1) Diabetic foot problems are a serious complication of diabetes that often result in amputation and cause physical, social, and economic hardships. 2) Those at high risk include people with uncontrolled diabetes, the elderly, and those with neuropathy, ischemia, or a history of ulcers or amputations. 3) Daily foot inspections are necessary to check for lesions, as diabetics may not notice ulcers due to loss of sensation; family members should also inspect feet regularly.

1. Retrieved from http://www.dairaheja.org/GUIDELINES_physicians.html
DIABETIC ASSOCIATION OF INDIA-GUIDELINES FOR DIABETIC FOOTCARE
Diabetic Foot Problem is a serious complication of diabetes requiring hospitalization
which invariably results in a loss of toe or limb. It causes tremendous hardships to individuals
with diabetes and his family. It handicaps them physically, socially and economically.
Prevention:
Following subjects may be at high risk for developing foot lesions:
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Diabetes uncontrolled for a long time
Elderly Persons
Presence of neuropathy
Presence of ischemia
History of previous ulceration
Amputation of toe
Presence of retinopathy and neuropathy
Illiterate patients
Prevention Programme
Daily inspection of feet is necessary. Because of loss of sensation a diabetic may not
notice an ulcer. Pressure point areas like ball of the big toe, heel, outer aspects of the feet need to
be inspected every day. Due to poor vision it may be difficult to inspect the foot properly. Use of
a mirror placed on the ground is helpful. Family members should also take active interest in
respecting the foot whenever possible. Family physician should make it a point to examine the
foot of the patients on each visit.
Overcome Dryness: Automatic neuropathy affects sweating mechanism leaving the foot
very dry. Dry skin is vulnerable to cracks and fissures as it loses its suppleness. This can be best
overcome by application of petroleum jelly, coconut oil or cold cream to the sole of the foot
including inter digital area. We have noticed consumption of vegetable oils increases the dryness
of the foot resulting in cracks and fissures. Consumption of fish oil and correcting nutrition
reverses the dryness. Details of nutrition are given in the nutritional guidelines.
Careful pedicure: Diabetics tend to injure their toes in the process of cutting their nails
because of impaired sensation and poor vision. Great care needs to be taken while cutting the
nails and they may need the help of someone else to cut their nails.

2. Avoid walking bare surgery: It is a common practice in India to shave corns or callus on
the sole of the foot with the help of a shaving blade. This is dangerous in a diabetic because of
impaired sensation. Unknowingly he might cut deeper leaving a raw area and a possibility of
infection creeping in. This job should be left to the doctor concerned or podiatrist.
Avoid walking bare foot: Walking bare foot is harmful because of loss of sensation and
inability to feel hot or cold. Soft slippers are recommended.
Shoes should be comfortable and well padded. Socks should always be worn. New shoes
should be gradually broken in over a few days.
If a foot problem does occur it should be detected early. Foot problem should be treated
with great caution by bed rest, appropriate dressing, correct footwear and antibiotics as suggested
by the doctor.