Diabetic Neuropathy

Foot care

People with diabetes need to take special care of their feet. Neuropathy and blood vessel disease both increase the risk of foot ulcers. The nerves to the feet are the longest in the body, and are most often affected by neuropathy. Because of the loss of sensation caused by neuropathy, sores or injuries to the feet may not be noticed and may become ulcerated.

At least 15 percent of all people with diabetes eventually have a foot ulcer, and 6 out of every 1,000 people with diabetes have an amputation. However, doctors estimate that nearly three quarters of all amputations caused by neuropathy and poor circulation could be prevented with careful foot care.

To prevent foot problems from developing, people with diabetes should follow these rules for foot care:

• Check your feet and toes daily for any cuts, sores, bruises, bumps, or infections--using a mirror if necessary.

• Wash your feet daily, using warm (not hot) water and a mild soap. If you have neuropathy, you should test the water temperature with your wrist before putting your feet in the water. Doctors do not advise soaking your feet for long periods, since you may lose protective calluses. Dry your feet carefully with a soft towel, especially between the toes.

• Cover your feet (except for the skin between the toes) with petroleum jelly, a lotion containing lanolin, or cold cream before putting on shoes and socks. In people with diabetes, the feet tend to sweat less than normal. Using a moisturizer helps prevent dry, cracked skin.

• Wear thick, soft socks and avoid wearing slippery stockings, mended stockings, or stockings with seams.

• Wear shoes that fit your feet well and allow your toes to move. Break in new shoes gradually, wearing them for only an hour at a time at first. After years of neuropathy, as reflexes are lost, the feet are likely to become wider and flatter. If you have difficulty finding shoes that fit, ask your doctor to refer you to a specialist, called a pedorthist, who can provide you with corrective shoes or inserts.

• Examine your shoes before putting them on to make sure they have no tears, sharp edges, or objects in them that might injure your feet.

• Never go barefoot, especially on the beach, hot sand, or rocks.

• Cut your toenails straight across, but be careful not to leave any sharp corners that could cut the next toe.

• Use an emery board or pumice stone to file away dead skin, but do not remove calluses, which act as protective padding. Do not try to cut off any growths yourself, and avoid using harsh chemicals such as wart remover on your feet.

• Test the water temperature with your elbow before stepping in a bath.

• If your feet are cold at night, wear socks. (Do not use heating pads or hot water bottles.)

• Avoid sitting with your legs crossed. Crossing your legs can reduce the flow of blood to the feet.

• Ask your doctor to check your feet at every visit, and call your doctor if you notice that a sore is not healing well.

• If you are not able to take care of your own feet, ask your doctor to recommend a podiatrist (specialist in the care and treatment of feet) who can help.

Several new drugs under study may eventually prevent or reverse diabetic neuropathy. However, extensive testing is required by the U.S. Food and Drug Administration to establish the safety and efficacy of drugs before they are approved for widespread use.

Researchers are exploring treatment with a compound called myoinositol. Early findings have shown that nerves in diabetic animals and humans have less than normal amounts of this substance. Myoinositol supplements increase the levels of this substance in tissues of diabetic animals, but research is still needed to show any concrete lasting benefits from this treatment.

Another area of research concerns the drug aminoguanidine. In animals, this drug blocks cross-linking of proteins that occurs more quickly than normal in tissues exposed to high levels of glucose. Early clinical tests are under way to determine the effects of aminoguanidine in humans.

One approach that appeared promising involved the use of aldose reductase inhibitors (ARIs). ARIs are a class of drugs that block the formation of the sugar alcohol sorbitol, which is thought to damage nerves. Scientists hoped these drugs would prevent and might even repair nerve damage. But so far, clinical trials have shown that these drugs have major side effects and, consequently, they are not available for clinical use.

• Ask your doctor to suggest an exercise routine that is right for you. Many people who exercise regularly find the pain of neuropathy less severe. Aside from helping you reach and maintain a healthy weight, exercise also improves the body's use of insulin, helps improve circulation, and strengthens muscles. Check with your doctor before starting exercise that can be hard on your feet, such as running or aerobics.

• If you smoke, try to stop because smoking makes circulatory problems worse and increases the risk of neuropathy and heart disease.

• Reduce the amount of alcohol you drink. Recent research has indicated that as few as four drinks per week can worsen neuropathy.

• Take special care of your feet.

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