Diabetes is a chronic disease that is best treated by a team of healthcare professionals including family physicians, diabetes educators, wound care specialists, nurses, podiatrists, surgeons, orthopedists, prosthetists, nutritionists and many others.  However, the person with diabetes remains the center of this team.
They are the recipient of the care and the entire reason the team was assembled.  This does not take away the diabetic's responsibility to do their part, to control their diabetes and take care of their feet preventing complications such as ulcers and amputations.  One of the simplest and most important things someone with diabetes can do to protect their feet is to examine their feet every day.  The good news is that you don't need any special tool or be an athlete or super flexible to do a foot self exam.
It is recommended that all persons with diabetes check/examine their feet daily.  The purpose of checking the feet is to identify any active or potential foot problems that may lead to ulcers.
Getting an ulcer or wound on the foot puts the diabetic at high risk for getting an amputation.  To prevent an amputation we must do all we can to prevent an ulcer.
Looking at your feet regularly can prevent an ulcer as well as alert you to the presence of an ulcer which can be treated and healed quickly before it becomes infected.  If any problems or potential problems are identified they can be prevented or treated early by the podiatrist to prevent ulcers and amputations.
A number of challenges such as a poor vision, blindness, limited flexibility, arthritis, foot deformity and a large belly can make doing a foot self exams difficult.  If you are unable to check your own feet, ask a friend, family member or caretaker to help.  Here are some simple steps to follow to give yourself a good foot exam.
Get into position to
check your feet
After cleaning and drying your feet, after a bath for example, sit on a bed, chair, or toilet in a well-lit room.  Both legs should hang comfortably in front of you.  Bend one foot at the knee and place it over the opposite knee so you can easily see the foot.  The supporting leg should be bent and relaxed in front of your body.
 
Look at your feet
o Look carefully at your feet, do a visual inspection.  Search for anything abnormal on the foot -- on the top, on the bottom and between the toes.
o When looking at your feet you are looking for any signs of irritation, or a break in the skin that may indicate an ulcer.  These may include dryness, scaling, redness, swelling, pain, a break in the skin, build up of hard skin, scratches, cuts, scabs, sores, bruises, or corns, etc.
o Changes in the shape of the foot -- flattening of the middle part of the foot, curling up of the toes (hammer toes) and large bump on the side of the foot (bunions)
o Signs of infection -- redness, swelling, heat, pain, drainage (blood or pus) on the foot, socks or on the ground, bad smell (odor), etc.  A really bad infection may also cause you to have symptoms in your whole body, like fever, chill, high blood sugar, etc. If any of these occur, you must see the doctor immediately.
 
Where to look.
o Look at the bottom of your feet.  Turn your foot to the side, so that the bottom of the foot is visible.  If you are unable to do so, put one foot on the other knee to see the bottom of your foot, use a handheld mirror to view its reflection.  You can also place the mirror on a foot stool or on the ground so you can just hold your foot over the mirror and see it without having to lift up your feet.  You must be very careful not to walk on the mirror because it can break and cut you.  Ask a family member to look at your feet for you if you are unable to do so yourself.  I recently heard some good advice about looking at your feet.  A colleague said he tells his diabetic patients, just as they look at their faces in the mirror every day, they should also look at their feet in the mirror every day.
 
 
o Look at the bottom of your feet, under the toes for any bumps, raised areas and irregular textures.  Because this area receives a lot of pressure when walking, calluses (thick, hard skin) or corns may develop here.  Proper-fitting shoes can reduce your risk of developing this.
o Look at the soles of the feet, and look and feel for bumps and lumps, which can be signs of injuries or changes in the shape of the underlying muscles or bones of the feet.  Look for any opening in the skin, scratches, fissures, or open wounds.  Again, a thick callus may develop here as a result of high pressure.
o Check your heels, by feeling for dry, rough, or cracked skin.  Even small fissures can become infected by bacteria (germs) on the skin.  To treat this, moisturize your feet daily with moisturizing lotion or cream.  Don't apply moisturizers between toes because bacteria love to grow in warm, moist places.
o Check the tops of the feet looking for scabs, scratches, sores, and bruises.  Look for signs of decreased blood flow, such as no hair on the toes, cold feet, pale color, thin or shiny skin.  Blood glucose control and physical activity like walking can help boost blood flow to the feet.
o Examine your toes carefully.  Spread toes apart with your fingers so that you can look between your toes.  Look under the toes and check each toenail as well as the fleshy area surrounding it.  Toes with normal blood flow will be pink and warm.  Pale or grayish blue looking toes indicate possible circulation problems.  Look between the toes for cuts, scratches or fissures, which can be signs of an ulcer developing.  Soft white tissue or dry scaly skin may be an indication of a fungal infection between the toes.
Checking your toenails are important as well.  Remove the polish and examine your toenails for proper nail color (clear or pink), length, shape, texture and thickness.  Discolored (yellowing, brown, even black), thick, crumbling or flaking nails may indicate signs of nail fungus.  This must be treated by a podiatrist.
The toenails should also not be neglected.  Look for signs of ingrown toe nails.  Look for red, puffy skin on the sides of the nails, drainage, pain and swelling.  Ingrown nails may require surgery if ignored for too long.
Feel your foot
Feel both feet with your hands, check the bottom and top for any bumps, or temperature changes from one part of the foot to another.  Check your feet for feeling -- does it feel the same on all parts of the foot?  If the foot feels numb or "different" from the leg, or on top of the foot, you may have neuropathy.  This makes it even more important for you to examine your feet regularly.
Check your shoes
Check your shoes to make sure they fit properly, and that they are in good condition, not worn out, are without holes or rough edges.  Any shoe that causes foot injury and are worn out should not be worn and should be replaced.
Track your foot self-exams over time.  It is very common that persons with diabetes do not remember how long they have had a problem with their feet, so making a record of your foot exams can help you remember when a ulcer or other foot condition started.  This will alarm you, and encourage you to seek medical care earlier and you will be able to tell the podiatrist when the condition started.  On a piece of paper, or in a book, record the date, make a note of anything out of the ordinary such as cuts, blisters, corns, unusual temperatures, injury, etc., and describe it, how it looks, feels, and smells.  Compare your notes from exam to exam, maybe weekly or monthly.   If any area of concern continues or gets worse, or if you notice any new issues, contact your podiatrist as soon as possible.
There are a number of tools out there that may help you examine your feet, including a foot exam mirror or even a thermometer that can identify areas of high temperature on your feet indicating places where ulcers will develop.  These tools are great if you have them, but you already have all the tools you need to examine your feet -- your eyes, your nose and your hands.  Now that you have the tools, examine your feet regularly and see a podiatrist if you have any concerns.
This information on how to examine your feet is intended to help the person with diabetes to have the knowledge and skills to look at their feet and identify any problems that may indicate an ulcer.  If a concern or problem is identified you must see a podiatrist right away.
Source: www.diabeteslivingonline.com.
 
For more information or to see a podiatrist, visit Bahamas Foot Centre, Rosetta Street or telephone 325-2996; Bahamas Surgical Associates, Albury Lane or telephone 394-5820 or the Foot & Ankle Institute, Dean's Lane 326-5402 or email us at foothealth242@hotmail.com or visit www.apma.org or heal2gether.org.

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