Diabetes is a condition which is affecting a growing number of the population. Most people understand that diabetes has an effect on blood glucose, but fewer understand the implications for feet.

Common changes to a diabetic foot include:

• Dry skin (anhidrotic)
• Change in shape of the foot (extensor substitution)
• Hard skin
• Lack of sensation (neuropathy)

Diabetes can lead to dry skin, to effects on the autonomic nervous system. Dry (anhidrotic) skin is more likely to crack or split (fissures). This poses a risk as it can create a portal of infection. It is advisable to moisturise the feet on a daily basis to reduce the risk of this from ocurring.

Changes in foot shape can also occur, with the classic retraction of the lesser toes. This produces areas of higher pressure at the base of the toes (plantar to the metatarsal phalangeal joints). To make the problem worse, the natural fatty pad that lies under these joints is displaced forwards as the toes retract, further increasing the pressure under these joints. This extra pressure increases the risk of ulceration, particularly if the person has neuropathy.

Pressure often causes hard skin to form, and usually before ulceration. If hard skin forms, it is important to have it debrided by a Podiatrist on a regular basis, and of course continue to moisturise on a daily basis.

Lack of sensation is a particular risk factor. The obvious risks include standing on a sharp object, and being unaware, and not dressing any breaks in the skin. Any person with neuropathy should always protect their feet with footwear, even around the home. Regular inspection of the feet is also paramount, looking for any breaks in the skin. If a break in the skin does occur, seek medical advice as soon as possible.

Regular application of moisturiser, attendance at a Podiatrist for debridement of hard skin, appropriate footwear and vigilance can reduce complications in the diabetic foot.