checking pulses in the feet and potentially using Doppler ultrasound to assess blood flow.
• Wound Assessment (If Present): Evaluating the size, depth, and signs of infection in any ulcers or breaks in the skin.
• Nail/Skin Samples: If fungal infection is suspected, clippings or scrapings may be taken for laboratory analysis.

Annual diabetic foot assessments are recommended, or more frequently if risk factors are present.

Management focuses on safe, professional care to address specific issues and prevent complications. Self-treatment of corns, calluses, or ingrown nails is strongly discouraged for individuals with diabetes due to the high risk of injury and infection.

• Professional Nail Care: Safe trimming and reduction of thick, difficult-to-cut nails by a podiatrist. Management of ingrown toenails using sterile techniques. Treatment for fungal nail infections (options depend on severity and patient factors).
• Skin Care Management: Professional reduction (debridement) of calluses and corns to relieve pressure and check for underlying issues. Application of appropriate dressings for any cracks or minor skin breaks. Prescription or recommendation of suitable emollients (moisturizers) for dry skin.
• Wound Care (If Applicable): Specialized care for foot ulcers, including debridement, infection control, and offloading pressure.
• Footwear and Orthotic Advice: Assessment and recommendations for appropriate diabetic footwear and custom orthotics to reduce pressure points and accommodate deformities.

Note: Our podiatrists provide gentle, safe, and effective treatments tailored specifically for the diabetic foot, prioritizing prevention and risk reduction.

Consistent daily self-care is crucial, alongside professional guidance:

• Inspect Feet Daily: Check tops, bottoms, heels, and between toes for cuts, blisters, redness, swelling, or nail problems. Use a mirror or ask for help if needed.
• Wash Feet Daily: Use lukewarm (not hot) water and mild soap. Test water temperature with your elbow first.
• Dry Feet Thoroughly: Pat gently, especially between the toes.
• Moisturise Daily (But Not Between Toes): Apply a thin layer of recommended lotion to tops and bottoms to prevent dry, cracking skin. Avoid the area between toes to prevent fungal growth.
• Nail Care: Cut toenails straight across after bathing when softer. File edges smooth. If you have poor eyesight, difficulty reaching, thick nails, or neuropathy, have your nails professionally cut by a podiatrist.
• Never Go Barefoot: Protect your feet from injury, even indoors.
• Wear Appropriate Footwear: Choose well-fitting, supportive shoes with a wide toe box. Check inside shoes daily for foreign objects or rough seams. Wear clean, dry socks (preferably cotton or moisture-wicking, seamless types).
• Manage Blood Sugar Levels: Work with your doctor to keep blood glucose within target ranges.
• Don’t Smoke: Smoking further reduces blood flow to the feet.
• Regular Podiatrist Visits: Attend scheduled diabetic foot assessments as recommended.

Report any concerns immediately to your podiatrist or doctor.