Diabetics at Higher Risk for Foot Problems, Healthy Cells Magazine November 2015

This year marks the 75th Anniversary of the American Diabetes Association (ADA). Each November, tens of thousands of Americans join the ADA’s crusade to heighten the nation’s awareness on diabetes, and to inspire millions of people who are impacted by the disease to live healthy and active lifestyles.

This year’s theme focuses on healthy eating. Recipes and cooking techniques from noted chefs and cookbook authors will be featured throughout the month on the ADA website. Although eating well and being active are essential ingredients for managing diabetes, it is also important to recognize that diabetics are at a higher risk for developing foot problems than non-diabetics. Here is a basic overview of the foot problems that are related to diabetes, and simple preventive measures.

Peripheral Neuropathy
Peripheral neuropathy is a predisposing factor for diabetic foot complications and development of foot ulcers. A progressive and irreversible disease, it damages nerves and lessens the ability to sense heat, cold, and pain. A loss of feeling leads to injuries, like blisters and infection. It also affects moisture in your skin, causing dryness and cracking. Unhealed sores can turn into gangrene, and lead to amputation. Nerve damage can lead to changes in the shape of your toes and feet.

Peripheral Vascular Disease
Diabetes damages the blood vessels, and leads to poor blood flow to the lower extremities. As the blood vessels narrow and harden, it makes it more difficult to fight infection and heal. Poor circulation decreases sensation, making it difficult to gage temperatures. Walking can cause intermittent claudication (pain in calve muscle). The combination of peripheral neuropathy and vascular disease cause major problems. Unhealed sores can turn into gangrene and amputation.

Foot Ulcers
Ulcers usually appear on the bottom of the feet. Treatment depends on the nature of the ulcer. X-rays can determine if bone is infected. The site can be cleaned by removing dead tissue, and antibiotics may be administered. Treatment by a vascular surgeon may be necessary if an ulcer is due to poor circulation. Special wound treatment may be required if a wound fails to heal. Special therapeutic shoes are usually prescribed to prevent ulcers.

Skin Changes
The nerves that control moisture and oil production in the foot are flawed. Consequently, skin becomes dry, and prone to crack and peel.

Diabetics are prone to calluses because there are high-pressure areas under the foot. Often, they turn into open sores, if they are not properly treated in a timely fashion. Improper removal of calluses and corns with chemical agents or unsterile tools can lead to serious consequences. Skin moisturizers need to be carefully applied to avoid infection.

Toenail Fungus
Toenail fungus can lead to further infection and complications for diabetics if left unchecked. It can also lead to complications if it is in conjunction with an ingrown toenail. There is a wide range of conventional treatments and medications available, with varying success rates. New laser treatments are available, and have higher success rates (70-80 percent) of eradicating the fungus with no side effects from medications.

Foot Deformities
Foot deformities, such as hammertoes, claw toes, and bunions, can increase the risk of calluses, corns, blisters, ulcers, and infections. Increased friction from shoes can cause problems. Therapeutic shoes are prescribed to accommodate changes in foot shape. In some cases, operative treatment is necessary.

Diabetics have a much higher chance of having their foot or leg amputated than non-diabetics, because peripheral arterial disease (PAD) restricts blood flow. It is estimated that 73,000 lower-limb amputations were performed in 2010.

Most of us pay little attention to our feet compared to other parts of our body. This is a problem, especially if you have diabetes. Regular inspection of your feet is essential on a daily basis. It won’t cost you a nickel, and it is one of the best ways to prevent foot complications. There are many other things you can do to care for your feet. Here are some tips:

  • Wash your feet daily
  • Keep circulation flowing in your feet when inactive
  • Be active, and exercise regularly
  • Always protect your feet by wearing socks and shoes
  • Protect your feet from extreme temperatures
  • Moisturize your skin regularly
  • Trim your nails carefully
  • Wear comfortable shoes that fit properly

The National Diabetes Education Program (NDEP) recommends that diabetics receive foot checks at least twice a year. Frequent visits may be required for the treatment of open wounds or conditions that are more chronic.

Ask your podiatrist about Medicare’s Therapeutic Shoe Program for diabetics. This is a fantastic program, and one of Medicare’s successes. The program provides one pair of diabetic shoes, and three pair of special sole inserts every year for free. The shoes and inserts will help prevent a callus and ulcer from developing. Eligibility requirements require a medical confirmation that you have a foot ulcer, nerve function problem, reduced blood flow, previous amputation, or foot deformity, such as a hammertoe, claw toe, or bunion. Prescription shoes are a safe and effective way to minimize your risk of chronic problems.

Podiatric technology continues to advance every day. Many of the recent innovations in wound care and operative care are bringing new hope to diabetics.