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Decreased sensation, or less feeling, in the lower body is common among people who have various disabilities, including spina bifida and spinal cord injuries. Decreased sensation can lead to serious injuries and infections which is why it is important to take care of the skin on the lower body. You can help to avoid serious problems by choosing appropriate footwear, caring properly for your skin, and protecting yourself from injuries.  


How to Choose Shoes and Socks When You Have Low Sensation

The best way to protect your feet is to wear high-quality, sturdy shoes and socks that fit well. Select your footwear carefully. Always wear socks and shoes, even indoors.

Be sure to shop at stores where you can have your feet measured by employees who are trained to measure feet and fit shoes. To ensure a good fit, shop at the end of the day when your feet could be more swollen. Ask the store employee to measure both feet each time you shop for shoes. If your feet are different sizes, try on the larger size or ask if you can buy a mismatched pair. If you wear braces or special insoles, always wear them while shopping. Wear the shoes around the store for a while before buying them. 

When selecting shoes, consider the fit, material, and shape of the shoes:
Fit: Shoes should always fit properly and offer cushioned support. Never buy shoes that need “breaking in.” Look for shoes with deep toe boxes. Health insurance might cover the cost of custom shoes. 
Material: Leather shoes breathe better and offer more protection than shoes made of vinyl or plastic. Vinyl and plastic shoes do not stretch and can trap moisture and odor. 
Type and Shape: Shoes with high heels or pointed toes put too much pressure on your feet and can cause foot sores. Open-toed shoes or sandals with straps do not protect your feet from injuries. 

Always check your shoes before putting them on. Look and feel for pebbles, protruding nails, and rough spots. When putting your shoes on, always make sure that your toes are straight, not curled under. Wear new shoes for two or fewer hours at a time. Do not wear the same pair of shoes every day.  

Good-quality socks help keep your feet dry while offering protection. Always wear socks with your shoes. When selecting socks, consider the fit, material quality, and color: 
Fit: Socks or knee-high stockings that are tight around the calf or ankle can cut off circulation, so avoid wearing them. Make sure that your socks are neither too big nor too small. If you are an adult with small feet, wear children’s socks.  
Material: Choose acrylic-blend or woolen socks to help keep your feet dry.  
Quality: Avoid wearing mended socks or socks with holes. They can cause blisters or pressure sores. 
Color: White socks let you see any discharge from sores that you cannot feel. 

If possible, buy seamless, cotton, therapeutic, or diabetic socks. These types of socks are designed for people with poor circulation and sensation. You can order low-cost therapeutic socks online (use the search words “seamless socks” or “diabetic socks”). 


Wearing Orthoses When You Have Low Sensation

Follow these tips to prevent pressure sores and related problems. 

  • Tell your orthotist or physician if your feet swell while wearing our orthoses. You might need to adjust your wearing schedule. 
  • Ask your physician if surgical socks or a restricted diet would decrease swelling. 
  • If your skin reddens or cracks near your orthosis, call your orthotist or physician.  
  • If your orthosis cracks or if you have problems with the orthosis straps, call your orthotist. 
  • Before putting on your orthosis, check for any sand or loose particles.

Checking Your Lower Body for Wounds When You Have Low Sensation

When you experience reduced sensation in your lower body, it is important to check your skin regularly and practice good hygiene. Check your feet, legs, and buttocks daily to notice problems early. If you cannot check your skin by yourself, ask someone to help you. Every day, you should: 

  • Inspect your thighs, buttocks, the tops and bottoms of your feet, and the area between your toes (use a mirror to look at the places you cannot see on your own). 
  • Look for redness, blisters, sores, cracks, peeling, and swelling. 
  • Feel your skin for hot areas. 
  • Watch for swelling in your feet and ankles. 
  • Report any problems to your doctor immediately. 

Instructions for Foot Care When You Have Insensate Feet

People who lack lower-body sensation require gentle foot care. Taking care of your legs and feet involves keeping them clean and dry. To keep your feet healthy: 

  • Wash daily. Wash your feet every day using a mild soap free of chemicals or strong antiseptic solutions. Always check the temperature of the water with your hand or elbow to make sure it is not too hot. Ask your doctor whether you should soak your feet. 
  • Dry thoroughly. Use a soft towel to dry your feet, paying special attention to the bottoms of your feet and the areas between your toes.
  • Moisturize. You can moisturize the top and bottom of your feet once or twice a day to prevent dryness and cracking, but avoid getting moisturizer between your toes.  
  • Cut toenails carefully. Wash or soak your feet to soften your nails. Trim the nails straight across, then smooth them with an emery board or file. Do not cut the corners of your nails to prevent ingrown nails. To prevent accidental nicks in your skin from the clipper, ask someone else to trim your nails if you cannot see well or have nails that are thick, yellowed, or growing into your skin. You may visit a trained foot care provider or pedicurist for routine nail care. If you have foot deformities or other serious issues, talk to your physician about seeing a podiatrist or orthopedist. 
  • Treat calluses and corns properly. Do not cut them, use liquid callus removers, or apply tape or sticky products to your feet; such products can damage your skin. A foot-care specialist can teach you how to use a pumice stone to smooth the calluses or can refer you to a nurse or doctor to trim them.
  • Report any issues to your care team. If you notice any problems such as corns, severe calluses, swelling, or ulcers, seek prompt medical attention.

Diminished sensation can increase the likelihood of experiencing injuries and infections. Always take precautions to protect your lower body. For example, use a thermometer to ensure the bath or shower water is not hotter than one hundred degrees. You can purchase a tub thermometer at stores that carry baby supplies. 

Proper seating distributes pressure evenly and safely. When using your wheelchair, always: 

  • Make sure your seating fits appropriately (a seating specialist can adjust your seating). 
  • Use properly adjusted footrests and cushions. 
  • Shift your weight five to ten times every hour to redistribute pressure. 
  • Transfer in and out of your wheelchair carefully to avoid scraping or banging your legs. 

You can prevent injuries to your lower body with basic precautions. Protect your lower body by: 

  • Check surfaces. Always check surfaces for hot, cold, and rough spots before sitting on them. Use special cushions on wooden and metal chairs and benches. 
  • Monitor for heat and cold. Never place anything too hot or too cold on or near your lap, legs, or feet. Check car seats, buckles, footrests, and other objects for heat and cold. Use protection, such as a lap board with a lip, when cooking or eating hot foods. Be careful with hair dryers and curling irons, keeping them away from your lap. 
  • Support your circulation. Never wear tight clothing or clothing with tight elastic bands at the waist, at the ankles or below the knees. Do not cross your legs or sit on your feet for prolonged periods of time. Put your feet up as much as possible to prevent swelling. Do not smoke! 
  • Wear protective shoes and clothing. Always wear shoes and socks that fit well. People who crawl should wear long pants, socks, and shoes. They also should avoid concrete and consider using foam knee pads. 
  • Receive regular medical care. Ask for a foot examination at all your medical appointments. Call your doctor immediately if you have even a minor foot injury. 

Hot weather poses specific dangers for your lower body. Make sure you:

  • Drink at least half a cup of water every hour. 
  • Wear a hat to prevent overheating. 
  • Always wear sunscreen, especially on skin that is usually covered by braces. Do not forget the tops of your feet! 
  • 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. Sand is abrasive, so frequently check your legs and feet at the beach. Dry your feet carefully after swimming. 

Cold weather poses specific dangers for your lower body. Make sure you:

  • Wear socks, waterproof boots, long underwear, mittens, and a hat in cold, snowy weather.  
  • Check surface temperatures before sitting. Do not sit on cold concrete steps or curbs or lean on cold pipes. 
  • Remove wet clothing and socks as soon as you come inside. 
  • Check your feet, including the soles, heels, and skin between your 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. 

On rare occasions, children, adults, and pets have chewed on parts of the body that have decreased sensation. To avoid such injuries, which might lead to amputation, always protect your feet with shoe slippers. Keep pets out of your bedroom.  


For Parents

Children cannot care for body parts they do not regularly think about. That is why it is important to teach children that taking care of their legs and feet should become a habit, like brushing their teeth. The following activities can help.  

Babies are becoming aware of their senses and the environment around them. As they start to explore their independence and do things for themselves, you can encourage lower-body awareness by: 

  • Playing games and singing songs that draw attention to your baby’s feet and toes. 
  • Teaching your child how to wash feet and toes in the bathtub. 
  • Allowing your child to try putting on socks and shoes. 

Children at this age learn by modeling adult behavior. Teach your child about lower-body skin care by: 

  • Maintaining a sticker chart for activities such as washing feet, applying lotion, or putting on socks and shoes. 
  • Reinforcing proper foot-care techniques during role-playing activities, such as caring for a doll or stuffed animal’s feet. 
  • Placing a sticker on the child’s foot and having the child find it; vary the location so your child learns to examine all areas of the foot.

Children at this age start to understand more formal explanations and rules. Books about the human body can be helpful. Teach your child self-care routines by: 

  • Allowing your child to talk with providers about lower body care. 
  • Speaking with a health teacher about the importance of foot care; encourage a lesson on the topic at school. 
  • Finding pictures of animal foot prints; ask your child to guess which prints belong to which species.  

Teens desire independence. They should start becoming independent by participating in health-care decisions and appointments. You can help foster independence by: 

  • Encouraging your child to continue using a reminder chart. 
  • Discussing scientific facts about the importance of lower-body skin care and the consequences of inadequate care 
  • Respecting your child’s privacy and confidentiality by allowing your child to decide how much to tell a friend about health-care issues.  

This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.