When talking about foot health, the group of people that need to pay extra attention are diabetics. They have poor circulation to their feet so much so that a tiny prick can cause a life-threatening infection.

What is diabetes?

Diabetes mellitus is a medical condition caused when the body lacks the production of insulin. Insulin is what helps lower down our blood sugar and redistribute it to other organs that need it. Without insulin, the sugar in our blood skyrockets causes all sorts of issues.

There are mainly two types of diabetes mellitus: type I and type II. The former is an autoimmune condition whereby the body attacks the cells in our pancreas which actually produces insulin: beta cells. Type I is usually found among adolescents but it can happen at any age.

Type II diabetes mellitus on the other hand happens when the body is more resistant to insulin. Meaning, they can produce insulin just fine, but it has little or no effect in controlling blood sugar.

What makes diabetes dangerous is not the disease itself, but the complications that arise from the constant high level of blood sugar.

How does diabetes attack the lower limbs?

We hear a lot about diabetics needing toe, foot, or even leg amputations. Most of the time, they need those amputations because they are lifesaving. Compared their bodies shutting down due to an infection from their toes, it’s better to remove the source of infection instead.

So, why does diabetes hate our feet so much? The reason is more complicated, actually. To understand this, we need a deep dive on the complications which diabetes causes: particularly disease and peripheral neuropathy.

1. Vascular disease

Firstly, vascular complications refer to the negative effects that diabetes has on our blood vessels, be it the larger blood vessels (macrovascular) or the smaller ones (microvascular). When discussing about the effect of diabetes son the legs, macrovascular is our point of interest.

Diabetes is highly associated with atherosclerosis: the destruction of the inner layer of our arteries and plaque formation. There are a few theories explaining this, one of them being the production of glycation end-products (AGE).

These are harmful compounds that results from combining sugar and other things such as fats and proteins. These AGE clump around in the bloodstream and damage the inner lining of our blood vessels called the intima.

When there’s injury to the intima, it will start to thicken. As you can imagine, a thick intima will cause the blood vessels to narrow. Surely, a narrow pipe will deliver less water compared to a wide and clean pipe.

If the blood vessels that lead to your feet are become narrow, less blood will be delivered. This is called ischemia. An ischemic foot will appear pale, its pulse will become weak, and wounds will heal much, much slower. In fact, in severe diabetics, a small cut if go unnoticed will cause the whole to black or gangrenous, leading to amputations.

2. Peripheral neuropathy

Neurons are cells that function to move around signals across your body, from your brain all the way to the tip of your finger and toes. Peripheral nerves refer to nerves outside of your brain and spinal cord. These nerves innervate either your movement or your sensations.

It’s proposed that neuropathy caused by diabetes is connected with vascular disease. Meaning, less blood is supplying nutrients and oxygen to nerve tissue causing them to die off.

Another theory is that, similar to vascular disease, glycation end-products (AGE) are the culprits that cause damage to the nerves. This leads to symptoms such as allodynia, burning, tingling, pins and needles or electric shock-like- sensations, pain, muscle weakness or cramps.

The result

The consequence of having poor blood supply to the lower limbs is that small wounds such as pricks and blisters take a long time to heal. Through the loss of sensation from peripheral neuropathy, diabetics won’t notice if they have a wound on their feet because they can’t feel any pain!

This formula creates a devastating effect: an unnoticed, non-healing wound.

How should diabetics implement foot care?

Foot care might be an alien term for most of us, but it’s a must-know for high-risk populations such as diabetic patients. Nobody likes getting amputated, and it’s not like it’s something totally unpreventable.

With special care by the patients themselves, along with concern of family members, nobody should lose a limb. Ever.

1. Inspect your feet daily

Vision is extremely important for diabetic foot care, as patients most likely have lost sensation to pain. You need to make sure every inch of your feet is clear of any wounds, even the smallest of cuts.

Experts recommend using a magnifying hand mirror in a well-lit setting to aid in looking at the bottom of the feet.

Make sure to dedicate a time of the day to do these inspections. Even better, set an alarm on your phone to make sure you don’t forget. Choose a time when you’re at home and free from distractions.

Here are the things that you need to inspect:

• Check the skin over your foot, soles, heels, and toes for any dry, scaly skin.
• Look at the ball of your foot and heels for any calluses or pressure areas. These areas have high potential of developing ulcers.
• Look for any changes in skin color such as bluish, blackish, or reddish. Skin changes can be a late sign of severe infection.
• Look for any swellings.
• Look for any scratches, blisters, cuts or bruises.
• Look for any obvious ulcers.
• Check between the toes for any fungal growth.
• Check the toenails for any dystrophic changes and ingrown toenails.
• Feel your feet for any areas that are warmer than usual. This can be a sign of infection.

If you notice any of these during your inspection, notify your doctor immediately. Remember, even if a cut doesn’t hurt, you need to get it looked at!

2. Clean your feet daily

To prevent infection and to keep the skin of your feet clean and healthy, you need to wash your feet daily. However, the process is not straightforward as there are a few things to look out for.

Here is the list of instructions for your convenience:

1. Take off your foot attire and your socks. (duh)
2. Do a brief inspection of the foot.
3. Wash your feet with lukewarm water: not too cold, not too warm.
4. Apply mild soap. Make sure to clean every part of your foot especially between the toes.
5. Be gentle when bathing your feet. We don’t want to damage the skin or make any cuts bigger.
6. Wash it all off with lukewarm water.
7. Grab a dry towel and pat your feet dry. Don’t rub your skin as this can damage it.
8. Apply moisturizer to the skin, but don’t moisturize between the toes. We want to prevent the skin from drying out, but the webs between the toes are excluded because too much moisture can be a breeding ground for fungus. It’s best to use a hypoallergenic moisturizing cream because it’s gentler for sensitive skin.

The rule of thumb is to be gentle.

3. Cut your toenails properly

Now you’ve gotten your feet squeaky clean. The next step is to cut your nails. Ingrown nails can cause a cut to the skin and a nasty infection, especially with all that dirt accumulating under the fingernails.

You need to cut the nails straight across, meaning, spare the edges of the toenails. Let the edges of the toenails lie loosely against the skin. If you cut the edges, they can actually grow into the edge of your toe. Here is a photo for reference:

4. Wear diabetic socks

The first line of defense for your feet against the outside world is your socks. Choosing the right socks will do wonders for your foot care.

There’s actually a thing called diabetic socks. Compared to your usual socks, they have a few features that make them perfect for a diabetic’s foot.

• Moisture-wicking: these socks can absorb the moisture from your feet sweat and make sure your feet are dry.
• Seamless: seams can cause friction to your feet. It might not be a big deal for non-diabetics, but for diabetics with poor glucose control, a seamless sock is a small precaution that can make a big difference.
• Soft material: this is a no brainer. The softer the fabric of the sock is, the gentler it is on the skin.
• Non-elastic: regular socks have an elastic property. They stretch out when you slide your feet in and return to their original shape to hug your feet tightly. We don’t want this feature for diabetic socks because it can obstruct blood flow to your feet by putting pressure on your blood vessels.
• Anti-microbial: some fabric, such as polyester, vinyl, and acrylics can fight off bacteria to help prolong the life of the textile. Interestingly, a study found that fabric can be coated with copper to kill bacteria within 45 seconds.
• Protective cushioning: hard padding over the insoles can protect the foot from foreign objects. A diabetic with reduced sense of touch might not notice that they have stepped on a pebble or something sharp. This cushioning property can help with that.
• Smart technology: some brands go even further with their diabetic-friendly approach. They incorporate heat-sensing technology to alert the wearer if there is an area of injury such as ulcer. Our skin produces heat when inflamed and detecting that can be a lifesaver.
  

Now that we’ve listed the important property for a diabetic sock, let’s have a look at some recommendations in no particular order.

1. Dr Scholl’s diabetic socks

These socks are amazing. They fulfil most of the characteristics of an excellent diabetic sock that we’ve listed.

Firstly, they are moisture-wicking with their moisture management technology. Secondly, their Invisiseam technology ensure an ultra-smooth, irritation-free toe seam.

They’re made of soft, 96% polyester which fights off bacteria and controls the odor. They also have a non-binding comfort top to protect the circulation to your feet.

Finally, they have protective cushioning in the heel, toe, and footbed for extra protection and comfort. Their TempRite technology keeps the socks cool and comfortable no matter your body temperature.

2. Doctor’s Choice diabetic socks

Doctor’s Choice socks prioritize comfort and foot health. they have non-binding tops that prevent socks from cutting off circulation to the foot. Secondly, they provide cushioning for the whole foot with 360-degree coverage to protect the soles from hard surfaces.

Moreover, their moisture control technology is perfect for sweaty feet. Their seamless toes prevent friction that can damage sensitive skin over the toes, maximizing comfort.

Finally, they’re made of 94% polyester and coated with cooper, silver, and zinc to fight off bacteria and keep your feet healthy, infection-free, and odorless.

3. Hugh Ugoli diabetic socks

If you’re looking to try for something different, then you should have Hugh Ugoli under your radar. Their diabetic socks are specially made from 80% bamboo fabric, a type of textile that’s known to be highly stretchable (even more than cotton) and has excellent moisture-wicking capabilities.

You can read more about bamboo fabric here. Apart from that, they also have standard diabetic-friendly features such as a non-binding top, a seamless toe, and a reinforced toe and heel.

5. Check your shoes before wearing them

You should always check the insides of your shoes before wearing them. A small pebble can cause friction to your skin and injury it. Simply shake your shoes upside down to make sure their insides are empty from any foreign material.

6. Wear loose footwear

Choosing the right size of shoes is essential for every chronic diabetic. You might feel that the shoes fit just fine, but your judgement can be clouded by your loss of sensation. In the long run, tight shoes can cut off circulation to your feet, increase friction to the skin, and deform the whole foot.

You should find a shoe with a wide toe box. This gives a space for the toes to move around, breathe, and overall maintains blood circulation. Here is a good example for diabetic-friendly shoes by FitVille for men and women.