Prevention of Diabetic Foot Pain
The best strategy for prevention is frequent and routine foot evaluations for possible diabetic nerve disease (neuropathy). There are several screening tests that can be used, typically consisting of a history, a tuning-fork test for the ability to sense vibrations, and a check of skin integrity, sensitivity, and reflexes.
In diabetic care of the feet, there should be routine inspection of the toenails for evidence of fungal infection, and the feet should be examined for changes due to improper footwear, such as calluses and discoloration.
An annual comprehensive exam includes:
- A check of the skin for integrity, redness, calluses, and fissures, especially between the toes and at the pressure points involved in simple walking. Bony and joint deformities, as well as mobility, balance, and gait are part of a comprehensive exam
- Assessment of vascular disease by noting any history of circulation problems and by determining the quality of the pulses in the feet
- A test for loss of sensation using a thin filament to map areas that are suspicious for insensitivity. Additionally, tuning fork testing, pinprick sensitivity, and reflexes are checked
- Quitting smoking if a smoker
- Avoiding going barefoot, even at home
- Determining the water temperature before stepping into a bathtub
- How to trim toenails properly, i.e., to the shape of the toe, filing sharp edges, and avoiding cutting the cuticles
- Washing and checking one’s feet daily
- Advice on shoes, i.e., snug but not tight and, if necessary, customized for any ulcerations or deformities (calluses, bunions, etc.)
- Wearing socks at all times