Diabetes Forecast

Caring for Your Feet When You Have Neuropathy

By Tracey Neithercott ,

Foot checks are critical for anyone with numb feet, but everyone with neuropathy should perform them daily. "When patients start to develop loss of feeling, the main thing we're concerned about is injury and self-injury," says Douglas Albreski, DPM, assistant professor of dermatology at the University of Connecticut School of Medicine and podiatrist at the University of Connecticut Foot Center. "The big thing is inspection. Finding these problems early can prevent amputation."

Taking steps to prevent cuts, scrapes, blisters, and ulcers lowers the risk for infection. For people who can't feel their feet, finding the right shoes is important. For starters, sneakers beat high heels and flip-flops as long as they're the right size. A pair that's too small can cause blisters or otherwise damage the foot. Bunions and hammertoes are real worries for people with advanced neuropathy.

When it comes to numb feet, diabetic shoes, which Medicare covers, are the best bet. They provide structure and a toe box that's almost twice the size of a normal shoe. While sock choice isn't critical—most reduce friction and cushion the foot—wearing the right ones could help you notice a problem sooner. White socks will help you spot red or yellow discolorations that, Albreski says, may indicate a cut or infection. Either way, inspecting the foot is especially important since catching an infection early can mean the difference between a painless recovery and amputation.

Regularly checking the feet isn't the only thing that will keep feet healthy. "The key is hydrating, getting something on there," says Albreski. Start with clean feet, but skip the foot soaks—they're dangerous for people who can't feel the temperature of the water and they can lead to infection if the soaking basin isn't clean. "The safest way is simply washing of the foot using a washcloth, cleaning between the toes," he says, followed directly after washing by applying moisturizer (but not between the toes). "If skin is soft and elastic, there's less chance of injury than when it's dry and cracked."

Of course, that doesn't mean you'll never get a cut or scrape. If you still have sensation in your feet and the wound is very small, you can treat it at home by cleansing it with warm, soapy water and then applying a topical antibiotic like Neosporin. Cover the wound with a bandage or gauze, which you should change daily, and be on the lookout for redness. That's a sign you need to see a doctor.

People who can't feel their feet need to be more cautious, calling the doctor's office at the first sign of a wound, even if it's minor. A doctor can determine whether the injury is deep or superficial and will take steps to prevent infection. Sometimes that means starting on a round of antibiotics or using an antibiotic ointment. Before you leave, your doctor will dress the wound to protect it from infection.

Home care includes washing the wound, applying ointment, and changing the dressing. "When there's no longer drainage on the bandage, the day after you can take the bandage off," says Albreski. Uncovered, the skin should develop a scab before fully healing.

If you have any concerns during the healing process—say, your wound starts oozing or you experience pain in your numb foot—call the doctor. "If a wound becomes painful in a patient with [diabetic neuropathy], that is worrisome," says Albreski. "That means the wound is deeper than we thought. That would constitute a medical emergency."

But if all goes according to plan—and you check your feet daily—a basic wound should heal within six weeks.



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