Diabetic Foot Care: What You Need To Know
by: Christine Dobrowolski, DPM
It is estimated that over 18 million Americans have diabetes. Over 200,000 people under the age of 20 have diabetes. Children and young adults in this age group are more typically are affected by type 1 diabetes. This type of diabetes results from the inability to produce insulin. Insulin is a hormone that the body needs to utilize sugar for energy. Unfortunately, there is an increasing trend of children in this age group developing type 2 diabetes.
About 10 million people between the age of 20 to 60 are affected by diabetes. Most individuals in this age group have type 2 diabetes. In type 2 diabetes the body produces insulin, but it does not produce enough of this hormone or the cells don't respond appropriately to it. The result is an elevated blood sugar. The blood sugar is high because the sugar is not being taken into the cells and utilized for energy properly. Over 8 million people 60 years of age or older have type 2 diabetes.
Although all races are affected by diabetes, over 11% of non-Hispanic blacks over age 20 years have diabetes. American Indians and Alaska Natives have 2.2 times the risk of developing diabetes than non-Hispanic whites of similar age and Pacific Islanders are thought to be at increased risk for developing diabetes.
Serious complications associated with diabetes include stroke, heart disease, blindness, kidney disease, high blood pressure, nervous system diseases and amputations. In 2002 there were 82,000 lower extremity amputation in diabetes. Six individuals out of every 1,000 people with diabetes will have a lower extremity amputation. A slow healing or non healing open sore (known as an ulceration) on the foot is the most common reason diabetics will end up with a foot or leg amputation. Over 2 million diabetics have ulcerations and one in four diabetics with an ulcer will have an amputation. Unfortunately, over 25% of diabetics have not heard of an ulcer.
Treating diabetic ulcers is difficult. Preventing diabetic ulcers is not. Preventing diabetic ulcerations is the key in decreasing the risk of amputation. Other important steps to help in avoiding amputation are decreasing the chance of infection and the development of gangrene. Infections can develop at the site of an ulcer, at an ingrown toenail, from a corn between the toes or from a blister or a callous. Gangrene is the result of poor circulation. Any of the above possible causes of infection can result in gangrene if the circulation is poor. Very few individuals will develop gangrene spontaneously. Most individuals have some sort of trauma or injury that predisposes them to development of an open sore (or ulcer), a blister or an ingrown nail. The trauma may be something as simple as the shoe rubbing on the side of the foot. In individuals with poor circulation, it becomes difficult to heal even the most minor sore on the foot. When the body does not send enough blood to the feet to heal the sore, gangrene will set in. It is important to see a podiatrist for diabetic checkups every two months to help keep ingrown nails, corns and callouses from becoming a problem. Your primary care physician will refer you to see a vascular surgeon if he or she feels it is necessary.
Take these steps to help prevent diabetic foot complications:
1. Check your feet everyday! This is an absolute necessity. If you canÃ¢â‚¬â„¢t reach your feet, have a friend or family member check your feet. If needed, put a mirror on the floor and put your foot over it to look for cuts, scraps, bruises, openings or areas of irritation. Make sure you check between your toes. Very moist areas, white areas or red areas are bad. Check for foot fungus, patchy, scaly white areas between your toes or on the bottom of the feet. Check for irritated areas with redness or swelling. Check for infection. Redness, pus and drainage are signs of infection. Look for ingrown nails.
2. Check your shoes before you put your feet in them. Small pebbles or rocks can hide in the shoe. Put your hand in first and check it before you place your foot into the shoe. Items that I have found in patientÃ¢â‚¬â„¢s shoes include socks, stockings, staples, rocks, legos and even a pencil. The most common response when I pull these items out of their shoe is Ã¢â‚¬Å“How did that get in there?Ã¢â‚¬Â
3. DonÃ¢â‚¬â„¢t walk around barefoot or in sandals. Splinters and needles can be hidden in the carpet and can puncture a foot without sensation. Punctures can go unnoticed. Unprotected feet can be more damaged when bumped or hit against furniture.
4. Watch out for folds in your socks. Believe it or not, small folds in the socks can lead to ulcers and infections. Rough seams in the socks can also cause areas of irritation that may lead to skin breakdown and ulceration.
5. Dry off your feet after showers and dry between your toes. Increased moisture between your toes can lead to the skin breaking down. This will eventually lead to an ulcer between the toes. Ulcers between the toes are very difficult to cure.
6. DonÃ¢â‚¬â„¢t be a victim of fashion. High fashion shoes usually lead to a high number of problems in the feet. Make sure the shoes are wide enough. DonÃ¢â‚¬â„¢t buy shoes that are too wide or too long which can cause a lot of slipping. Pick shoes that are soft and flexible and allow for cushioning on the top and sides, but are rigid on the sole. Make sure they donÃ¢â‚¬â„¢t fold in half. You may be eligible for your insurance to pay for diabetic extra-depth shoes with custom insoles. These shoes will take the pressure off your feet. Ask your doctor.
7. Check your bath water with your hand before you put your foot in it. The temperature your foot feels is much different from the temperature your hand feels when you have neuropathy. Make sure to check the temperature with your wrist. This will be much more accurate than testing the water with your foot.
8. DonÃ¢â‚¬â„¢t use a heating pad on your feet. This may cause burns without you realizing it.
9. Do not use medicated corn pads or any medicated pads from the local drug store. These medicated pads are usually not effective and may cause a chemical burn on the surrounding skin. DonÃ¢â‚¬â„¢t use any medication on the skin unless you are instructed to do so by your physician.
10. Do not cut your own toenails. If you have loss of sensation or poor blood supply, make sure you have a podiatrist trim your toenails.
11. Do not trim your own callous or corns. As mentioned above, if you have a loss of sensation or blood supply then have your podiatrist trim your corns or callouses.
12. Lose Weight. Easier said than done, but this is one of the most important steps you can take for your overall diabetes health and foot health. Your feet are not designed to carry that extra 100 pounds, that extra 50 pounds or even that extra 20 pounds. The more pressure on your feet, the more problems you will develop.
13. Exercise. Not only will exercise help you lose weight, contribute to your health, it will also help increase the circulation in your legs and feet.
14. STOP SMOKING! This applies to everyone, but especially to diabetics. Smoking causes the blood vessels to shrink. Smoking contributes to clogging of the arteries. Smoking also makes it more difficult for the nutrients in the blood to get to the areas they are needed. Diabetes + Smoking = Disaster.
15. Visit a podiatrist regularly.
Christine Dobrowolski is a podiatrist and the author of Those Aching Feet: Your Guide to Diagnosis and Treatment of Common Foot Problems. To learn more about Dr. Dobrowolski and her book visit SkiPublishing.com. For more information on foot productsNorthcoast Footcare.
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