Lower-Extremity Skin Care for People with Insensate Feet and Legs

It’s really important to take good care of your skin. Not doing so can result in a potentially life-threatening infection. If you have insensate feet and legs, meaning you lack feeling in your lower extremities, you really need shoes that fit you well. You should also have a caregiver do regular foot checks and provide skin care if you can’t do it yourself.

• Buy shoes at the end of the day when your feet are likely to be more swollen. That way your shoes won’t be too tight. Don’t buy shoes that need “breaking in.”
• If you wear orthotics, braces or special insoles, wear them while you try shoes on.
• Measure both feet each time you purchase shoes. If there is a size difference, buy shoes for the largest foot or buy shoes at stores where you can get a mismatched pair.
• Wear the shoes around the store for a while before buying them.
• Buy shoes with leather uppers. Leather breathes better and offers more protection.
• Try to buy your shoes from stores that have trained shoe fitters.
• If you have foot problems, such as hammertoes or bunions, you might need shoes with deep toe boxes. Insurance might cover the cost of custom shoes.

• Wear well-cushioned shoes.
• Make sure your toes are out straight and not curled under in shoes.
• Wear new shoes for two hours or less at a time.
• Don’t wear the same pair of shoes every day.
• Shoes with high heels or pointed toes can create pressure and ulcers.
• Always wear socks with your shoes.
• Look and feel for pebbles, protruding nails and rough spots.

Don’t wear open-toed shoes or sandals with straps. They don’t protect your feet and wearing them can lead to injuries.

• If your feet swell, report it to your orthotist or physician so an adjustment can be made to your wearing schedule.
• Your physician will determine if you are a candidate for surgical hose or dietary restrictions.
• If you notice a red or pressure area, consult your orthotist or physician.
• Report any cracks in the brace or strap problems to your orthotist.

If you’re not able to feel your feet and legs very well, you’re at risk of injuries to your feet. To prevent ulcers and infection and to keep feet healthy, it’s important to do the following:

• Check your feet every day. Inspect the tops, bottoms and in-between the toes.
• Use a mirror to look at the places that you can’t see on your own. If you can’t check your feet by yourself, ask someone else to do it.
• Look for redness, blisters, sores, cracks, peeling and swelling.
• Feel your feet to see if there are any hot areas.

• Wash your feet every day. Check the temperature of the bath water with your hand, elbow or a bath thermometer to make sure that it’s not too hot.
• Use only mild soap.
• Ask your doctor if you should soak your feet.
• Using a soft towel, dry off well — especially between the toes and on the bottom of feet.
• It’s OK to moisturize your feet twice a day, but avoid moisturizer between the toes.

• Cut toenails carefully or have someone assist you if needed. Trim straight across.
• Protect your feet by always wearing socks and shoes, even indoors.
• Do not use any chemicals or strong antiseptic solutions.
• Do not use tape or sticky products such as corn plasters.
• If you have corns or calluses, do not cut them or use liquid callus removers. A foot-care specialist might teach you to use a pumice stone or refer you to a doctor.

If you can’t do some of these things by yourself, ask someone to help you.

• Acrylic blended or wool socks help keep feet dry.
• Cotton socks breathe well, but they hold moisture.
• White socks let you see any blood or discharge from sores that you can’t feel.
• Avoid wearing socks or knee-high stockings that are tight around the calf or ankle. They can cut off circulation.
• Make sure that socks are not too big or too small. Purchase children’s socks for small adult feet.
• Avoid wearing mended socks. The mended area is rough and might cause blisters.
• Do not wear socks with holes. Pressure could shift to the rim around the hole and cause sores.
• Buy seamless, therapeutic or diabetic socks that are designed for people with poor circulation and sensation. You can order relatively low-cost therapeutic socks online (use the search words “seamless socks”).

Do:

• Use special cushions on wooden and metal chairs and benches.
• Use protection, such as a lap board with a lip, on your lap and thighs when placing hot cooking items on your lap.
• Wear loose fitting clothing on legs. Tight clothing can impair circulation.
• Be careful during transfers not to scrape or bang legs.
• Check temperature of car seats and buckles, especially if wearing shorts. Put a towel down on the surface if it is hot.
• Wear long pants, socks and shoes for crawling. Be sure to avoid concrete.
• Put your feet up as much as possible to prevent swelling.
• Take off your socks and shoes at all medical appointments for a foot examination.
• Call your doctor right away if you have even a minor foot injury.

In a wheelchair, do:

• Use footrests set at the proper height to maintain good body alignment and protect your feet from getting caught. Proper height of footrest helps distribute pressure away from the thighs.
• Make sure your seating fits appropriately.
• Five to ten weight shifts, such as leaning forward and back and side-to-side, every hour to redistribute your weight.
• Use wheelchair and chair cushions at all times to distribute pressure evenly.

Don’t:

• Put a hot hair dryer or curling iron on your lap.
• Place hot foods or liquids in your lap.
• Place dishes from the microwave on your lap.
• Wear tight elastic bands at waist and ankles.
• Get too close to radiators, hot water pipes and baseboards.
• Have bare feet on hot or cold surfaces, (i.e. wheelchair footrests).
• Smoke! It decreases circulation and increases the risk of ulcers and slows healing.
• Cross your legs or sit on your feet for long periods of time. It cuts off the circulation.

In hot weather:

• Drink at least a half cup (4 ounces) of water every hour.
• Wear sunscreen at all times, especially on skin that’s typically covered by braces.
• Avoid insect bites (wear repellent), poison ivy and poison sumac. Scratching can cause infections.
• Before sitting, use towels or cushions to cover hot surfaces, rough surfaces or surfaces that might pinch the skin.
• Wear swim shoes at pools and beaches. Because sand is abrasive, check legs and feet frequently when at the beach. Dry feet carefully after swimming.

In cold weather:

• Avoid exposure to the cold or contact with objects that have been exposed to the cold. Such exposure or contact could lead to frostbite.
• Wear socks, waterproof boots, long underwear, mittens and a hat.
• Remove wet clothing and socks as soon as you come inside.
• Check feet — including the soles, heels and skin between toes — as soon as you come inside. Swelling, red marks, and white or gray areas can indicate frostbite. Call your doctor immediately if you notice signs of frostbite.

Adapted with permission from Skin Care for Spina Bifida by Roz Gleeson, MSN, RN, APN at the Alfred I. DuPont Institute.