According to Marc Lipton, DPM, podiatrist with Orthopaedic Associates of Central Maryland (OACM), individuals with diabetes need to take special precautions during the winter to avoid foot injury, infection and worse.Diabetics experience a number of foot issues in the cold winter months resulting from diabetic-specific conditions such as:
- Vascular disease
- Peripheral neuropathy and painless neuropathy (loss of feeling in the foot)
- Dry, cracked skin that can lead to infection if not cared for properly
“Vascular disease is usually arterial and can affect the very small vessels of the foot and toes, impeding the flow of blood into the foot. This can cause pain and/or cramping in the feet or legs. As a result, the feet and toes are much more susceptible to thermal injuries such as frost bite or frost nip. This is magnified in people who smoke,” explains Dr. Lipton.
“Neuropathy can be either painful or painless. Numbness, itching and/or unusual sensations such as tingling or feeling something on the foot that is not there characterizes painless neuropathy,” adds Dr. Lipton. “People with painful neuropathy can experience chronic, sharp shooting pains in the feet, as well as burning and tingling that become worse when at rest. Some people suffer from elements of each type of neuropathy.”
A major problem for diabetics who suffer from painless neuropathy is the inability to sense that their feet are cold. In some instances, people with painless neuropathy do not recognize that there has been an injury to the foot until they remove their shoes and socks and notice discoloration or even blistering.
Safe Ways to Warm Up from the Cold
People who suffer from diabetic neuropathy of the feet and loss of sensation and feeling need to take extra precaution when trying to warm up cold feet.
“Do not immerse your feet in hot water, hold them up to a source of fire or a heater or use a heating pad,” cautions Dr. Lipton. “Burns are very common in the cold weather months from people trying to warm up cold feet. Unfortunately, with the loss of sensation, a person may not even realize that they have caused a full thickness burn from an external heat source or scalding hot water until it is too late.”
For diabetics with vascular and/or neuropathic disease, it is critical to examine the feet several times a day for any sores, blisters or discoloration, especially when coming in from the cold. If any skin discoloration, blistering or wound of any type is noticed, Dr. Lipton recommends contacting a podiatrist or the individual’s primary care physician immediately to avoid infection and even limb loss.
Dress for the Weather
“It is crucial to dress for the weather,” stresses Dr. Lipton. “Don’t trust your body’s sense of what is cold. Dress for the weather as though you were dressing a small child.”
Especially for individuals who have diabetic neuropathy in the feet, Dr. Lipton offers these important tips for dressing for the weather and keeping feet warm, dry and safe in the cold:
– Wear appropriate fitting thermal socks in cold weather. Ski socks made from wool blends as well as acrylic socks wick moisture away from the skin and are appropriate for keeping the feet warm and dry.
– Waterproof, insulated boots are the best way to go for wet and cold weather as they help to keep the skin dry and warm.
– Check the fit of winter boots and shoes. Boots that fit too tightly can cause foot sores and blisters. With neuropathy, the blister can go unnoticed and infection may occur before the person realizes what has happened. Healing can be hampered by poor circulation. Thick, deformed toenails, ingrown nails, and foot deformities such as bunions and hammertoes can also be aggravated in the winter due to the change in shoe types.
– Make sure to check feet for swelling, redness, sores every day!
“Life and limb can hang in the balance for people who are not prepared for bad weather and end up with prolonged exposure to the cold,” adds Dr. Lipton. He stresses that people with diabetes should work with their primary care physician or endocrinologist on tight glucose control, wear appropriate shoes and socks that fit well and see their podiatrist on a regular basis to maintain the health of their feet during the winter, and year ‘round.
For more information on diabetic foot care, visit Orthopaedic Associates of Central Maryland on the web at www.mdbonedocs.com or call (410) 644-1880.
