Best Foot Forward    

Because of nerve damage, patients with diabetes need to consider proper foot care

If your doctor diagnoses you with diabetes, he or she will likely refer you to specialists for multi-disciplinary care. One of those specialists will be a podiatrist, or foot doctor.

Naturally, you may wonder: What does management of blood glucose and insulin have to do with my feet?

“The biggest factor for a patient with diabetes from a foot morbidity standpoint is peripheral neuropathy,” explains podiatrist Samuel Hall, DPM. “Neuropathy is seen in around 8 percent of diabetics when they’re diagnosed. At 25 years from diagnosis, 50 percent have some level of neuropathy.”

If the severity of peripheral neuropathy increases, so does the risk for ulcerations and amputations of the foot, and even death.

What is peripheral neuropathy?

Diabetes is just one of several causes of peripheral neuropathy, which is nerve damage. Your peripheral nervous system is the nerves outside the brain and spinal cord.  Damage to these nerves often causes numbness or pain. If a patient with diabetes has chronically high blood sugar, this can damage the peripheral nerves in the feet.

“Most patients will first say, ‘I have this burning, tingling, maybe some numbness,’” Hall says. “Or they may experience aching or cramping that is usually worse at night.”

Numbness caused by neuropathy is particularly dangerous for patients with diabetes because their feet could become injured without them realizing it. Minor injuries could become infected. In addition, the lack of healthy blood flow could lead to ulcerations, which are open sores that can also get infected.

“Wounds are devastating if they get infected,” Hall says. “If the infection reaches bone, we have to either cut it out, or the patient has to take long-term antibiotics, which can negatively affect the kidneys.”

Treatment and prevention

If patients have diabetes but little to no level of neuropathy, they will only need to see a podiatrist about once a year. If complications arise, more regular visits and a treatment plan will be needed.

“Hopefully, patients only have some level of neuropathic compromise with no wounds, and our goal is to keep it that way,” Hall says. “If a new patient comes in with a wound, we’ll figure out what is causing it and go from there.”

Along with help preventing the infection, Dr. Hall will make sure the patient’s foot is off-loaded, meaning that pressure on the foot will be reduced with the use of special footgear or casts.

“Pressure is the enemy,” he says. Dr. Hall will also apply medication or dressings and remove dead skin. In some cases, surgery is needed to remove bony prominences or to correct other foot deformities such as hammertoes, where the toes curl under the feet and increase pressure points.

The most important thing a patient can do to help their feet is properly manage their diabetes by working with physicians to control their blood sugar levels. Dr. Hall also stresses to his patients not to wait to have him look at a wound.

“It doesn’t matter if it’s tiny, if you have a wound you need to have it looked at,” he says. “There’s a reason it formed, and without addressing that reason, it’s not going to heal. We can help take care of it before it gets worse.”

Foot Care’s Top Ten

Podiatrists have basic guidelines for foot care that they emphasize for every patient with diabetes:

1. Wash your feet every day, washing in between the toes well and then drying really well. Don’t soak your feet.

2. If you use cream or ointments, don’t put it between your toes.

3. Check your feet every day. Use a mirror on the floor or have someone help you.  Also, use white socks, which can be pulled inside-out and make it easier to see any signs of a wound.

4. Always check your shoes for foreign objects or a torn lining.

5. Never go barefoot, even in the house. Don’t wear thong-type sandals that rub between the toes. Always wear socks with shoes.

6. Check the water temperature before setting your feet in a bath or shower.

7. Don’t use heating pads for warmth. Use extra socks instead.

8. Don’t wear restrictive clothing.

9. Don’t smoke or excessively drink.

10. Let your primary care physician know immediately if you have any problems. Don’t wait.