People with diabetes have a higher risk of suffering from the so-called diabetic foot. The pathology is due to the sum of three factors: poor circulation or lack of blood supply to the feet (ischemia), nerve damage (neuropathy) as a result of high glucose levels and infection.

It is important that people with diabetes pay close attention to different symptoms and signs that may appear at their feet to avoid further complications.

Mild symptoms:

• Color changes: the foot may be purple
• Changes in form: the foot can be inflated or deformed
• Changes in temperature: the feet can be very cold or very hot
• Blisters or wounds seen, but they don't feel
• Bad smell of an open wound

Serious symptoms:

• Sensation of tingling and numbness: the patient notices as if they were pinning needles
• Pain or burn
• Bright skin and smooth at the feet
• Loss of hair in the leg and foot area
• Inflated feet
• There is no sweat at the feet
• Wounds or ulcers that don't get better
• Cramps when walking or resting

The ulcer is the most serious complication and often the most difficult to treat. It can have different degrees of affectation. Dr. Wagner's classification is the most used to evaluate the diagnosis and treatment of injuries.

The treatment of the diabetic foot requires the existence of a multidisciplinary team in which the podiatrist plays an important role.

Podiatrist is the most indicated specialist to cut the nails in a correct way, treat ulcers, carry out a biomechanical study to improve the footprint, eliminate oversupport and all kinds of pressure when walking or running and make recommendations on the most suitable footwear.

The priority problem is the treatment of diabetic ulcers , because these wounds are a very high risk of infection.

To achieve healing of the ulcer, it is necessary to eliminate the cause that produces it, that is, the excess friction or pressure that prevents healing and contributes to its extension to deeper planes. The redistribution of pressure in the foot can be achieved through molds, insoles or adapted shoes.

Cleaning the ulcer is indicated in cases where there is accumulation of corns, or fibrous tissue. This treatment reduces pressure, allows full examination of the extent of the wound, facilitates drainage, and stimulates scarring.

Studies to date show that it is useful as a coadjuvant in the treatment of diabetic ulcer as it is not an invasive therapy, it is fast and without significant adverse effects. In addition, laser therapy produces in tissues a triple effect of improved vascularization, tissue regeneration, and antibacterial effect.

Other beneficial effects are pain relief in neuropathic ulcers due to their anti-inflammatory action, reducing the total area of ulcers by stimulation of neovascularization and accelerating cellular proliferation.

In the following lines we put forward some advice, but the most important thing is:

Follow his doctor's advice on nutrition, exercise and medicines. Keep your sugar level in the blood within the recommended range. Visit the podiatrist regularly.

• Don't smoking
• Keep a healthy and balanced diet
• Perform moderate physical activity for about thirty minutes
• Control body weight
• Raise your feet when sitting, trying to move your fingers and ankles several times a day

Whasing:

• Wash the feet daily with temperate water, neutral soap and soft bathing. Never use strong brushes
• The wash duration must not be longer than 5-10 minutes
• Particular attention must be paid to interdigital spaces during washing

Drying:

• It will be done carefully with a soft towel
• Insist on interdigital spaces

Hidration:

• Apply hydrating lotion after drying
• Avoid the use of irritating creams
• It must not be applied cream between the fingers

Periodic reviews:

• Diabetic must make every necessary visit to Podomedic Centres
• You should not use sharp or abrasive objects on your own, nor apply callicidal preparations.

Stockings and socks must be:

• Soft and absorbent, preferably cotton, in spring and summer, and wool, in autumn and winter.
• They will adjust to the foot
• They must always be clean
• They have to be changed on a daily basis, even several times a day if the foot transpires too much
• They must be well adapted to the foot and shoe model

Footwear:

• It must be bought at the end of the afternoon, when the feet are more inflated
• It must be made of leather, soft and light. With an anti-freezing and not too thick sole
• It must fit as well as possible at the foot. NEVER TRY TO FIT THE FOOT IN THE SHOE. The lead must not be too narrow or wide, and the heel will have a discrete height
• New footwear must not be used more than 30 minutes or an hour during the first days.
• You must have at least two pairs of shoes to alternate it
• Do not use a footwear that exposes the heel and/or fingers
• Never walk barefoot, neither at home nor in places of risk like beaches
• It is important that footwear contributes to blood circulation:
  • It's important to practice some physical exercise like walking, riding a bike...
  • Massages are useful
  • Do not use tight girdles, stockings or socks.