We’re hosting a footcare Q&A – got questions for us?

[Diabetes UK]

Every year my consultant points out the callouses on the balls of my feet. Doesn't everyone have these? Why does he seem to think they are a problem? All he has said is that dry skin gets cracked leading to infection, but I have had no problems of this sort. I think I have them because I walk a lot.
I did have them filed away a few years ago when I was having treatment for a verruca, and for a few weeks it was quite sensitive walking until the callouses grew back! Are they really a bad thing and if so what should I do?

"Thanks for asking this question. It could be that you have hard skin on the balls of your feet because you walk a lot. It could be that you’re wearing the wrong kind of shoes. It might be that you need a bit more of a cushion in your shoes. Not everybody gets hard skin, the problem is that hard skin cracks. And cracks in the skin are a good breeding ground for infection. It could also be masking over some of the nerves in your foot, so if you were to get any pain there you may not feel it. Hard skin can be treated with just a basic moisturiser applied once or twice a day, depending on how hard the skin is. Avoid using any of those mechanical devices that take off the skin. And you should see a podiatrist yearly to review your feet generally." Dan, Head of Care, Diabetes UK

 

[Diabetes UK]

Is plantar fasciitis more common in type 1's or is that a myth? some people seem to say it is and others say otherwise. All i know is my heels are killing me lol

"Fortunately, it’s a myth. There’s no reason why someone with Type 1 diabetes is more likely to get plantar fasciitis than anybody else." Dan, Head of Care, Diabetes UK

 

[Diabetes UK]

As a carer for a type 2 diabetic, what am I looking for in foot health / foot problems
What questions to ask to ascertain/quantify the symptoms (but Dr asks on the phone, but better to be prepared!)
feet are often cold - is this due to circulation? and/or elderly - thin blood/anticoagulants/other known conditions or diabetes or both?
There is sometimes tingling and burning in feet or toes - what is this?
swollen ankles/feet - is it always urine infection or anything else?
how to spot cellulitis early (prevention always but it happened twice)

Thank you very much for this.

"Big question! Thank you. It’s great that the doctor asks about the feet but it’s even better if the doctor could look at the feet (not over the phone), or if the person with diabetes is housebound, district nurses could do a home visit and provide a foot examination. You’re right, colder feet can be due to age or other conditions AND to diabetes, as the high blood sugars over a long period of time may have affected the blood vessels. Tingling/burning in the toes is a very common symptom of neuropathy (nerve damage) and this can often be worse at night. It can however be related to other conditions (a vitamin deficiency or nervous system conditions such as MS). We would suggest seeing your GP for an assessment as given the symptoms you have told us it is likely to need some further advice on keeping the feet safe and protected." Dan, Head of Care, Diabetes UK

 

[Diabetes UK]

What footcare regime would you recommend for a person with diabetes doing a mountain marathon / ultra marathon?
If the answer doesn't include explanation of dry socks, plastic bags for feet etc, then can I suggest you ask someone who does mountain marathons / ultra marathons with T1D - like me or at least four friends. Some of us have provided foot care for competitors, too.
Don't let anyone tell you that well controlled diabetes should stop your aims!

"Great question. It depends on what your feet are like currently. If you’ve got low risk feet with full sensation and no ulcers then you should have the same footcare advice as any ultra-marathon runner. So you should use dry socks, the right fitting shoes. If you’ve got a reduction in the amount of sensation in your feet then you’ll need really individualised information from a podiatrist. You’d need to make sure that your running shoes are looked at, to make sure that the spongy bit on the sole is appropriate. You’d need to make sure that you’re wearing the right kind of socks. Sports socks, the short ankle socks, can rub. You might need to change your socks frequently depending on how long your ultra-marathon is going to be. If you’ve got very high risk and have got an active ulcer it might be advisable to avoid such activities for the moment." Dan, Head of Care, Diabetes UK

 

[Diabetes UK]

I am concerned about the swelling of foots (and sometimes hands). In some cases isn't diabetes related like wh the climate is hot or when one get an infection and gets antibiotics. In other cases is diabetes related. What are the warning signs to watch in case of foot swelling?

" You’re right, the foot swelling can be numerous things – infection, arthritis, water retention, to name a few. And often these conditions can be made worse by having diabetes. The weather is unlikely to cause noticeable swelling. It’s great that you have taken an interest in your feet (and hands) as you will know whats usual for you. Be on the look out for hot, swollen feet as this could be an infection and will likely need antibiotics. Looking after your heart is really important to help with foot swelling so mention this to the GP and get their assessment." Dan, Head of Care, Diabetes UK

 

[Diabetes UK]

Thank you to everyone for posting your questions!

 

[clive555555]

Cheers Hannah and Dan, going to see Lyndsey the Healthcare Nurse on Weds 18th October, (first visit) Got to get use to somebody looking at my feet FIRST, before I could think of someone cutting my toe nails,
Cheers clive55555

 

[Radders]

"Thanks for asking this question. It could be that you have hard skin on the balls of your feet because you walk a lot. It could be that you’re wearing the wrong kind of shoes. It might be that you need a bit more of a cushion in your shoes. Not everybody gets hard skin, the problem is that hard skin cracks. And cracks in the skin are a good breeding ground for infection. It could also be masking over some of the nerves in your foot, so if you were to get any pain there you may not feel it. Hard skin can be treated with just a basic moisturiser applied once or twice a day, depending on how hard the skin is. Avoid using any of those mechanical devices that take off the skin. And you should see a podiatrist yearly to review your feet generally." Dan, Head of Care, Diabetes UK

Thank you. I don't think it's the shoes. I am very particular about the shoes I wear. And strangely one foot is far worse than the other! I also moisturise regularly but don't really see how that helps as it doesn't remove the dead skin. My DSN and consultant told me I should file it on a regular basis so now I'm very confused by the ban on mechanical devices!

 

[trophywench]

Thing I find if I file all the hard skin off and have lovely pink skinned well moisturised tootsies - it hurts like merry hell to walk anywhere, until I've built up some replacement hard skin in a few places!

 

[Ally beetle]

Thanks for the advice

 

[Radders]

Thing I find if I file all the hard skin off and have lovely pink skinned well moisturised tootsies - it hurts like merry hell to walk anywhere, until I've built up some replacement hard skin in a few places!

Yup! Which makes me wonder, hence my initial question really.

 

[Seabreeze]

"Big question! Thank you. It’s great that the doctor asks about the feet but it’s even better if the doctor could look at the feet (not over the phone), or if the person with diabetes is housebound, district nurses could do a home visit and provide a foot examination. You’re right, colder feet can be due to age or other conditions AND to diabetes, as the high blood sugars over a long period of time may have affected the blood vessels. Tingling/burning in the toes is a very common symptom of neuropathy (nerve damage) and this can often be worse at night. It can however be related to other conditions (a vitamin deficiency or nervous system conditions such as MS). We would suggest seeing your GP for an assessment as given the symptoms you have told us it is likely to need some further advice on keeping the feet safe and protected." Dan, Head of Care, Diabetes UK

Ahh yes the burning tingling can be at night and it is intermittent as can be the cold feet.
It's home visits and they discuss on the phone before coming out to see, or say to give it a day or two.
She is on vitamin injections as her octogenarian body isn't absorbing them so well now, so the vitamin deficiency and age related makes sense.
Thank you Dan, that's joined up some pieces of the jigsaw.