Diabetic Footcare

Patients with diabetes need to take particular care of their feet as any injuries are more likely to develop complications such as ulceration, due to the patients’ slow healing ability. Diabetic patients are more likely to develop neuropathy due to the amount of blood reaching the feet being limited, resulting in trauma going unnoticed.

It is important for diabetic patients to be examined at least annually for the onset of reduced sensation or poor circulation, and more regular appointments should be made with a podiatrist, foot health practitioner or chiropodist for routine foot care, particularly if poor vision is a problem. Under no circumstances should a diabetic patient attempt to treat any corns, calluses or sores themselves, and if an injury occurs that does not heal quickly, they should see their GP as soon as possible.

Verrucae

Verrucae are warts on the feet, caused by the human papillomavirus. Although they can occur at any age, they are more common in children and teenagers. Some patients my have one verruca, while some, particularly those with a suppressed immune system, may have several larger verrucae which cover a large area of the foot.

The appearance of verrucae can vary, with some being smooth papules and others having a cauliflower-like texture, although each has the presence of thrombosed capillaries, giving them the appearance of black dots.

Verrucae can be painful due to the pressure exerted when a patient stand or walks, and although they sometimes regress spontaneously within months or years, treatment is often sought sooner due to this discomfort. Different treatments are recommended for different patients, but all require commitment from the patient and regular visits from a podiatrist, foot health practitioner or chiropodist.

Ingrown Toenails

Ingrown toenails occur when the nail curves round and the sides penetrate into the skin, causing pain, redness and swelling. The condition is more common in teenage boys and the elderly, and is most likely to affect the big toe.

Common causes of ingrown nails are trauma, ill-fitting footwear, feet which are more prone to sweating and incorrect nail cutting. In order to treat ingrown toenails, the nail splinter should be carefully removed from the skin. The edge of the nail should be smoothed, so that the nail no longer presses on the surrounding skin. Inflamed tissues can become infected, in which case antibiotics may be required. In more severe cases the nail may be either partially or completely removed.

Long or Thick Toenails

Long and thickened nails present a problem for patients who lack the mobility or good vision required to trim them correctly. This can in turn lead to pain and discomfort, and cause further problems, such as corns and ingrown nails. Correct nail cutting is particularly important for diabetic patients, who may have some degree of neuropathy in the feet, and so not realise damage is being done.

Fungal Nail Infections

Fungal nail infection, also called onychomycosis, are caused by dermatophyte fungi and are more common in elderly patients. Causes include failure to maintain good foot hygiene, with communal showers and failure to dry the feet thoroughly being other contributing factors. As with other nail conditions, a patient is more likely to develop a fungal nail infection if they already suffer from pre-existing medical conditions, such as diabetes, psoriasis, poor immune system or poor state of health.

There are several types of fungal nail infection, with varying symptoms, although in all cases the nails exhibit discolouration, with nails appearing green, yellow, white or black. The nails are often thick and brittle, and can become crumbly with parts of the nail falling off. Usually nail infections do not cause pain, although thickened nails cause result in pain when wearing shoes, or the nail bed can become damaged, causing pain particularly when walking. 

Fungal infections are difficult to eradicate, but treatment by topical antifungal solution is more likely to be successful if begun at an early stage. The nail should be thinned before application of a topical antifungal agent and the solution applied until the infection is completely cleared, which can take months.

Corns

Corns, also known as heloma, are a small area of thickened skin, characterised by a central core that presses into the skin, causing discomfort and pain. They are caused when an area of the foot is exposed to friction and pressure, resulting in a thickening of the skin in order to prevent the tissue of the foot from being damaged.

The most common form is a hard corn (heloma durum), which usually presents on the joints of the toes and under the metatarsal heads. It has a smooth appearance and is hard and dry to the touch. These corns sometimes contain blood vessels and nerve endings from the dermis.

Corns which develop between the toes are known as soft corns, or heloma molle, and have a rubbery texture and can become macerated due to the excess moisture being unable to evaporate.

Seed corns are small clusters of corns which form within a callus on the sole of the foot or around the heel. This type of corn does not usually produce excessive pain.

In order to relieve the discomfort caused by corns, it is necessary for a podiatrist, foot health practitioner or chiropodist to remove the surrounding callus as well as the core (also called a nucleus) and reduce the pressure on the dermis. Well-fitting footwear can help reduce the likelihood of  the condition returning.