How to Perform Diabetic Foot Care: Risks and Treatment

Diabetic foot care consists of daily foot checks, moisturising, and choosing the right shoes to prevent nerve damage and circulation issues caused by prolonged high blood sugar. The most effective way to prevent foot ulcers in diabetic patients is to wash your feet every evening with warm water, dry thoroughly between the toes, and consult a specialist without delay at the slightest sign of redness. As part of World Diabetes Day awareness in November, we take a closer look at this sensitive issue, which directly affects your quality of life and can be kept under control with daily habits.

• Diabetic foot develops as a result of nerve damage (neuropathy) and vascular blockages.
• Loss of sensation, tingling, and coldness in the feet are the most common early symptoms.
• The soles of the feet and the spaces between the toes should be checked every day with the help of a mirror.
• Nails should be cut straight across, and the corners should not be dug into deeply.
• You should never walk barefoot indoors or outdoors.
• Open wounds, colour changes, or bad odours require urgent medical attention.

What is a Diabetic Foot?

Diabetic foot is a clinical condition that occurs as a result of damage to the nerves or blood vessels in the legs and feet of individuals with a long-term history of diabetes. Nerve damage, known medically as diabetic neuropathy, reduces the sensation of pain, temperature, and touch in the feet. Due to this loss of sensation, you might not notice a sharp object stepping on your foot, a tight shoe rubbing, or a hot water burn for days without feeling any pain.

Simultaneously developing peripheral artery disease (narrowing of the vessels) prevents sufficient oxygen and nutrients from reaching the tissues. Since the cells' ability to regenerate themselves decreases, even the smallest scratch can quickly grow into a wound that is difficult to close. It is known that one in four people diagnosed with diabetes in the community experiences a foot problem at least once in their lifetime. This picture develops much faster, especially in patients with uncontrolled blood sugar. Simple precautions taken in the early stages of the disease prevent serious tissue loss that may occur in the future.

Causes and Risk Factors

The main cause of diabetic foot problems is that constantly high glucose (sugar) in the blood damages the capillaries and nerve sheaths at the extremities of the body over time. While the slowing of blood flow impairs the nourishment of tissues, a condition called autonomic neuropathy affects the functioning of sweat glands, leading to extreme dryness and deep cracks in the skin. These cracks act as an open door for bacteria to get under the skin.

At the top of the risk factors are having diabetes for many years and failing to keep HbA1c (three-month blood sugar) levels within the target range. Smoking is one of the biggest triggers that accelerates circulation disorders because it narrows the vessel walls and reduces the oxygen-carrying capacity of the blood. Excess weight increases the pressure on the soles of the feet, paving the way for callus formation. Choosing the wrong shoes also initiates tissue damage due to friction. Those with a family history of diabetes should regularly monitor their blood values. For more detailed information on this topic, you can review our article titled What is Prediabetes? The Danger in Packaged Foods.

Symptoms

Foot problems in diabetic patients usually progress slowly and insidiously. In the early stages, patients typically experience complaints such as increased tingling, a pins-and-needles sensation, or burning, especially while resting at night. Foot numbness is one of the most obvious signs that diabetes has started to affect the nerves. Over time, this loss of sensation becomes so pronounced that patients may have difficulty feeling their feet touching the ground, a slipper slipping off, or the temperature of the water.

In advanced stages, visible structural changes begin on the skin. The skin of the foot becomes dry and scaly, and the heels thicken. Paleness, bruising, or regional redness may be observed in skin colour. A constant feeling of coldness in the feet can be a harbinger of vascular occlusion. The most serious symptoms are open wounds (ulcers), usually painless, that appear on the sole of the foot, between the toes, or on the heel. Deformities in the foot structure due to the affection of motor nerves, curling of the toes inward (hammer toe), and thickening of the nails are other common findings.

Diagnosis: How is it Diagnosed in the Hospital?

The diagnosis of a diabetic foot begins with listening to the patient's complaints and a detailed physical examination by the physician. Your doctor will first observe the skin structure, nails, colour changes, calluses, and possible deformities on your feet. The pulses on the back of the foot and the ankle are checked manually to get an initial idea about the state of blood flow.

To measure the extent of nerve damage, a painless method called the monofilament test is applied. In this test, a thin nylon wire is gently pressed against certain points on the sole of the foot to check whether the patient feels the pressure. In addition, deep sensation is evaluated using a vibrating instrument called a tuning fork. In cases where a circulation disorder is suspected, an Ankle-Brachial Index (ABI) measurement is performed, and a Doppler ultrasound is taken to see the blood flow in the legs in detail. If there is an open wound or infection on the foot, an X-ray or MRI (Magnetic Resonance) imaging may be requested to understand the depth of the wound and whether it has reached the bone. When necessary, a swab sample is taken from the wound to identify the type of bacteria causing the infection in the laboratory.

Diabetic Foot Care and Treatment

The most important pillar of treatment is the preventive diabetic foot care that you will meticulously apply at home every day. Wash your feet every evening with warm (never hot, check the temperature with your elbow) water and a non-irritating soap. After washing, gently dry the spaces between your toes completely with a soft towel without rubbing, especially to prevent fungal formation. To prevent skin dryness, apply a urea-based moisturising cream to the top and sole of the foot, but strictly avoid applying cream between the toes. Cut your nails straight across while they are soft after a bath, do not dig deep into the corners, and soften sharp edges with an emery board. You can take a look at our content Does Choosing the Wrong Slipper Cause Cracked Heels? regarding the role of shoe selection in foot health.

Treatments applied in the hospital vary depending on the stage of the wound and circulation. If a foot ulcer is present in diabetic patients, first, dead tissues preventing healing on the wound are cleaned with surgical instruments (debridement). If an infection is detected, antibiotic treatment appropriate for the laboratory culture is started. Completely removing the load on the wound is the basic condition for healing; for this, special casts (Total Contact Cast), pressure-distributing insoles, or special orthopaedic shoes are prescribed. In advanced vascular occlusions, cardiovascular surgery steps in to restore blood flow to the foot with balloon, stent (angiography), or bypass surgeries. The treatment process requires patience and can last from a few weeks to months, depending on the patient's blood sugar control.

Complications and Risk Groups

When diabetic foot problems are not noticed in time and treated correctly, they lead to life-threatening and irreversible serious complications. Bacteria entering through open wounds can multiply rapidly, causing deep tissue infections, abscesses, and bone inflammation (osteomyelitis). If insufficient blood reaches the tissues, the cells die, and black gangrene appears. When gangrene develops, it may be necessary to surgically remove (amputate) a part of the toe, foot, or leg to stop the infection from mixing with the blood and spreading throughout the body (sepsis) and to save the patient's life.

In terms of these complications, the highest risk group includes patients who cannot control their blood sugar with diet and medication, and whose HbA1c value is constantly high. In addition, those who have had diabetes for more than 10 years, heavy smokers, those with kidney failure, and those experiencing vision loss due to diabetes are at great risk. Because patients with vision problems cannot notice small scratches, bleeding under calluses, or colour changes on their feet, wounds are usually detected at a very late stage. Therefore, individuals in the risk group must perform their daily foot checks with the help of a mirror or with the support of their relatives.

When to See a Doctor?

It is of great importance to seek medical support without delay when you feel or observe a situation different from normal on your feet. Trying to treat a wound yourself at home can make the process even worse. You should consult your doctor on the same day if you notice any of the following symptoms:

• Sudden redness, swelling, or localised heat increase in the foot or toes.
• Blistering, water bubbles, cracks, or bleeding under calluses on the skin.
• An unusual bad odour coming from the foot, between the toes, or the shoe.
• Painful or painless superficial wounds opening on the sole of the foot, heel, or toes.
• Ingrown toenails, inflammation around the nail, or colour change in the nail.
• Sudden paleness, bruising, or blackening in foot colour.

If you have a high fever or chills along with your foot wound, if the redness is spreading rapidly towards the ankle or leg, if yellow/green pus is draining from the wound, if a sudden and very severe foot pain has started, or if you feel confusion in your consciousness, this may be a sign that microbes have entered your blood. In such a scenario, you should call the 112 Emergency Call Center without waiting or apply to the emergency room of the nearest hospital.

The Process at BHT CLINIC İstanbul Tema Hastanesi

As BHT CLINIC İstanbul Tema Hastanesi, we stand by you with our experienced expert staff in ailments that require a multidisciplinary and sensitive approach, such as diabetic foot. When you apply to our hospital, detailed evaluations regarding your foot health are carried out in coordination by our expert podiatrists in our Podiatry department and related specialist physicians (Endocrinology, Orthopaedics, Cardiovascular Surgery, Infectious Diseases). With medical foot care performed in hygienic conditions adhering to international JCI quality standards, early intervention is provided for problems such as calluses, ingrown toenails, and skin dryness, minimising the risk of wound formation.

Bringing an up-to-date list of the diabetes medications you use, your previous blood tests, and the shoes you wear most frequently in daily life when you come to your appointment will be highly beneficial for personalised treatment planning. In case of unexpected wound openings, sudden colour changes, or suspicion of infection, our fully equipped emergency department, serving 24/7, offers uninterrupted medical support. To reach our hospital, get detailed information about the process, or schedule an appointment, you can call our call center at 0850 811 34 00 or visit our appointment page on our website.

Frequently Asked Questions

How long does it take for a foot ulcer to heal in diabetic patients?

The healing time of the wound depends on the depth of the wound, the severity of the infection, the patient's blood sugar level, and the quality of blood flow to the foot. While superficial wounds that are noticed early and have no circulation problems can close within a few weeks with appropriate care, the treatment of deep wounds that have reached the bone or are accompanied by vascular occlusion can take months.

Which creams are used for diabetic foot care?

Generally, urea-based medical creams that intensely moisturise the skin, prevent water loss, and strengthen the skin barrier are preferred. However, your doctor or podiatrist must decide on the content, urea ratio, and frequency of use of the cream to be used. Creams should never be applied between the toes, as they can pave the way for a fungal infection.

Is foot numbness a definite sign of diabetes?

Although foot numbness is one of the most common symptoms of diabetic neuropathy, it does not diagnose diabetes on its own. Herniated discs, vitamin B12 deficiencies, thyroid problems, or different circulation disorders can also cause numbness in the feet. A detailed neurological examination and blood tests are essential to determine the exact cause.

How should diabetic shoes be?

Diabetic shoes should be seamless inside, made of soft and flexible leather, have a wide toe box, and not squeeze the foot at any point. The sole should be designed to distribute the pressure on the foot evenly during walking, the shoe should be made of breathable material, and it should have an adjustable lace or velcro system.

Is it harmful for diabetic patients to get a pedicure?

Standard pedicure procedures performed in beauty salons are strictly not recommended for diabetes patients, as they carry the risk of sterilisation deficiencies, infection, and tissue damage with sharp tools. Instead, medical foot care performed in a hospital environment by expert podiatrists who have received anatomy training and use sterile medical devices should be preferred.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.