I hear a lot about footwear and foot care for diabetes. Why is this so important?

Proper care and protection of the feet are extremely important for people with diabetes. This is due to the fact that  the feet are  frequently affected by diabetic

nerve damage with a resultant loss of protective sensation. Protective sensation is the perception of poten- tial  injury,  such  as  awareness  of  sharp,  rough,  or excessively hot or cold objects or friction, such as rub- bing  against  the  inside   of  shoes.  When   this  is impaired, it is possible for the person with diabetes to sustain wounds, abrasions, burns, or freezing of which he or she may be unaware. Other  types of injuries such  as bites and blisters can similarly occur unno- ticed.  Even  fractures to  the  bones  of the  foot  can occur painlessly  when more severe forms of diabetic nerve damage are present.  The  most serious conse- quence of unperceived injury is infection. Because the blood supply to the feet may also be  impaired, the healing and immune response to both the injury and the infection can be compromised, so that a chroni- cally  infected  wound  results. The  most  dangerous consequences   of   chronically  infected  wounds  are spread of infection to the deeper tissues, including the bones,  and  entry  of  infectious  organisms  into  the bloodstream,  which  can  lead  to  blood   poisoning (septicemia) or spread by the bloodstream of infec- tion to other body tissues. Both of these consequences can cause severe illness or even death. Local infection of the bones of the feet can require amputation, since infection in the bone (called “osteomyelitis”)  is very difficult to treat. Even powerful  modern  antibiotics given intravenously over several weeks  may fail to completely eradicate infection in bone when its blood supply is poor.

Diabetic nerve damage in the feet may lead to distur- bance of the mechanics of the foot, such that pressure may occur on  bony areas not  designed to bear this. This can cause unusual  prominences of the bones of the feet on all of their surfaces, which are more prone to injury than usual. Corns, calluses,  cracks, fissures, and ulcers of the feet can all occur in people with dia- betes in the absence of specific injury, but as a result of  abnormal  pressure  distribution  caused  by  nerve damage.

For all of these reasons, it is very important to protect the feet by wearing suitable footwear, not going bare- foot, paying attention to the environment (i.e., removal or covering of protruding furniture legs etc. and hard, abrasive floor surfaces), performing daily inspection of the feet, foot hygiene, nail care, and prompt cleaning and dressing of minor injuries.