Diabetes is the leading cause of kidney disease. According to the most recent United States Renal Data System report, there are over 400,000 ESRD patients in the US with diabetes. In 2011, almost 49,000 of the new ESRD patients had diabetes as their primary cause of ESRD. These numbers present the renal community with a serious challenge. While diabetes can affect various areas of the body, one of the most common problems is nerve damage which can reduce blood flow to your feet. This reduction in blood flow can lead to loss of feeling in your feet. In addition, this reduction in blood flow can impair the normal sweat and oil production that lubricates the skin of the foot. These two factors together can lead to abnormal pressure on the skin, bones, and joints of the foot while walking and can lead to breakdown of the skin.
People with diabetes must be aware of how to prevent foot problems, recognizing problems early, and working with your dialysis team to receive the right treatment when problems occur. Failure to recognize problems early could lead to infection, gangrene and possibly amputation. The American Diabetes Association estimates that one in five people with diabetes who seek hospital care do so for foot problems. Many dialysis units do monthly foot checks on diabetic patients to identify issues that may lead to more severe problems.
You can prevent serious foot problems by following some simple steps. Here are some tips to help you take care of your feet:
1. Take care of your diabetes by managing your blood sugar and diet. Check your blood sugar, as recommended by your health care provider, and keep it in the target range.
2. Wash your feet every day in warm water with a mild soap, making sure you dry your feet well, especially between your toes. Do not soak them. Make sure the water is not too hot by checking it, just as you would do before bathing a bath.
3. Check your feet by looking for blisters, cuts, red spots and swelling. Use a mirror to check the bottom of your feet or ask someone to assist you if you have trouble seeing. Remember you may not be able to feel the pain of an injury due to nerve damage.
4. Keep the skin of your feet smooth and soft by rubbing a thin coat of lotion over the tops and bottoms of your feet. Do not put lotion between your toes.
5. Use a pumice stone, gently, to smooth corns and calluses.
6. Trim your toenails each week, cutting them straight across and filing the edges with an emery board. If you are unable to cut your own nails, ask your health care provider for assistance. They may be able to recommend someone that can help you with this.
7. Never walk barefoot, always wear shoes and socks to protect your feet. At night, wear hard-soled slippers to protect your feet. Make sure your shoes fit well and are not too tight. Ask your doctor about Medicare coverage for special shoes.
8. Protect your feet from hot and cold, by wearing shoes on hot pavement and socks to keep your feet warm at night. Never use hot water bottles, heating pads or electric blankets, as they can burn your feet.
9. Keep the blood flowing to your feet. Wiggle your toes and ankles when sitting and do not cross your legs for long periods of time.
10. Be more active and stop smoking. Do not exercise when you have open sores on your feet.
So what should you do now?
- Set a time each day to wash and check your feet.
- If the staff at the dialysis unit wants to check your feet, let them, as they may catch any problems you might have missed.
- With the assistance of your doctor, plan a physical activity program to keep you active.
- Always tell your health care provider if you notice cuts or breaks in the skin, have an ingrown toenail or have any problems with pain in your feet or a sore that does not heal.
- Make sure your shoes are right for you. Closed toes and heels, and a stiff outer sole to protect your feet. Make sure the inside of the shoes are smooth. They should be as wide as your feet and have at least a ½ inch of extra space at the end of your longest toe.
Taking care of your feet now may help prevent complications in the future. YOUR FEET WILL THANK YOU.