Why Diabetics should NEVER soak their feet!

Sometimes the simplest things in life create tremendous pleasure.   Time spent with loved ones, a day at the beach or a hike along a beautiful mountain trail.  A slice of pizza, a warm bath or at the least, a relaxing foot bath.  

The benefits of therapeutic foot bath can be as much physiological as psychological, and well being is the key.   That being stated, there are potential dangers where soaking of the feet is concerned among the diabetic population.

I still remember one of my instructors who taught infectious disease and authored The Handbook of Lower Extremity Infections, asking a question of my class.  “When should you soak a diabetic foot?”  A few answers ensued from my classmates.  After a pause of a few seconds, the answer was clear.  “NEVER!  You should never soak a diabetic foot!!”

One of the more memorable moments during that part of my education as that lesson remains with me to this day.  I have attempted to forward this message countless times to patients over the years in my own clinical practice.   Patients often will ask, “Is it OK for me to soak my feet?”  If they are diabetic, I always respond with the same response of Dr. Warren Joseph, my colleague and friend.  “NO, you should NEVER soak a diabetic foot!!”

Here are a few reasons why.

Many people, not just diabetics, suffer from peripheral neuropathy, or nerve damage to the nerves that supply the skin, that may cause loss of feeling and protective sensation in the feet and hands.  Soaking feet in a tub filled with hot water could cause burning and damage to the skin that someone with decreased feeling may not notice.  Think in terms of the hot pot on a stove.  The normal response when touching a hot object is to pull away.  This is a reflex and your body’s way of protecting itself from danger, in this case, a serious burn.   People who have peripheral neuropathy often lose this protective mechanism and cannot sense painful stimuli and subsequent danger.

Diabetic skin has decreased moisture content than non-diabetic skin.  Much of this is due to autonomic neuropathy, which damages the innervation of the skin and the normal hydration and perspiration that is vital to maintain healthy skin turgor and texture.  Turgor, by the way, refers to rigidity of cells and tissue that results from absorption of fluid.

When skin dries excessively, it can result in cracking and scaling, which at the microscopic level, can allow bacteria, fungus or other organisms to enter the body. 

What does this have to do with soaking?  Simply stated, soaking in a tub or a foot bath will cause a resulting drying of the skin.  Without getting too technical, putting the feet in a wet environment will cause a rebound drying afterwards.  This is one reason why moisturizing of diabetic skin, especially on the feet, should become part of a daily routine.  Just like brushing teeth twice daily, diabetic skin should be rehydrated through moisturizing in the morning and before bed. 

The act of moisturizing the skin also allows for time to inspect the skin for any cuts or minor trauma, such as blisters, red spots, insect bites, or splinters, or other damage that may cause greater problems if neglected. 

“Which moisturizer should I use?” is another common question.  Preferably, one without alcohol.  Alcohol is often found in skin creams and moisturizers.  Alcohol will, like soaking, cause additional drying of the skin.  A moisturizer without alcohol is the key, and they are available under various brands.  Regardless, remember, never soak a diabetic foot and moisturize diabetic skin twice daily!

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