Caring for the feet of diabetics

Xerosis in diabetics

Skin disorders are common in patients with type 1 and 2 diabetes². People with high blood sugar levels have 1.5 times more skin problems than those with normal blood sugar levels³. Among the most common problems is diabetic xerosis,⁴ which is defined as a dry skin condition⁵. The latter is partly explained by a decrease in the functioning of the glands that produce sweat. This makes the skin drier and more fragile⁶. Xerosis is the earliest and most common manifestation of diabetes and will mainly affect the shin area and the feet^7,8. 

Failure to diagnose and treat skin disorders, including xerosis, at an early stage can lead to the development of open cracks or fissures, which are susceptible to infections, particularly bacterial and fungal².

Beyond the problem of xerosis, hyperglycaemia as a result of diabetes has other physiological consequences^11,12:

• Diabetic neuropathy, which is an injury to the nerve fibres. When sensory nerves are affected, i.e. those that transmit sensory information such as touch, heat or pain, there is a decrease in sensitivity. This symptom starts in the feet and then gradually moves upwards. This means that pain can no longer play its role as a warning and the risk of a wound that can become superinfected is increased.
• Diabetic arteriopathy, which is a disease of the arteries. Hyperglycaemia encourages cholesterol deposits on the artery walls, which are known as atheromatous plaques. This reduces the diameter of the arteries and, therefore, blood flow. Lower limb arteriopathy occurs when the legs are affected. The blood supply to the feet decreases and this increases the risk of ulceration, decreases healing and reduces the influx of white blood cells involved in the immune response to fight off possible infections.

The combination of dry skin, loss of sensitivity and poor circulation increases the risk of foot infections in diabetics. The main complication that can be observed is called diabetic foot. It is defined as destruction of the foot tissue¹³. If left untreated, the wound can become infected with micro-organisms, have difficulty healing and can end in amputation if gangrene occurs. It is estimated that 10% of diabetics are at risk of amputation.

It is also believed that the majority of these amputations could be avoided, mainly through better prevention and more suitable daily care⁶.

How do you minimise the risk of foot infections in diabetics?

Fortunately, the management of diabetes has improved considerably and current treatments allow patients to better manage their disease. The number of amputations due to diabetes has decreased significantly¹⁴.
In addition to sticking to dietary rules and diabetes treatments, it is essential for diabetics to pay special attention to their feet every day. Simple habits can be implemented to limit the risk of infection¹⁵:

• Wash feet daily with a mild soap. Dry them meticulously, concentrating on the space between the toes. Avoiding soaking the feet for more than 10 minutes and avoiding water that is too hot are both recommended.
• Combat xerosis by moisturising at least once a day with a suitable cream. This will prevent or reduce the formation of calluses and cracks that can be the gateway to superinfection.
• Nails should also be well maintained. Use a nail file rather than scissors or nail clippers to prevent injury. Nails should not be shorter than the tip of the toe, so that they can fulfil their protective role in case of impact.

• Corns and calluses should be carefully monitored and treated gently. If in doubt, consult a pedicurist.
• Preferably wear cotton socks or socks made of a soft material that avoids maceration and rubbing. If there are any circulatory problems, opt for compression socks or stockings.
• Change your choice of shoes: they should be closed to protect the forefoot as much as possible, wide at the toe and without seams in the sensitive areas of the foot. There are specific shoe ranges for diabetics.
• It is important to examine your feet daily, even if there are no symptoms. This ensures that there is no wound (even a small one), no fungus, no blister or anything else.
• Finally, diabetics should have their feet examined at least once a year by a doctor. In addition to looking for wounds, the doctor will carry out a check-up and assess the sensitivity of the feet and legs, reflexes and muscle strength.

If in doubt, consult a doctor as soon as possible to detect any hidden complications¹¹.

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