8 Cold Weather and Winter Foot Care Tips For Diabetics

couple enjoying winter

Here in Toronto, diabetic nursing foot care clients of McDermott Footcare are beginning to feel the change in weather. With the cooler temperatures, many clients are wearing thicker clothing, including socks and closed-toe shoes instead of sandals. Cooler temperatures call for a change in foot care routines to ensure the continued health of people living with diabetes.

Here are 8 diabetic foot care tips for a safe, healthy autumn and winter:

  1. Socks:  Wear thick, breathable socks that wick away moisture. Feet continue to sweat in colder temperatures and it is important to wear socks that promote air circulation and wick away perspiration.
  2. Keep feet dry: This goes hand in hand with the advice above. It is important to keep feet dry. Feet that are allowed to remain damp may develop fungal and bacterial infections. Dry your feet thoroughly after bathing or after becoming wet from exposure. Pay particular attention to drying the area between the toes since this is where athlete’s foot infections most commonly develop.
  3. Proper footwear: Wear boots and shoes with a rounded toe box that allows the toes to wriggle comfortably. At the same time, foot wear should fit properly so that the foot is secure. Choose leather and suede over synthetic material since natural materials allow air circulation to the foot. Look for foot wear with adequate traction. Boots and shoes should provide sufficient warmth since diabetic neuropathy may prevent the person from realizing that their feet are becoming cold.
  4. Foot soaks:  Soaking the feet should only be done occasionally. Ten minutes is a safe amount of time to prevent over-drying or maceration of the skin. Maintain a lukewarm water temperature of 90 degrees fahrenheit (32 degrees celsius). Use a thermometer to gauge the temperature or have a non-diabetic person test the water first.
  5. Heated massagers, hot water bottles and heat pads: Because of neuropathy, diabetics have a decreased ability to feel hot temperatures on the feet. For this reason, it is advisable to avoid heated foot massagers, heat pads and hot water bottles.
  6. Moisturize, moisturize, moisturize: During the winter months, it is advisable to use an extra emollient moisturizer on the feet. Keeping the feet moisturized prevents heel cracks and fissures that are painful and are prone to infection. Avoid moisturizing between toes since added moisture encourages bacterial and fungal skin infections.  Ask your certified foot care nurse or doctor to recommend a suitable moisturizer.
  7. Check your feet:  Inspect your feet daily for swelling, heel cracks, dryness, open sores, cuts, bruises, blisters, corns, calluses.  Check for peeling and dampness between the toes since this is a symptom of athlete’s foot.  Use a hand-held mirror to check the soles of the feet.
  8. Nail care: Have a certified foot care nurse clip and file your nails regularly. Nails should be clipped straight across. Thickened, fungal nails should be filed down.

Related articles:

The Importance of Nursing Foot Care for Diabetics

Why Athlete’s Foot is Dangerous in Diabetes

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

The Importance of Nursing Foot Care for Diabetics

According to a 2009 report by the International Diabetes Federation, 7% of the world’s population has diabetes.  That’s approximately 300 million people worldwide with the majority of cases (85% – 95%) having Type 2 Diabetes.  Type 2 Diabetes is preventable in 60% of cases, according to the IDF.

At McDermott Footcare, almost half of the clientele have Type 2 Diabetes.  All of the clients exhibit neuropathic and circulatory deficits which negatively affect the health of their feet and lower legs.  Read here about neuropathic and circulatory changes.

The following case studies illustrate the importance of regular nursing foot care for diabetics:

Case Study #1

Client A is a nursing home resident.  He was a McDermott Footcare client when he lived at home; at the family’s request, McDermott Footcare has continued his foot care in the nursing home.  On a recent foot care visit, he told me that he had stubbed and cut his toe.  He noticed some discharge coming from the cut.  He did not tell the staff nurses and they did not notice the injury.  On closer inspection, I noticed redness, inflammation and a white discharge when I squeezed the toe, all symptoms indicative of infection.  I cleaned and bandaged the injury site.  I reported the injury to Client A’s family, the Charge Nurse, the Director of Care and requested that my client be seen ASAP by the doctor-on-call.  Within 2 hours, Client A’s family received a phone call informing them that the doctor had just seen their father and antibiotics were now prescribed.  

Case Study #2

When I first saw Client B  12 weeks ago, he exhibited Tinea Pedis (Athlete’s Foot).  The fungal infection completely covered the bottom of both feet, as well as along the sides and top of the feet.  It was starting to spread upwards towards his ankles.  He had large areas of peeling, scaling, redness and itching.  Upon inquiry, I learned that Client B likes to sleep with his socks and shoes on because his feet are extremely cold at night.  During the day, he continues to wear the same shoes.  I discussed a Plan of Care with Client B and his caregivers.  I recommended thick, cotton, breathable diabetic socks for nighttime use and advised my client to stop wearing shoes to bed.  I suggested leather or cloth slippers for daytime use at home.  Athlete’s Foot fungus (read here) thrives in dark, moist places.  Constantly wearing shoes provides the perfect opportunity for the fungus to grow.  I taught the caregivers how to make a vinegar-water foot soak, how to properly dry Client B’s feet and advised Client B to get a prescription anti-fungal medication from his doctor.  6 weeks later, most of the Athlete’s Foot infection was gone, with only a small amount of scaling and peeling on the bottoms of his feet.

Diabetics are at a higher risk for foot-related infections leading to lower limb amputation.  This is because of neuropathy and micro/macroangiopathy.  Since their feet have decreased sensation, diabetics may not realize that they have an infected cut or open sore on the feet.  Decreased eyesight in diabetics means that they may not be able to see the cut or open sore. Poor circulation means that the ability to fight the infection is compromised.

My main concern with both clients was eliminating the infection.  The whitish discharge, redness and inflammation of Client A indicated a bacterial infection in his toe.  Client B’s Athlete’s Foot could have progressed to cellulitis with open sores.  Knowing the appropriate nursing actions and referring both clients to their physician addressed their needs in a timely and effective fashion.

Being in regular contact with both clients, knowing their complete medical history and having up-to-date knowledge in diabetic nursing foot care prevented two situations from worsening.  Regular visits from a certified foot care nurse effectively addresses the needs of diabetics.

On-going nursing assessments during visits are able to identify problem areas that the client and their family are unaware of.  One of these assessments, mono-filament testing for neuropathy, determines changes in the client’s ability to detect sensations in the feet.  Physically checking the client’s feet for abrasions,cuts, sores, blackened areas is important for the nurse to do since diabetic clients have poor eyesight and may not be able to see them.  That is why it is important for diabetic clients and/or their families and caregivers to rely on the skills and knowledge of a certified foot care nurse.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Athlete’s Foot: What Is It? What To Do About It?

At McDermott Footcare, I see Athlete’s Foot on a fairly regular basis.  Here is a primer on what it is, how you get it, how to prevent it and how to get rid of it.

Athlete’s foot (a.k.a. tinea pedis) is caused by a skin fungus.  The skin fungus or dermatophyte is known as trichophyton rubrom.  A common name is ringworm, although it’s not a worm. Here’s what it looks like under a seriously high-powered microscope:

Tinea doesn’t limit itself to the feet.  Variations of tinea infections can show up on other parts of the body.  It is very contagious and can even be caught from cats and dogs.

What does Athlete’s Foot (Tinea Pedis) look like:

  • Most of the time, Athlete’s Foot is found between the toes, especially between the fourth and fifth toes.  It looks like scaling, flaky skin and you may notice some cracking (fissures) in the skin between the toes.  It may be itchy.   The flaking and itching may extend to the bottom of the feet.
  • It may progress to a moccasin-type outline, covering the same area that a moccasin shoe would cover.  You’ll see scaling, flaking, redness, a rash.  It may be itchy.
  • Much less common is Athlete’s Foot with open sores.  This may occur in people with immune – deficient conditions or diabetes.

How do I get Athlete’s Foot?

  • Tinea thrives on hot, sweaty feet that spend a lot of time in covered footwear, especially non-breathable shoes and socks.
  • Athlete’s Foot fungus is found on the floors of public swimming pools, saunas, locker rooms, washrooms, shower stalls.  Walking barefoot in any of these areas increases the chances of picking up the fungus.
  • Poor basic hygiene of the feet is another  cause.

How do I prevent Athlete’s Foot?

  • Daily washing and thorough drying of the feet, especially between the toes, is the first step.  Avoid moisturizer between the toes.
  • Wear sandals or other appropriate footwear in public swimming pools, saunas, locker rooms, shower stalls, washrooms.
  • Wear breathable shoes and socks.  See my McDermott Footcare page (above) on Socks and Shoes for some pointers.
  • Don’t share shoes.
  • Avoid sharing towels if you have Athlete’s Foot or with someone who has Athlete’s Foot.
  • Wash your hands thoroughly – at least 15 seconds – if you touch an infected area.  Be careful not to touch your face or any other part of your body or anyone else before thorough hand washing.

How do I get rid of Athlete’s Foot?

  • Mild, uncomplicated Athlete’s Foot can usually be cleared up without prescription medications.
  • Try a foot soak of 1/4 cup white vinegar with enough warm water just to cover your feet.  Soak for 15 minutes daily until the scaling, flaking, redness, itching are gone.  If you’d like, add a couple of drops of tea tree oil to the solution.  Dry your feet thoroughly after soaking, including between the toes.
  • Over-the-counter Athlete’s Foot powders work well.  Using a cotton ball,  lightly dust the powder over the affected areas.
  • Wear breathable, moisture-wicking cotton socks and breathable canvas or leather shoes.
  • As much as possible, avoid wearing nylon pantyhose.
  • You don’t have to get rid of your shoes.  Spray a solution of a few drops of tea tree oil or white vinegar and 1 or 2 ounces of water inside the shoes.  Air out the shoes.
  • If none of these suggestions solve the problem after a couple of weeks, or if the condition worsens, see your doctor.  She/he can prescribe an anti-fungal cream.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author