Diabetic Foot Dangers – ‘the barley bag’

As winter approaches the southern hemisphere, the risks of damage to the feet of people with diabetes increase. The weather turned nasty in Johannesburg last weekend – wet and cold – as a result I saw my first Autumn diabetic foot disaster yesterday. A burn on the big toe of a lady who went to bed with her ‘barley bag’. It doesn’t have to be barley, rice, lentils, in fact anything that can be heated in the microwave.

After heating the bag in the microwave this lady put it into the bed to warm it up. Her big mistake was, that when she went to bed she didn’t remove the bag from the bed. During the night her foot came to rest on the bag and burned her big toe, leaving a blister along the whole length it.

When she saw me, the blister had broken and the base was infected. So now she is under treatment for a foot ulcer. The sad thing is that I spent months in 2007 succesfully healing an ulcer on this lady’s other big toe.

So what’s the message? You could say the ulcer is a result of a failure of diabetic foot health education – we didn’t get the right message across – but it does highlight the fact that everybody involved in diabetic foot care has to be constantly alert to potential dangers. In this case we have a high risk patient with peripheral vascular disease and diminished sensation who made a mistake with serious consequences. So what are the key messages for winter protection for the diabetic foot?

  • wash and dry your feet thoroughly
  • remove any heating bags or hot water bottles before getting into bed
  • turn off any heating pads or electric blankets when you get into bed
  • make sure your winter socks are not too tight on your feet and around your legs
  • take care that you can wriggle your toes in your shoes when you have thicker socks on
  • remember that a thicker-soled shoe will keep your feet warmer
  • if you live in a winter rainfall area, dry your feet as soon as possible after they get wet
  • try wearing loose-fitting cotton or woollen socks in bed
  • if your feet swell during the day, remember to allow for it when you wear your winter shoes or boots

Take care of your pair and see a podiatrist


Andrew has taught at the University as well as providing podiatry services in South Africa since 1977. Twice chair of the Podiatry Association of South Africa and a commentator on care of your feet on both radio and television he now works in private practice in Cape Town and Hout Bay.

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Glen Martin - July 4, 2008 Reply

Thank you for the above info, intersting.
I have suffered with ‘feet problems’ ALL my life.
I have never been able to have me feet under the blankets/duvet, I suffer mostly in winter. My feet ‘stick out’ winter and summer
I switch on my electric blamket on full before going to bed, but turn it off at the wall switch when going to bed.
I was a sugar addict, my count went to 11.8, my doctor advised me to cut out sugar altogether, which I have done since September last year. I have changed my diet to suit my problem. The only sugar I now have is in spices, chutney etc, but only in very small ‘taste’ quantities.
However I still have a problem with ‘winter feet’ with my left big toe being the main problem.
I did suffer with serious gout problems many years back, the left big toe getting the worst. It is now a ‘stiff toe’ not being able to move it at its middle joint. I do not touch liquor today. I have not smoked for +-30 years.
I have two ‘pure milk’ coffees a day, morning and evening, with tea during the day [3-4cups], the rest being plain water.
I eat very little red meat, mainly chicken and fish. I am more of a ‘veggie’ as I have a constipation problem. I eat 2/3 apples a day, and any other seasonal fruit, but not citrus. Oats for breakfast.
Otherwise I am a healthy 66 year old, without stress and an English bed warmer, thus the elect. blanket.
Anyway of solving the problem??
Thanks in anticipation,
Glen Martin.

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