כף רגל סוכרתית מידע למניעת התפתחות המחלה (אנגלית)

Diabetic Foot
Information on how to prevent development of the disease

What is diabetic foot?
According to the World Health Organisation, diabetic foot is defined as infection, pain or destruction of the deep tissues of the foot, associated with neurological damage and various degrees of peripheral vascular disease. Some diabetes patients are likely to develop diabetic foot during their lifetime. Wounds in the feet of those suffering from diabetes are the main reason for amputation and, therefore, the most common reason for the recurrent hospitalization of diabetes patients.

What are the risk factors for developing diabetic foot?

• Peripheral sensory neuropathy which results in a diminished sense of pain, pressure and heat.
• Peripheral motor neuropathy which results in weakness of the foot muscles and causes deformity of the foot.
• Peripheral autonomic neuropathy which leads to the development of dry skin and cracks in the soles of the feet and increases the tendency to hard and thickened skin.
• Peripheral vascular disease which reduces blood circulation to the foot and thus increases ulceration and slows down the healing process.
  

Appropriate care of your lower limbs is vital for keeping them healthy and for preventing complications, suffering and hospitalization.

It is important to follow a strict daily routine at home, as detailed below:

Balanced blood sugar level
Maintaining a balanced blood sugar level may help to prevent or delay complications of diabetic foot, as well as other complications of diabetes. It is important to be strict about correct nutrition, physical exercise, taking medications, monitoring blood sugar levels and following the instructions of the medical team.

Daily foot check / skin condition check

• Check feet every day, with the help of a mirror, to identify, as soon as possible, cracks, cuts and skin ulcers.
• Pay attention to nails: a nail which is torn, red or oozing.
• Do not cut or remove corns or hard skin.
• Consult the doctor in the foot clinic about any noticeable changes in your feet.
  

Maintaining foot hygiene

• Wash feet every day in warm running water. Avoid soaking your feet in hot water.
• Test the temperature of the water with your elbow or palm. If this is difficult ask someone for help or use a thermometer.
• The water temperature should be below 37° C.
• Do not use your feet to test the temperature of the water. If your feet have lost sensation you cannot judge the temperature of the water and may get burnt.
• Dry your feet with a soft towel, especially between the toes.
• If the skin is dry or cracked you should rub in cream to lubricate the skin and prevent dryness (but not between the toes).
• To protect the skin, it is advisable to apply moisturizing cream daily to your feet and shins.
  

Nail cutting

• Cut nails in a straight line and leave at least 1 mm of nail at the end of the toe. Avoid using a nail clipper. Do not use any sharp instruments for cleaning under the toe nails. Do not remove corns or hard skin on your own, but rather use the services of a foot care expert – a pedicurist, qualified to treat diabetic
• foot (an up to date list can be found on the site of The Israel Diabetes Association).
• Do not apply any type of antiseptics, chemicals, creams or plasters for removing hard skin or corns without instructions from a doctor or nurse, specializing in diabetic foot.
  

Shoes and socks

• Wear dry clean cotton socks. White socks are preferable. Wear seamless socks, which are not tight fitting. Make sure that the top of the sock does not have tight elastic.
• Do not wear shoes without socks. Change socks every day. If you have a tendency to sweat, change into dry socks whenever necessary.
• Check shoes every day by hand. Check the insides in case of any roughness (folds or stitching), or foreign objects (such as stones or protruding nails).
• Fit the shoe with an insole made from shock absorbing material and make use of new technologies for fitting according to levels of pressure on the foot, as instructed by the doctor.
• The shoe must be comfortable from the time you buy it. Do not wear pointed, tight or narrow shoes. Shoes should not be too big but should be wide enough to allow free movement of the toes.
• It is advisable to buy shoes at the end of the day, as feet tend to swell, and it is more likely to get the correct size.
• Walk in new shoes just a few hours a day until they fit properly. Avoid plastic materials that do not allow the shoes to breathe. It is advisable that the leather be soft, pliable and light.
• Avoid walking barefoot either inside or outside the house. Do not walk barefoot in the sand.
• The lining of the shoe must be smooth, soft and spongy. The sole must be thick. It is important to have two pairs of shoes to allow them to dry out properly from sweating. Do not wear the same pair for more than 8 hours at a time.
• The shoe should be closed, with no open heel or toes. Avoid open sandals or flip flops.
• Protect your feet from exposure to cold by wearing suitable shoes and good socks.
• If there are corns of hammer toes or another foot deformity, protrusions or deformed toes, it may be necessary to have a special shoe made to your size. The diabetic foot doctor will give you information about suppliers or makers. You are entitled to receive partial funding from the Ministry of Health every two years. The permit can be obtained from an authorized doctor. In Hadassah Hospital the doctor authorized to give permits for shoes receives patients in the Foot Clinic in Ein Kerem or in the Rehabilitation Clinic in Mount Scopus.
   

Refraining from smoking

Do not smoke, as smoking contracts the peripheral blood vessels and limits the flow of blood to the limbs, possibly causing loss of a limb of a patient suffering from diabetic foot or blood vessel disease.

Preventing scalding

Avoid putting feet down near a source of heat, because you may scald yourself without realizing it, for example: a hot water bottle, electric blanket, electric pillow, electric heater, radiator or bowl with hot water.

Checking feet

• Check feet daily.
• Remember to have feet checked by the treatment staff at least once a year.

When do you need medical treatment?
Go for medical treatment in the following circumstances, as soon as possible, as changes in the condition of the feet can be swift and severe:

• Spotting a crack, cut or wound on the foot. The appearance of new wounds, blisters or chafing.
• A nail infection or ingrowing toenail.
• An infected wound, heavy smelly discharge, feeling unwell, fever or chills.
• Irritation or redness which may be a fungus or infection.
• Sharp pain, decline or delay in the wound's healing process.
• Changes in temperature of the skin of the limbs (hot or cold).
• Appearance of any irregularity in the limbs.
  
  
  For inquiries and scheduling appointments: 02-5842111

The information appearing in this publication is for educational purposes only and does not constitute a medical opinion and in any event, is not a substitute for professional medical advice. All rights reserved to Hadassah © Do not photocopy, duplicate or make any commercial use without written permission from Hadassah. The booklet is intended for both men and women