Summer is the season for strapping on sandals and strolling barefoot along the beach; but for elderly persons with diabetes, wearing adequate foot protection is a necessity. Diabetics with peripheral neuropathy have the greatest risk of getting a foot infection. Why? Numbness in the lower extremities may prevent the elder from feeling a blister on the heel or small cut on the sole of the foot.
What is Peripheral Neuropathy?
Neuropathy refers to a disorder of the peripheral nerves that connect the spinal cord to muscles, skin and internal organs. Peripheral neuropathy often causes numbness or a sensation of tingling or burning in the hands and feet. Traumatic injuries, infections, metabolic problems and exposure to toxins can cause peripheral neuropathy. One of the most common causes is diabetes.
According to Lauren Fritsky, contributing author for the magazine, Advance for Physical Therapists and PT Assistants, a skin injury or blister can cause major problems. In the article, "Feet, Do Your Stuff" (April 2008, pgs. 20-21), Fritsky says, "Diabetes causes about 30 percent of neuropathy cases."
Fritsky quotes Patricia Kluding, PhD, PT from the University of Kansas Medical Center. Kluding states, "High levels of blood glucose can also present a double whammy following a skin injury: tissue healing can be impaired because of damage to the small blood vessels in the skin, and bacteria can feed on the sugar content in that environment."
An elderly person with peripheral neuropathy is likely to have mobility problems. Lack of coordination and muscle weakness – two symptoms of peripheral neuropathy – can compromise balance and result in dangerous falls. Slippery floors, pool areas, and poorly-lit paths compound elderly mobility issues.
Footwear Concerns for the Elderly Diabetic Person
Socks and hosiery that are too small can result in in-grown toenails. Socks that are too big will crowd the toes and won't fit the heel properly. Choose "breathable" cotton material that won't trap heat. Caregivers and elderly diabetics need to understand that even slight infections can quickly spread to the bone. If not treated quickly, a severe infection can lead to amputation.
Shoes that have an open toe or exposed heel can't protect the entire foot against breaks in dry skin, cuts, or scrapes. Sandals don't provide enough protection; leather straps can cause pressure spots on the skin, causing a blister or an ulcer. Flip-flops offer no protection and an elderly person can easily trip going up and down steps. A shoe thong rubbing the skin between the first and second toes can quickly escalate to an open sore.
Summer Footwear for the Elderly Person Who is Diabetic
It's a good idea for an elderly person to "break in" new shoes before wearing them away from home or on vacation. Always test shoes with the socks or nylons that will be worn. Choose shoes that can "breathe" such as canvas walking shoes. Shoes should be supportive with a good heel and plenty of room for the toes. How can a caregiver choose shoes that are right for the diabetic elder?
- Check the elderly person's stride and walking gait.
- Avoid shoes that are too heavy.
- Look for (facial) signs of tension or discomfort.
- After the elder wears the shoes at home for a while, check for reddened areas on the skin. Pay particular attention to the heel and just under the ankles.
- Check for foot swelling and/or impressions left on the skin that may indicate the shoe is too small or is laced too tightly.
- Note any areas on the foot that feel too warm to the touch. Rubber and plastic shoes can trap heat and cause inflammation of the tissue.
Should a Person With Diabetes Go Barefoot?
Walking barefoot – even on the beach – is not a good idea. Shells can cause tiny nicks or cuts on the soles of feet and it's possible to step on broken glass or other debris. Wear walking shoes for best protection. Avoid hot decks, boardwalks (heat, nails, wood slivers), hot sand or walking barefoot on asphalt. It only takes a few moments for the skin to blister and break.
While on vacation, avoid walking barefoot in hotel rooms. Other footwear tips caregivers can keep in mind for diabetic elders:
- Seek medical attention immediately for a new blister or ulcer.
- Never cut a corn or callus on the foot.
- Wear shoes while exercising.
- Shield exposed ankles and insteps with sunscreen.
- Wear shower shoes in the shower and around the pool area.
- Avoid getting a pedicure – it's too risky.
- Use a good foot powder to absorb perspiration.
Summer foot care starts with choosing the right shoes and socks or hosiery for the occasion, and conducting a thorough foot examination every day. Of all the duties and responsibilities a caregiver has, maintaining proper foot care for the diabetic elder is very close to the top of the list. Remember that a person with peripheral neuropathy may not feel foot trauma. While at home or on vacation, be sure the elder with diabetes has comfortable footwear to wear at all times.
Mary King - Mary King is a Suite101 Topic Editor for the Caregiver Support and Home Management sections. She has authored 5 teen-based novels.
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