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
• STOP SMOKING!

Take care of your pair and see a podiatrist