Foot Care for Elderly Diabetics

Diabetes is responsible for up to 60 percent of all lower limb amputations. Among patients with type II diabetes, the estimated risk of developing a foot ulcer is 15 percent. Proper foot care is crucial for long-term survival and well-being, especially among the elderly. Following some basic steps will reduce the risk of foot ulceration and subsequent amputation.

Decreased Sensation

• People with diabetes are at risk for developing peripheral neuropathies, which can lead to diminished or absent sensation in the lower limbs and feet. Protective sensation is frequently absent among elderly diabetics. Ulcer risk increases when sensation is absent because patients do not feel foreign objects in their shoes, and don't feel pain or discomfort when their skin cracks or blisters.

  Patients can test their protective sensation by using a Semmes-Weinstein 5.07/10g monofilament to poke areas of the foot. If you feel the poke, sensation is intact. If not, that is an area of the foot that needs to be monitored daily. Ask your physician for a supply of monofilaments.

Foot Inspection

• Elderly patients with diabetes should get a foot examination by their primary care physician at every visit. Patients should also request a foot screening at every other visit.

  Along with physician care, diabetes patients need to perform their own self-care daily. Each day, elderly diabetics should wash and dry their feet thoroughly, especially between the toes. Toenails should be checked daily and trimmed as necessary. Perform a visual inspection daily, paying special attention to areas with dry, cracked skin, areas with pain or decreased sensation and areas that may be bleeding. If you cannot physically lift your foot to examine it, use a bathroom mirror or recruit assistance from a family member. If you are familiar with your feet, you'll recognize when something is wrong.

  Keep your feet moist and supple by applying an alcohol-free moisturizing lotion to your soles every day. Alcohol can lead to dryness, which increases the risk of cracking with resultant ulceration. Avoid putting moisturizer in between the toes to avoid the risk of fungal infection.

Proper Shoes

• Diabetics should always wear comfortable shoes with a deep, wide and rounded toe box. Flip-flops, high-heels and pointed-toe shoes should be avoided. Make sure that your shoes are breathable. Select shoes that are easily adjustable. Consider getting shoes with Velcro straps for easy adjustment.

  Purchase your shoes from stores that have knowledgeable staff who are familiar with diabetes. Always get your shoes fitted at the end of the day, when your feet are their widest. Fit your shoes to the largest foot, so that it comfortably accommodates the longest toe.

  Rotate your shoes regularly, and break new shoes in gradually. Always check inside your shoes before putting them on. If you have neuropathy or diminished sensation in your feet, you may not feel objects that can damage your skin.