© SKI Publishing
Diabetes, and Your Feet
By Christine Dobrowolski,
There are so many changes the body undergoes during pregnancy that it
becomes easy to ignore the changes in the feet. During pregnancy the
body releases hormones that allow the ligaments to relax in the birth
canal. The ligaments in the feet also relax, causing the foot to lengthen
and widen. Many will complain of a shoe size increase by one or two sizes.
In most circumstances, this flattening and widening of the foot is benign
and no problems result. In the diabetic, this change in foot size is
important to recognize. Despite the increase in foot size, many moms
will continue to wear the same size shoes. As a diabetic, properly fitting
shoes are of utmost importance. Increased pressure on the foot can cause
areas of rub or irritation and potentially result in ulceration. Once
there is an ulceration, one is at risk for infection, delayed healing
and further diabetic foot complications.
Diabetic neuropathy is the single
greatest risk factor for developing foot ulcerations. Neuropathy is
the loss of sensation in the feet commonly
caused by diabetes. Many individuals will develop neuropathy before
they are diagnosed with diabetes. Others will develop neuropathy years
being diagnosed with diabetes. Luckily, gestational diabetes is not
typically associated with neuropathy. Unfortunately, type I diabetics
much earlier than type II diabetics and may have neuropathy during
their pregnancy. Regardless of the type of diabetes, it is still extremely
important to have the feet evaluated to assess the status of the nerves.
Even mild neuropathy increases the risk of ulceration. Wearing shoes
which are too small causes an increase in friction and an increased
of skin breakdown.
Wearing properly fitting shoes during and after
pregnancy is of particular importance. Although the ligaments relax
in the foot during pregnancy,
they do not stay relaxed. The post-pregnancy foot is at higher risk
for developing foot problems. There are multiple reasons contributing
the increased risk. The flattened foot places excess stress on the
ligament that holds up the arch. The weight gain from pregnancy places
stress on the feet. Moms are also carrying their baby, added weight
which transmits to the feet. Moms are staying at home more often
around in slippers and flexible shoes which are generally not supportive.
To decrease your chances of foot problems during and after pregnancy
follow these steps:
your feet everyday. This is an absolute necessity
if you are a type I diabetic or if you have diagnosed neuropathy.
It is a
good habit to practice. Look for cuts, sores, bruises, openings or
Remember, if your nerves are not functioning properly, then you
may not feel everything in your feet. If you cannot reach your feet,
have a family
member check your feet or place a mirror on the floor and put
your feet over it.
- Check your shoes before you put your foot in them.
walk around barefoot. Wear a supportive shoe, one that has a rigid sole and
bends only where the foot bends (at the toes). If a shoe
seems too confined, find a slipper which has a semi-rigid sole,
or try a clog or slip-in shoe with a more rigid sole. The remaining
the shoe can be soft and flexible and allow for swelling, but the
sole should be rigid from the heel to the ball of the foot.
- Buy shoes
that fit your feet. Be aware of the changes your feet are going through.
The feet are most likely widening and lengthening. Make
sure the shoes don't cramp the toes. Your feet will not shrink
after the birth.
out for folds in your socks. A simple fold can cause
rub or irritation on your feet. Swelling will be greater by the
end of the day
and the small crease that didn't bother you in the morning can
rub an open sore or blister on the toes. Serious consequences in diabetics
include ulceration and infection.
- Dry your
feet and between toes after showers. Increased moisture between your toes can lead to skin
breakdown and eventual ulceration.
be a victim of fashion. Most moms will avoid high fashion during pregnancy,
but many try squeezing into that strappy heel after. Wearing
high heeled shoes puts excess stress on the ball of the foot, cramps
the toes and increases the chances of ankle sprains. Tight shoes
will increase the chance of ulceration for those with neuropathy.
- Test the
bath water before stepping in. If you have neuropathy, you will
not recognize when the temperature is too hot. Check the water by
inserting your hand into the water to wrist depth.
use a heating pad on your feet. Although the idea of heat on your feet may sound
soothing after a long day, the heat will increase
swelling and inflammation. Sore feet respond better to ice. Roll
your foot over a frozen sports water bottle to help ease the achiness
the arch. Wear a sock while doing this and don't put ice directly
feet. The heating pad can cause burns in those who have neuropathy.
use any medication on the skin. Be careful of topical medications
during pregnancy and during breast-feeding. Consult your doctor before
use. Don't use medicated corn pads from the local drug stores if
- Visit your podiatrist. At the first sign of a problem,
make an appointment with your podiatrist. Prevention is much easier
is a podiatrist, runner, and author of "Those Aching Feet:
Your Guide To Diagnosis and Treatment of Common Foot Problems," available
via her publisher, SKI Publishing, and at Barnes & Noble and Amazon.com.
by Dr. Christine Dobrowolski, DPM