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May is World Foot Awareness Month – Diabetes & Crocs

Foot Health Awareness is vital for people with diabetes.


Today I want to issue a timely reminder to people with diabetes who want to wear ‘Crocs’.

Last Friday, I saw a patient who “lived in her ‘Crocs’.” That was until she got splinters which penetrated the soles and stuck into her big toe, as she was walking across the university campus. The splinters were removed by her GP and today she told me there was a small remaining piece that also had to be removed. Fortunately, although she has neuropathy, the wounds are healing well.

Last Christmas, a family member (with no diabetes) also had a piece of metal go through the sole of  his ‘Crocs’, whilst walking across the garden.

Previously, I have not taken a strong stand on this, but these two events have prompted me to express my opinion in the form of a WARNING.

If you have diabetes, think very carefully about wearing ‘Crocs’. If you have poor circulation or reduced nerve sensation; do not wear them outside the home.


The Diabetic and the barley bag – part 2

Loss of sensation and reduced blood flow to the lower limbs and feet are a well known complication of diabetes. As winter progresses, people with diabetes are at increased risk from problems associated with damage caused by trying to keep the feet warm. The lady I wrote about on May 7 is still at high risk.

Fortunately she is sticking to her care routine and the toe has stabilised. The blistered skin dried and formed a hard crust – actually this is a dry gangrenous crust – has formed over the centre of the wound, but the edges are clean and pink. The primary key to a successful outcome is control of blood sugar and that is good. Secondary is the quality of wound care and hopefully we are up to standard.

The biggest problem we have when treating diabetic foot ulcers is to keep weight off, called off-loading. Naturally, this is very difficult for a patient who knows they have a foot ulcer, but doesn’t feel any pain. Remember, pain stops us from doing further damage to an injured body part.

Here are a few WINTER FOOT TIPS FOR PEOPLE WITH DIABETES.(It’s winter in the southern hemisphere).

Keep up the daily washing and drying -especially drying

Keep up/start a daily routine of gently massaging moisturiser into your legs and feet

Remember that your shoes may become tighter because you are wearing socks and closed shoes

When you take off your shoes, check your feet for tell-tale red marks – this means dangerous pressure

Check that your shoes do fit, you possibly haven’t worn then for some months

Thicker-soled shoes will keep your feet warmer

Don’t let your boots squeeze your calf muscles and reduce circulation

Keep your feet warm at night – wear socks. NOT nylon, but cotton or wool or mixtures

Heat your bed BEFORE you get in and turn off electric blankets and heating pads. Remove hot water bottles

Try to avoid sitting in draughts – difficult, because we have houses that are designed for coolness

Wrap a blanket around your legs and feet if you are in a cold room

Never sit too close to any fire or heater – (people have fallen asleep and burnt their legs & feet)

Try to keep your excercise routine going, even though it’s darker morning and evening

p.s. Cape Mohair make excellent socks

When did you last have a Holiday?

I had forgotten how well you can feel just by taking some time off. Having just spent 10 days away from the practice I feel really good and ready for anything. I have just asked my colleague’s patient when last did he have a holiday? His reply? “Holiday is a swear word.”

My colleague also says she hasn’t had a holiday in along time and needs to get away. The Eastern Free State and then the Drakensberg is beautiful in the Autumn. (Before I went away, our receptionist had resigned, the ADSL line had been out of order for 10 days and I hurt my back!)

However, it only takes a few days for reality to hit back in the practice. A patient of ours with diabetes and a history of ulcers, returned after an absence of two years because she had a problem. Some problem too!

An ulcerated bunion joint with a massive swelling and a local skin temperature of 37 Celsius. She said it happened just a few days ago after the foot began to swell. Unfortunately the skin damage was so severe that I decided that the best plan was to admit the lady for a full work up of blood tests, wound swabs and X-rays, plus the opinion of the diabetic foot team, but she requested to go to the local State hospital the following day!

This cavalier approach to diabetes and its complications is being researched as a probable additional complication of diabetes. The behaviour changes possibly being the effect of damage to the central nervous system.

Don’t delay that holiday.