If you have diabetes it is essential that you look after your feet, so that they can look after you. However, it does not mean that you are doomed to suffer serious complications such as loss of sensation, poor circulation, infection, ulcers, gangrene and finally, amputation. Fortunately, most of the conditions that affect your feet can be prevented by being well informed about the status of your feet, doing your best to control your blood sugar and taking some daily precautions to reduce this risk.

Most people with diabetes know they may suffer foot complications but often don’t know why. The best way to prevent complications is to understand your diabetes. For example, the comment that type 2 diabetes is less severe than type 1 is not true, diabetes is diabetes and it can affect your feet.

If the circulation to the limbs and extremeties is poor, it reduces your body’s ability to quickly heal even the smallest cut or abrasion. Due to this delay, a simple scratch can become infected and possibly develop into an ulcer. Another effect of poor circulation is reduced blood flow to your calf muscles, which cause pain in the legs when walking.

How do I know my circulation is poor?

Symptoms such as cold feet, pale or bluish skin on your toes or the sides of your feet, calf cramps when you walk, painful legs in bed, relieved by hanging your feet out of bed, frequent small sores or abrasions at the tips of your toes and ulcer under the nails or around the heels.

A gradual loss of sensation is a common result of diabetes. This is often unnoticed until a painless injury occurs. This neuropathy, as it is called, produces strange sensations such as walking on cotton wool, feeling as if you have socks on when you are barefoot, feeling as if you have water running down your legs, numbness, pins and needles, burning and even the failure to feel sharp objects or heat and cold.

How do I know I have neuropathy?

Symptoms such as burning feet, pins and needles, numbness, painful feet or no pain, dry, cracked skin and changes in the shape of your foot.

How do I know I have a foot infection?

Symptoms such as swelling and redness in the foot or leg, raised blood sugar and possibly feeling unwell, pus or discharge from a part of the foot, sores and cracks in the skin, especially the heels, and discolouration and swelling under a callus.

How can I try and prevent foot complications?

You need to know your level of risk. Is it low or high? Do you already have complication of an ulcer, infection, gang- grene or a previous amputation?

Find out your level of risk by having an annual foot examination by a trained healthcare professional - preferrably a podiatrist. This examination checks your circulation, nerves, skin, bones and joints, and your footwear. It usually takes about 30 minutes and will include some foot health advice specifically for you, based on the examination.

What else can I do?

Establish a good foot hygiene routine by inspecting your feet every day. Look for changes in colour (red, blue or white), blisters, abrasions, corns and calluses, and damage nails. Remember to look between the toes for soft white skin or cracks, which could be a fungal infection.

Basic foot care means daily washing with mild soap, drying carefully, especially between toes, fol- lowed by the application of a cream to moisturise the skin. Use a pumice stone to reduce calluses, but do it gently. Cut your toenails to follow the line of your toes and finish of with a sandpaper nail file.

Properly fitting footwear should not press or cut, into your feet or cause blister. You need a protective sole and a low (not flat) heel to protect your feet. Old, worn shoes should be thrown away and don’t spend all day in your slippers. There are fashionable shoes available with better fit.

Regular exercise helps to control both your weight and blood sugar, so try to walk for 30 minutes every- day, or break it up into shorter blocks of time. Do some bending and flexing between the adverts on TV!

Please don’t smoke. Did you know that after ciga- rette, your blood vessels go into spasm for six hours, so smoking keeps them in a constant state of spasm and reduces blood flow to your feet.

Finally, control your blood sugar. Not only does this prevent foot complications but it also helps to heal any damage more quickly.