Don’t let “diabetic foot” take away your happy old age

This is the 3296th article of Da Yi Xiao Hu

As we age, various parts of our bodies change quietly. As the saying goes, "the legs age first." When we get old, what changes will happen to our feet that drag us around? If the elderly happen to have diabetes, how should we take care of our feet to improve our quality of life?

Foot characteristics of the elderly

1. The sebaceous glands of the feet of the elderly have decreased secretion function, and there are even no sebaceous glands in the arch of the foot, which can easily lead to chapped and peeling skin on the feet.

2. Toenails are usually brittle and hard, and are prone to diseases such as onychomycosis and paronychia.

3. Hallux valgus is easy to occur, and the big toe tilts towards the little toe.

4. For some people who are bedridden for a long time, the ligaments that maintain the arch of the foot gradually relax, making it impossible to maintain the shape of the arch of the foot, causing the metatarsal bones of the foot to sink, muscles to atrophy, toes to deform, and claw toes to appear.

Traditional Chinese medicine has a saying that "Qi is the commander of blood, and blood is the mother of Qi". Qi is three times ahead of blood. Qi promotes the circulation of blood, and blood nourishes the abundance of Qi. When people get old, their bodies gradually become weak, and their Qi and blood are gradually insufficient. The body's "priority use" protection mechanism will give priority to supplying Qi and blood to important organs and tissues that maintain our lives, such as the internal organs and the brain. Most elderly people have plaques, high blood lipids, and high blood viscosity in their blood vessels. The thinning of blood vessels due to reduced activity increases the difficulty of blood circulation. Lack of blood supply to provide nutrition makes the skin of the feet increasingly drier, gradually forming what we commonly call "aging of the legs first".

The dangers of diabetic foot

The concept of diabetic foot was first proposed by Oakley in 1956, and Catterall defined it in 1972 as a foot that loses sensation due to neuropathy and vitality due to ischemia, and is complicated by infection. The WHO definition is: foot infection, ulcer and (or) deep tissue damage associated with distal nerve abnormalities of the lower limbs and varying degrees of peripheral vascular disease. According to statistics, 15% to 25% of diabetic patients will suffer from diabetic foot ulcers, the annual mortality rate of diabetic foot ulcer patients is as high as 11%, and the amputation rate is as high as 22%, which is a major public health problem that imposes a heavy burden on society.

For the elderly who suffer from diabetic foot, what should we pay attention to in our daily lives to reduce its harm?

1. Shoes

When going out, choose breathable and comfortable sports shoes or casual shoes. Do not wear leather shoes or shoes with open toes, such as sandals and slippers. When buying shoes, choose shoes that are one size larger than your feet (to avoid swelling of the feet caused by walking for a long time, which may cause injuries between the toes or friction between the feet and shoes).

2. Socks

Choose light-colored, breathable, sweat-absorbent cotton socks. Do not choose silk stockings, nylon stockings, or dark-colored socks made of other materials. This is because if the foot is injured and bleeding or tissue fluid seeps out, it may not be easily discovered due to the dark color of the socks. Silk stockings or nylon socks do not absorb sweat and can easily cause sweat stains on the feet, causing the foot environment to be humid, thereby breeding bacteria.

3. Foot skin care

1) Cleaning: Clean the skin of your feet every day, with the water temperature below 45°C and the time not exceeding 15 minutes. Depending on your own situation, you can choose health-preserving medicinal materials, such as ginger powder, mugwort powder, etc.

2) Check the skin: After cleaning, wipe it with a soft cotton towel, including each toe gap. After drying, carefully check whether there is any abnormality on the foot skin. If there is any special situation, deal with it in time (if there is ulcer, please do not deal with it yourself, go to the hospital for regular treatment). If you are unable to self-check the soles of your feet due to age or illness, you can ask your family to assist you or put a mirror in front of your feet and check through the mirror.

3) Trimming and massage: Trim toenails regularly. When trimming, the toenails should be flush with the tip of the toes, and not too deep (which can easily cause the nails to embed into the flesh as they grow, causing pain or paronychia). After trimming, apply skin lotion to the feet (to prevent or improve dry and cracked skin), massage the skin of the feet, and dredge the meridians.

4) Foot exercise: Sit upright on a chair (the height should be such that the legs are at a 90-degree angle). A: Place your heels on the ground, lift your toes to the maximum range, then stay for 5 to 10 seconds and slowly lower them. Place your toes on the ground, lift your heels to the maximum range, then stay for 5 to 10 seconds and slowly lower them. B: Lift your feet parallel to the ground, press your toes down to the maximum range, then stay for 5 to 10 seconds and return to the original position. Then, push your heels forward to the maximum range, then stay for 5 to 10 seconds and return to the original position. C: Lift your feet off the ground and spread them slightly apart. Rotate your feet clockwise once and then counterclockwise once.

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

Liu Ya, head nurse of the Endocrinology Department