12 tips for diabetic foot care during COVID-19
April 14, 2020
Hi, this is Dr. Meltem Zeytinoglu again, continuing our series with how to take care of yourself as an individual with diabetes or for someone who has diabetes. We have our series with now continuing with different specialists who take care of our patients with diabetes, and I'm very happy to welcome today my friend and colleague Dr. Ann Zmuda, a diabetes specialist and in podiatry and foot and wound care. Welcome, Dr. Zmuda. How are you today?
Thank you-- very good. Thanks for having me.
Very glad to have you here. And so what we really want to focus on today is helping our patients. They're worried they can't see you in the clinic now, and they really want to take care of their feet and are extra cautious now about preventing wounds and having good foot care. So for the patient who's generally doing well and would be coming in for a routine visit right now who doesn't have any active issues but has had diabetes for a while, what are some tips that you have for preventing any issues right now?
Absolutely. And looking and checking your feet is of the utmost important while you're in quarantine, and you can't get in to see me. Which, by the way, I miss you all. First and foremost, diabetics please don't walk barefoot at home. There's too many things that you can step on in an unprotected foot.
A lot of our diabetic patients don't have good sensation. So if you step on a child's toy or something that's left on the floor that shouldn't be there, certainly you can have some injury to your foot that you won't be able to feel that could eventually become something worse. So first and foremost, definitely keep something on your feet at all time. House shoes, slippers-- that's really not good stuff. I would rather go with a pair of gym shoes that will keep your feet protected.
After that, check your feet every day. After you get out of the shower, check. What you're looking for is anything red, hot, swollen painful. These are all signs of infection. If something is draining, that's also a sign that you either have an open sore or some sort of a blister. You want to definitely be able to look at that.
If you have a problem with vision due to your diabetes, hold your foot up to a mirror. Or have someone in your household look at your foot for you so that if there is anything going on that you can't feel or you can't see, they can help you with that as well. Additionally, use lotion to your feet every single day. Don't put any in between the toes. But when you're in the house, you have dry heat inside.
Right now we still have cold air outside. It depletes your skin of moisture. So make sure that you keep your feet nice and moisturized with lotion or Vaseline-- whatever you have at home. You don't have to go to the grocery store to get something because it says "diabetes" on it. You can use anything you have at home. Also, make sure that you are washing your feet daily. I know a lot of us are at home staying in our flats. Make sure we shower and wash our feet every day and good hygiene-- extra important.
Finally, make sure that you move. It's very important, not just for circulation but for your diabetes and for your mental health. Move, move, move. And there are lots of things that you can do. There are free videos online that you can exercise with, anything from yoga to Tai chi. If you're more advanced, to stretching exercises, some cardio in there.
Don't take on anything that you've never done before. Start slow, but keep moving. It will be good for you. It will be good for your feet, and it definitely will be good for your diabetes.
Thank you. Those are all incredible tips I think even for our patients who don't have diabetes for really good foot care. In particular related to the lotion, should our patients be waiting to put on their socks and letting it dry first-- letting their feet dry before they put anything on over it?
So it's OK to put your lotion on and then put your socks on. It'll keep that lotion in there. It'll make your feet sweat a little bit, which will actually help it to absorb a little bit more.
--thoroughly in at night. A nice trick for dry skin in general-- put lotion on, then put your socks on, and sleep in white cotton socks during the night. It'll help with all the dry skin and prevent the cracking and stuff you can get up the heel.
Wonderful. And I love your advice about staying moving. We're all watching a little bit more TV these days. Not all of us, but a lot of people are watching a little more TV. So I always recommend for my patients that you make a rule. You don't watch your favorite show. You pick one an hour, and you march in place if you can during that time in front of the TV if you don't have a treadmill.
Or you can use a step riser or even just marching in place. Certainly a half an hour or an hour is a long time. So even if you have a harder time moving, just getting up during each commercial break is a great way to just stay moving.
Absolutely. And it's also, I think, important and all you can walk outside. You just want to social defense and stay in very, very small groups. And if you are going to do that, just make sure if you are unsteady and you typically walk with a walker or a cane, continue to use those ambulation assistive devices to guide you and help you so that you don't fall.
The big thing was with foot care right now and with diabetic self care in general is we really want to try and prevent injuries so that we can prevent you needing to go to the emergency room, prevent the burden on the health care system that's already burdened to the max. So we're really trying prevention, prevention, prevention.
Exactly. That's wonderful. So let's transition a little bit to what if someone is not able to prevent something. Even with the best efforts, sometimes accidents happen. And so let's start with sort of smaller scrapes, and cuts, and wounds. How should patients take care of those if they're very minor cuts?
Sure. For minor cuts at the initial injury, if you have hydrogen peroxide at home, you can clean it out with hydrogen peroxide. Pat it dry, and then use an antibiotic cream on it and change that everyday. Cover it with a Band-Aid. Antibiotic cream-- it doesn't matter what kind you use. It can be Neosporin, bacitracin, double or triple antibiotic cream. All of those creams pretty much work the same way. You're keeping a nice and moist environment, and you're keeping bacteria away.
Also, if it's on the top of your foot or if it's on a toe from a tighter fitting shoe, then make sure that you don't wear that shoe. And you keep the pressure off of those injuries. Another thing that I have had some patients contacting me about is their long toenails. It's very difficult to clip your own toenails, and I understand that. And right now we just can't get you and take care of that either, but it's also very important care.
So if you are having problem with longer nails and you can't actually cut your own toenails, use a nail file. Get a black emery board and at least file them down a little bit until we can get in and get that taken care of for you. If you have a family member that you trust, that can help. They certainly could trim those for a while for you until we see you.
Definitely do not use any sharp objects on your feet. If you have painful calluses, those thick lesions on the bottom of your feet, or corns on your toes-- do not take razor blades or knives to cut those. That's very dangerous. You're adverse for infection. All you can do on those is a pumice stone and some lotion, and eventually we'll get there and get that taken care of for you.
One of the things with calluses though is make sure if there's any bleeding underneath the callus, if you see some red spots underneath, that's something that you should probably reach out to me if it's one of my patients. Or I'm sure all the other podiatrists in the area are tele-health'ing and using things like "my chart," email. You all can certainly take pictures of your feet and email them to me. I'm happy to look at them all day long if I need to. We really, really, really want to prevent ulceration.
Thank you so much for reminding us that. Because although this is a good opportunity for us all to educate each other and remind us of good health care, the purpose of this series is really to remind you that we're actually all here for you and that there's a lot that we can do through these Zoom-type visits that we're doing. So you really should not hesitate. It's always better to call than to take things into your own hand.
It's better to check in with us to make sure you're doing things correctly, and we can kind of guide you. So these are general guidelines, but you should always be checking in with whoever your podiatrist is or your doctor. And we can kind of guide you.
Now you mentioned some really great tools like pumice stones, files. Luckily, most of the pharmacies have these. If you're considered safe, and healthy, and you're going to the pharmacy and keeping social distance, you can get these things. If it's hard for you, if you are worried about being relatively in an older age group and you don't want to go to the pharmacy, you can always reach out to someone who can help you get these things or reach out to your doctors. We can try to see what resources we have to help get you what you need at home during this time.
What about for your patients who have very active wounds? We're trying to keep as many people out of the hospital, and we know that's something that we all take care of in the hospital often are diabetic foot ulcerations and cellulitis. So what are we doing at this time for active wounds?
So for the wounds-- those are the scariest of all the issues that we're dealing with and certainly the ones that we have to take very seriously. If you're already on a wound care regimen that your physician or I have prescribed, continue to use that regimen. And then absolutely if you can take pictures and send them to us so that we can gauge where your wound is and if you need something different. We all have the ability to order medications via the internet through EPC, e-prescribing.
So if we need to change medications or if we need to add medications, even wound medications, we absolutely have the ability to do that. With those wounds, you need to change your dressings as instructed. Most of the time dressings need to be changed every day. Some of them are every other day. It depends.
Things that you want to look for, though, if you think your wound is getting worse, you're going to have increased drainage. You will start to have an odor. An odor is never a good sign. You will also start to see some redness and some warmth in the area.
Some people will have increase in pain. But remember, some of you won't with neuropathy from diabetes, which sometimes you don't feel normally, you may not have pain. Pain is not an indication of whether or not something is infected. So red, hot, swollen, painful, draining, stinky-- these are all signs that you need to contact your doctor right away.
Otherwise, keep your wounds clean. Keep them covered. Do not let them air dry. You don't want them to dry out. That's not how we treat these types of things. And don't increase your walking and your activities because you're at home going crazy with the wounds if they're on the bottom of the foot. You need to keep sitting with your feet up.
However, you can stretch, and you can sit. And you can do exercises sitting. You can write the letters of the alphabet with your feet. It is important to move. We just don't want you to put any kind of pressure on those wounds so that we can heal them.
A lot of the wounds are going to start building up some callus around the area from doing the walking that you have to do just to do your day to day activities. Those other things that we like to debrief in clinic when you come in-- right now it's going to be a little bit longer than usual. So you certainly can do a little bit of lotion or Vaseline on the callus area. Just don't put it on the wound.
If you run out of medications and you can't get in touch with your doctors, an easy solution is to just take a piece of gauze, wet it, wring it out, and then apply that to the wound, and change that twice the day. That is called a wet to dry dressing, and that will keep your wounds in a moist environment so that they don't dry out. It will help them to not get infected, and it will keep them protected.
That's great advice. And as a reminder, we're always here with these virtual visits too. And so if we can look at it, this is a really good opportunity. Dr. Zmuda and I always work together because these wounds don't heal if your blood sugars aren't controlled. And so for many, many reasons this is as good of a time as ever to keep your blood sugars controlled and help those wounds heal in that way.
And so that's where I and all of your doctors and my colleagues who do your diabetes care at the University are here for you to help control your blood sugar as well while you're at home. You can give us a call, send us a my chart message, and we'll do whatever we can to help adjust your insulin during this time or your oral medications.
Yeah. To that point, bugs love sugar. So if you have sweet blood because you have those elevated blood sugars, it's definitely a greater risk for your wound becoming infected. So keep the sugary foods out of the house, and then you won't be at risk for grabbing at them.
Yes, yes. Well, thank you so much, Dr. Zmuda. Is there anything else that you to add? Those are all incredible tips for our patients.
Just stay in contact with us. We miss you as much as you miss us, and we're here for you if you need anything. Stay active if you can. Stay moving. Don't sit in front of that TV and eat, eat. There's definitely ways out there for you to move, more, move. And we all look forward to seeing you soon.
We sure do. Thank you so much. You take care and be well. Have a good day. Bye, bye.
During the COVID-19 pandemic, diabetes patients may be wondering how to take care of diabetic foot wounds. Right now, it’s important for people to prevent injuries and stay out of already-burdened emergency rooms and hospitals, which could increase their own risk of exposure to COVID-19.
Here are 12 preventative measures for diabetic foot care:
1. Don’t walk barefoot at home.
There are too many things you can step on with an unprotected foot. Many patients with diabetes don’t have good sensation in their feet, so if they step on something like a child’s toy, they might not be able to feel their foot injury and it could eventually develop into something worse. Gym shoes are better than house shoes or slippers to keep feet protected.
2. Check your feet every day.
What you’re looking for is anything red, hot, swollen or painful. These are all signs of infection. If something is draining, that’s also a sign that you have either an open sore or some type of blister. If you have problems with vision due to your diabetes, hold each foot up to a mirror, or have someone in your house look at your feet for you.
3. Put lotion on your feet daily.
Use lotion on your feet every single day but don’t put any between the toes. Make sure to keep your feet nice and moisturized with lotion or Vaseline or whatever you have at home. You don’t have to go to the store to get a lotion that says “diabetes” on it. It’s OK put on lotion and then cotton socks. It helps the lotion absorb, and it prevents the dry skin and cracking you can get in the heels.
4. Wash your feet daily.
I know a lot of people now are staying home in their sweats. That’s fine, but make sure to shower and wash your feet every day, and then dry them well before putting on your socks and shoes. Good hygiene is extra important.
It’s very important, not just for your circulation and your diabetes, but for your mental health, to move, move, move. There are lots of things you can do. There are free videos online you can exercise with, from yoga to tai chi to stretching or cardio. Don’t take on anything you’ve never done before, and start slowly. You can march in place while you’re watching a half-hour TV show. If you have a harder time moving, just get up during the commercials. You can walk outside. Just respect social distancing. If you are unsteady and use a walker or a cane, continue to use those devices so you don’t fall.
6. Take care of small scrapes, cuts and wounds.
For minor cuts, at the initial injury, you can clean it out with hydrogen peroxide, pat it dry, and then put an antibiotic cream on it and cover it with a Band-aid.
It doesn’t matter what kind of antibiotic cream you use — it can be Neosporin, bacitracin, or double or triple antibiotic creams. All of those creams basically work the same way to keep bacteria away. If the injury is on top of your foot, or on your toe from a tight-fitting shoe, then make sure you don’t wear that shoe and keep the pressure off those injuries.
7. Try to keep your toenails cut.
Clipping your toenails can be difficult, but it’s very important care. If you’re having a problem with longer nails, and you can’t actually cut your own toenails, get a black emery board and at least file them down a little bit. If you have a family member you trust, they can help. Don’t use any sharp objects on your feet. If you have painful calluses, thick lesions on the bottom of your feet, or corns on your toes, do not take razor blades or knives to cut those. That’s very dangerous. You’re at risk for infection. All you can do on those is a pumice stone with some lotion. When you can get to your doctor’s office, they can take care of these things for you.
8. Watch for red spots or bleeding under callouses.
If you notice any bleeding underneath the callouses on your feet, or if you see some red spots underneath, reach out to your doctor. All the podiatrists in the area use virtual visit tools like Telehealth, or you can take photos and email them to your doctor or use MyChart.
9. Take extra care of active wounds.
Always call your doctor if you have an active wound, because those need to be taken very seriously. If you’re already on a wound care regimen that your physician has prescribed, continue to use that regimen and regularly send photos to your doctor so they can gauge what you need. With these wounds, it’s important to keep them clean and change the dressings as instructed. Keep them covered. Do not let them air dry or dry out. And don’t increase your walking and your activities just because you’re going crazy at home. If the wounds are on the bottom of the foot, you need to keep sitting with your feet up. However, you can stretch and do sitting exercises. You can write the letters of the alphabet with your feet. It is important to move. Just don’t put any kind of pressure on those wounds, so they can heal. A lot of wounds will start building up some calluses around the area. You can put a little bit of lotion or Vaseline on those areas — just don’t put it on the wound.
10. Make sure your wound is not getting worse.
If your wound is getting worse, you’ll notice increased draining, an odor, redness or warmth in the area. These are all signs that you need to contact your doctor right away.
11. Control your blood sugar.
Your wounds won’t heal if your blood sugar is not controlled. This is a good time, for many, many reasons, to keep your blood sugar controlled. Your doctors are here to help you. Call them or send them a MyChart message so they can do whatever is needed, such as adjusting your insulin or oral medication.
12. Don’t hesitate to call your doctor.
If you’re unsure about something, it’s always better to call your doctor than to take things into your own hands. If you need something and don’t want to go to the pharmacy because of COVID, and a family member or friend can’t help, reach out to your doctor to see what resources they have.
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