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This guideline covers preventing and managing foot problems in children, young people and adults with diabetes. The guideline aims to reduce variation in practice.
In January 2016, recommendation 1.3.6 was updated to clarify the risk factors for and stratification of risk of developing a diabetic foot problem.
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Recommendations
The guideline includes recommendations on:
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investigating and managing diabetic foot ulcer, diabetic foot infection and Charcot arthropathy
Who is it for?
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Healthcare professionals that care for people with diabetes
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Commissioners and providers of diabetes foot care services
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People with diabetes, and their families and carers
Guideline development process
How we develop NICE guidelines
This guideline updates and replaces NICE guidelines CG10 and CG119, and the recommendations on foot care in NICE guideline CG15.
Diabetics Foot Care - Preventative Measures
One out of six adults have foot problems.
Some of the more common problems, like corns, calluses and bunions are almost entirely man-made, in that they are often caused by wearing shoes that are too narrow or too small.
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Women, more often than men, crush their toes into shoes that are too small or too pointy. If the shoes have high heels, they will push the toes into the pointy front end of the toe and compound the pressure. There is a price to pay for putting fashion before function. Corns are very common, especially among women because the pointy shoes just don't fit the shape of a human foot.
With each step, the pressure on your foot is equivalent to 1.5 times your body weight. It's no wonder, then, shoes that are too small will force the toes together or against the shoes too tightly. The constant pressure and friction will likely cause the skin on the toes to thicken and irritate the tissues underneath, and corns or calluses will often form, particularly on the big toe on or the pinky toe.
The best way to prevent calluses is to wear shoes that fit your foot properly. There are other causes for calluses however, such as foot deformities like hammer toe or claw toe. You may be able to relieve some of the pain by relieving the pressure with well positioned corn pads, or with regular foot soaks.
But remember, a corn is a buildup of skin with a hard center, so at-home soaks and scrubs will only exfoliate, they will not remove corns. To completely and permanently remove a corn, you must first correct the problem that started it.
And as soon as you see a corn developing, remove the thick skin by gently rubbing the callus with a pumice stone. To help avoid drying and cracking, use a moisturizer on your feet often. A dermatologist or podiatrist can also remove a corn by shaving the dead layers of thickened skin off with a scalpel. But often woman go back to wearing the same shoes that caused the problem in the first place.
You may think that the answer is to go barefoot or to wear open-toed flats or flip flops. But neither is necessarily any better for your feet. Since flats and flip-flops do not provide any support they can cause a variety of foot problems such as blisters, bunions, crowding toes, hammertoes, heel pain, plantar fasciitis, sprained ankles or tendonitis.
Try to limit your time wearing flip-flops or flats to a few hours. If you must wear them for longer periods of time, then spend a few moments stretching your Achilles tendon (the tendon at the back of your ankle) every couple of hours.
Going barefoot is bad for your feet for a variety of reasons. In addition to having absolutely no support, your feet also have no protection from bruises, cuts, punctures or scrapes. If you insist on going barefoot, limit it to inside your home.
Bare feet, or even sandaled feet are also not protected from sunburn, and many people fail to remember to apply sunscreen to their feet. "Skin cancer on the legs and feet actually has a high mortality rate due to people forgetting to do skin checks on that area. It's often caught too late," Vlahovic said. "This is due in large part to the fact that many people simply forget to apply or reapply sunscreen to the lower extremities."
Protect your feet with an SPF of at least 15 and with both UVB and UVA protection every 2-3 hours. Apply more often if you will be swimming or sweating.
Calluses, corns and other foot problems can be uncomfortable at best, but they are often extremely painful. However, they can usually be treated -- and often prevented -- with simple changes in footwear and foot care habits. If you develop any problems that do not go away with simple treatment or if you are in extreme pain, please seek the help of your health care professional.

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Keep your nails short, dry, and clean. Stick to one nail clipper for the infected nails and another for the normal ones.
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Don’t just treat your nails; use an antifungal cream to treat the skin that has athlete’s foot as well.
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Keep your feet dry, wear cotton socks, changed daily, and use ‘breathable’ shoes. Normal laundry in hot water clears most of the affected socks, but it can be made more effective if an antifungal spray can be used before laundry. Other clothes would not be infected by laundry with or without antifungal spray.
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Do not share your personal towels and socks with other people to reduce transfer of infection. In swimming pools special slippers should be worn for the same reason.
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Your activities need not be limited during treatment but, to avoid a recurrence, don’t walk barefoot around public pools, showers, and locker rooms. Check your feet regularly if you have previously had a fungal nail infection, especially if you are at increased risk such as those with diabetes.
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Avoid cutting the cuticle, either yourself or by a manicurist, since this increases the risk of nail damage and infection.