We all love our feet. For those of us lucky enough to have healthy and functioning feet, we bask in the luxury of being able to go wherever, whenever, using these versatile appendages. However, feet— the all-terrain vehicles of the human body—can often be at risk for those living with Diabetes Mellitus. Foot complications account for more than 25% of all diabetic hospital admissions between the United States and Great Britain, and foot complications are the leading cause of nontraumatic lower extremity amputations in the industrialized world. ^[1]

The significance of proper foot hygiene lies in the increased risk for individuals with diabetes mellitus to be prone to foot ulcers due to the factors inherent to the condition. Poor circulation due to peripheral arterial disease, high blood sugar otherwise known as hyperglycemia, neuropathy or nerve damage, foot deformities such as hammertoes or bunions, and a generally weakened immune response are factors contributing to foot ulcer development. Diabetic foot ulcers can lead to lower extremity amputation, with a prevalence rate of 0.03% and 1.5% reported in patients with diabetes.¹

Taking proper care of your feet is one of the easiest methods in preventing any unwanted hospital visits. And no conversation on proper foot care would be complete without exploring proper hygiene. There is no better precautionary measure than regularly scheduled self-examinations and health care provider assessments of the lower extremities, as we will discuss further. In addition to those assessments, here are some tips for patients with diabetes to practice proper foot hygiene.

Inspect Feet Regularly

The greatest offense in the battle against developing ulcers is a great defense. This means that precautionary measures are a must, and a simple inspection is a safe place to start.

When inspecting your feet, there are a few things to watch out for, or monitor. Firstly, find a well-lit area or prop a light on over you to make sure you can see any irritants. Watch for any blisters, redness, swelling, open sores, cuts, nail problems, or anything else that looks out of the ordinary.

Gently inspect between each toe or splay them out to ensure there are no blisters in hiding. Furthermore, use a mirror to view any hard to see areas, such as the bottom of the feet. When looking at your toes, try to see to it that your toenails are properly trimmed and do not display onychauxis, which is when finger or toenails thicken abnormally due to a disorder or connected infection.

When inspecting your feet, also be sure to softly feel around and eke out any discrepancies in temperature. If there are any noticeably hot or cold spots, which may be due to peripheral artery or vascular disease (PAD and PVD), this may be grounds to consult with a medical professional.

It may be wise to notate natural characteristics (pre-existing scars, freckles, moles, etc) and monitor any changes. In the event you find that something out of the ordinary is worsening, schedule with a general practitioner or seek out a reference to a podiatrist for further evaluation.

Wash Your Feet Daily

Washing your feet daily is essential to the health and wellbeing of the diabetic foot. Rinsing with warm (not hot) water can cause vasodilation, or the widening of blood vessels, which can mean increased circulation to areas restricted by means of PVD or PAD.^[2]

When washing feet, as long as you are wound free, you should also consider using a gentle, fragrance-free antibacterial soap in order to prevent infection without irritation. In the event you may have an infection or wound that is already being monitored, washing with a sterile saline solution should do the trick for a daily wash.

When done washing, dry your feet thoroughly, paying attention to get in-between the toes in order to prevent moisture buildup. Be sure to gently pat and not rub so vigorously as to cause injury. Avoid certain embroidered towels, as some seams and hard edges could leave an abrasion. Pure cotton, microfiber, or other specialty towels should be sufficient to safely and thoroughly dry your feet.

Moisturize (The Right Way)

There are a few key reasons that it is important for a person with diabetes to moisturize. It is possible for high glucose levels to lead to fluid loss, which can lead to dry skin. This dryness can result in itching, cracking, or an infection.

Another benefit of moisturizing is that certain lotions may act to maintain a skin barrier which works to keep skin resilient and prevent injuries. Moisturizing also aids in softening calluses which can oftentimes become thick and evolve into other complications. Aside from the moisturizer itself, the act of gently massaging a substance into the skin can improve blood circulation, which can be compromised in diabetic patients.

When seeking a diabetic friendly moisturizer, there are some agents to look out for. A safe lotion will often be dermatologist-tested, non-comedogenic, hypoallergenic and typically fragrance free.

Several ingredients that often accompany these moisturizers are ceramides, glycerin, hyaluronic acid, urea, and possibly chamomile or aloe vera to calm irritated skin.  Several of these compounds can act as a humectant, which means that they draw moisture to the outer layer of the skin, keeping it hydrated and free of dryness.

Trim Toenails Carefully

Before even starting to trim your toenails, ensure that you have the proper tools to do the job. Larger toenail clippers work better due to their increased cutting strength and size. Make sure that toenail clippers are sanitized before and after each use to mitigate the risk of infection. Cleaning with soap and water and following up with a soak in hydrogen peroxide or alcohol should work to sanitize the clippers.

When you are cutting, make sure to cut straight across and leave approximately 1 to 2 mm in length (1 or 2 credit card thicknesses in length). Cutting too rounded at the sides or too short can lead to sores or blisters. Smaller incremental cuts may work best so as to avoid splintering off or cutting too close to the skin and helps to create a smooth finish.

Complete the trim by gently using an emery board to smooth any sharp edges and reduce any risk of injury. When in doubt, seek care of a local podiatrist. It is recommended that patients with diabetes visit their podiatrist at least annually as part of a maintenance plan.

Final Thoughts

We all love our feet, and so it is as important to monitor their health and hygiene as it is to monitor anywhere else on our body. Especially in the case of individuals with diabetes, small slip ups in hygiene practice can compound and result in nasty infections or possible amputations. So make sure to monitor your feet so you can keep on living your best life.