Monday, December 28, 2009

Coffee Drinkers Have a Reduced Risk of Type 2 Diabetes!

Coffe Drinkers Rejoice!

December 23, 2009 — High intakes of coffee, decaffeinated coffee, and tea are associated with a reduced risk for type 2 diabetes, according to the results of a meta-analysis reported in the December 14/28 issue of the Archives of Internal Medicine.
"Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus," write Rachel Huxley, DPhil, of the George Institute for International Health, University of Sydney in Sydney, Australia, and colleagues. "Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes."

For full article click here.

Monday, December 7, 2009

Foot Padding, Foot Inserts and Foot Appliances Oh My!

Did you know the use of pads, inserts and other foot appliances are a great way to treat many foot problems? With a bit of research and help from your local Certified Pedorthist (C.Ped.), you just might find the right device to aid in resolving your foot issue.

Minor foot problems such as corns, calluses, blisters or other rubbing problems of the foot can easily be treated by an array of products available to you. The trick is to know what product to use and when to use it.

First ensure you know exactly what the issue is with your foot. For minor issues, meet with your local C. Ped. and bring a sampling of your existing shoes. Be prepared to discuss exactly what is happening, the area affected and when or how often the issue is occurring. Your C.Ped. can determine if your existing shoes are appropiate for your foot type and not a contributor to the issue along with recommending over the counter treatment options. If however, the issue is beyond a minor foot problem, you may be recommended to consult your local Podiatrist for further evaluation.

With minor foot issues, there are pads for relief of pressure sores from bunions or hammertoes, or for relief of a heel rubbing against the inside of the heel counter of your shoes. The item may be made of felt with an adhesive backing, but are also available in newer materials such as silicone or a soft, gel type material called viscoelastic polymer.

Some of the over the counter options available are:

Precut simple foam pads can help relieve certain forms of heel pain.
A rubber waffle pattern heel cup can help absorb the shock of heel strike.
Toe spaces, used to reduce symptoms caused by one toe touching another, such as soft corns: or to help maintain a corrected bunion.
Cushions can be used to relieve symptoms of a hammer toe or corns.
Toe caps are used to protect the toes from trauma or aid in the reduction of rubbing or blistering.
Forefoot pads to aid in the reduction of forefoot pain.
Orthotics or inserts to correct biomechanical issues – note, you should always see a professional to ensure you receive the appropiate amount of correction based on your foot type.

As you can see, there are many items to assist you in resolving your foot issue. At Healthy Steps, we provide many options for you to choose. Stop in and meet with our staff to help you step in the right direction this holiday season!

We would also like to thank you for your support and look forward to serving you in the upcoming new year. From the staff at Healthy Steps, we wish you and your family a safe and happy holiday season!

Healthy Steps…..for your feet…for your life!

Sunday, December 6, 2009

So what exactly is a Diabetic ulcer and why is it so bad?

Those with diabetes and their friends and family members have at one point and time heard the term “diabetic ulcer”. And it is usually followed by “that’s why their foot was amputated”. So what is a diabetic ulcer?

An ulcer is any break in the skin that does not heal in a reasonable amount of time, usually a week to 10 days. This can occur anywhere, not just the feet. But for diabetics, the feet are the most common place for ulcerations to occur. This is due to 2 problems: neuropathy and pressure.

Neuropathy is the loss of sensation that can occur with long term or uncontrolled diabetes. Once you cannot feel things like heat, friction or pain, then any area of pressure can form a callus on the foot. When this callus is present for several days to weeks without being treated, the skin under the callus becomes soft and breaks down, resulting in an ulcer. This is now an all access pass for bacteria to enter the body and cause infection. That infection, if left untreated, can cause loss of part or all of the foot or leg.

I often have patients that tell me they attempted to treat the ulcer for several days to weeks before coming in the office. They applied Neosporin and washed it every day, but it just wasn’t getting better. To treat an ulcer effectively, several things need to occur. First and foremost, stop any infection that may be brewing or already started. No ulcer will heal if it is infected. This is done with topical ointments that are more effective at treating infection than Neosporin and antibiotics. Next, removing any tissue that may be harboring bacteria and also slowing down the healing progress of the ulcer. Lastly, take away the pressure. If an ulcer has constant pressure applied, then good healthy skin cannot grow over it to heal. So using special offloading boots or shoes to reduce the pressure is crucial in treating the wound.

Other factors in treating your ulcer include keeping your sugars in control and eating a well balanced diet. With high sugars, the body has a great deal of trouble healing any wound and it has a harder time fighting off infection. Remember….bacteria loves sugar!!

Once the ulcer is healed, the next step is preventing another one. If you haven’t seen a podiatrist and you are diabetic, now is the best time to have those feet checked for any signs that an ulcer could form. If you have had an ulcer in the past and have not seen your podiatrist in over a year, get on the phone and make an appointment! Prevention is the key to saving your feet!

Tuesday, September 8, 2009

Treating my toenail fungus…what about all my shoes?

A lot of patients with toenail fungus inquire on what they can do to save their shoes. After all, many patients have “multiple, can’t be without, spent a lot of money and hardly worn” shoes in thier closet!

Introducing Sterishoe. Accepted by the American Podiatric Medical Association, it looks like a shoe stretcher and is available based on your shoe size. The device contains a germicidal ultraviolet light (UVC). This technology is well known to hospitals and water treatment systems. UVC is clinically proven to destroy microorganisms. The Sterishoe is the first ultraviolet shoe sanitizer that utilizes UVC inside a shoe.

How does it work? It’s simple. You insert the SteriShoe into your shoe. As slight compression is applied, the treatment begins as the UVC rays are activated. If compression is reduced, the light automatically turns off.

Since UVC can be harmful if you look at it too long or hold it close to your skin, Sterishoe provides two important safety measures to protect you. A compression sensor and an ambient light sensor. This way, if the shoe sanitizer is removed from the shoe, the compression sensor will automatically turn off the power to the lamp.

To treat open toe shoes or sandals, there are two shoe bags that are provided. If the ambient light sensor detects too much light, the sanitizer will turn off automatically.
The sanitizer should be applied after wearing the shoes. This way, microorganisms are eradicated and you have healthy feet!

For more information regarding Sterishoe, contact Healthy Steps.

Monday, September 7, 2009

Running With Diabetes

Diabetes is a disease that affects a person’s blood glucose levels which may lead to a large array of complications. According to the American Diabetes Association over 23.6 million Americans or 8% of the US population has Diabetes. Type 2 Diabetes, also known as adult-onset, is the most common form of diabetes and most commonly occurs in adults who are overweight. One of the recommendations given to type 2 diabetes patients is to watch their diets and exercise in order to control their weight. Since running is a sport that does not require much coordination, is relatively inexpensive, and is accessible to everyone, it is a popular choice for diabetics to try and get their bodies into the healthiest shape they can.

If you have Type 1 diabetes then you rely on insulin injections in order to convert glucose into energy to get you through the day. Running with Type 1 Diabetes can be very tricky, but it is definitely do-able and beneficial. The trick to running with Type 1 Diabetes is making sure that you have enough energy, or insulin, to sustain you through the entire run. You will want to ask your physician how long of a run they advise.

If you have Type 2 Diabetes, then your body either does not have enough insulin or the cells do not recognize insulin properly. Therefore these people require that they regulate their diets so that they have the optimal amount of glucose in their systems. If you are a runner that has Type 2 Diabetes then you might have to bring extra little energy packs with you on long runs as well as your blood glucose meter to make sure that your blood glucose levels are being sustained throughout your run. Again, for the best advice on what levels of running are safe for you if you are suffering from type 2 diabetes, consult your physician.

Diabetes is a disease that is becoming an epidemic due to our increasing sedentary lifestyle and the increasing number of people who are acquiring this disease. Running is a great option for people with diabetes to get into the best shape they can to help manage their diabetes. The key thing to remember is that when you run, your body is working much harder than in your normal daily activity. Your blood glucose levels will have to be strictly monitored to ensure you stay as healthy as possible.

Tuesday, August 18, 2009

Exercise Encouraged With A Good Diet

Exercise has long been considered an important method to improve and prevent diabetes. It has been shown in multiple studies to improve blood sugars and it improves insulin sensitivity. The method of this improvement includes exercise inducing proliferation of glucose-transport molecules that then move to the cell membrane. In a recent study, however, vitamin supplements with vitamin C and vitamin E blunted this effect. It was found that with these supplements insulin sensitivity was not improved with exercise. Better than supplements, therefore, would be the diet rich in fruits and vegetables to continue to improve insulin sensitivity with exercise.

For more information: Ristow M et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Natl Acad Sci U S A 2009 May 26; 106:8665. [Free full-text online] [Medline® Abstract]

Dr Gibson also has an additional blog on Diabetes.

Tuesday, August 4, 2009

Save a Leg, Save a Life

One of the many complications associated with diabetes is the presence of diabetic foot ulcers. These ulcers are open wounds that are slow to heal, and affect roughly fifteen percent of all diabetic patients. Often the wound is explained by a loss of sensation in the foot, and the patient can not feel that there is an open sore on the bottom of their foot, and may not see it, either.

When the ulcers become infected, which is usually the case; the infection can quickly spread to the other tissues. This can lead to infections of the bone (osteomyelitis) or of the blood (sepsis). Complications due to diabetic foot ulcers will often lead to amputations or even death.

On average, a lower extremity amputation will cost close to $50,000 annually. This cost is mostly from hospital stays and aftercare related to the surgery. Of the patients that do have an amputation, less than 50% will be able to walk with a prosthesis following a below the knee amputation, and less than 25% will be able to walk with a prosthesis following an above the knee amputation. Without the ability to move around on their own, many patients become institutionalized, which can cost upwards of $100,000 per patient. With a 25% reduction in the amount of lower extremity amputations each year, over $4 billion would be saved annually.

Save a Leg, Save a Life is an organization that is devoted to educating doctors and the public on the ways to address these issues. The organization is an interprofessional team, made up of podiatrists, vascular surgeons, nurses, and many other types of doctors with an interest in wound care. The organization seeks to provide information about the advanced methods of treating wounds, including new materials and technologies used in the treatment of diabetic foot ulcers.

Health care providers and health insurance companies are becoming more and more dependent on evidence based medicine as a foundation for treatment. Through Save a Leg, Save a Life, that information is being dispersed through the medical community. Products that are designed to help regenerate healthy tissue and promote healing are replacing the old methods of washing the wound with saline solution. However, these old methods are all that many doctors know, and so they become the standard in wound care. Through programs like Save a Leg, Save a Life, as well as the American Academy of Wound Management and the College of Certified Wound Specialists, hopefully the more advanced methods will become the new standard.

Saturday, July 18, 2009

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

•Prevention of infection.
•Taking the pressure off the area, called “off-loading.”
•Removing dead skin and tissue, called “debridement.”
•Applying medication or dressings to the ulcer.
•Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

•Keep blood glucose levels under tight control.
•Keep the ulcer clean and bandaged.
•Cleanse the wound daily, using a wound dressing or bandage.
•Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Thursday, May 28, 2009

Diabetes and Foot Surgery

One remark I hear frequently from my diabetic patients is that they have the belief that since they are diabetic, they cannot and should not have foot surgery. Is this true?

Let me answer this question by giving an example of a patient I saw in my office recently. She was referred by her primary care doctor for evaluation of sores on the ends of the third toes of both feet. When I first saw her, it was instantly evident that she had some serious problems. Not only were sores (ulcers) present on the ends of the third toes on both feet, but those same toes were red and swollen - classic signs of infection. I also noticed that she had severe contractures of the second, third and fourth toes of both feet. This caused her to put excessive pressure on the ends of the toes. It was this pressure that ultimately caused the ulcers to form, and became a hindrance in the healing of her ulcers. Further testing showed that not only did she have infected ulcers on both feet, but that the infection had progressed to the bone. After a lengthy discussion with her, we decided that it was best to remove the infected portions of the toes. For a podiatrist, this is not the kind of surgery that we want to perform, but sadly at times must be done.

Since her surgery, she has gone on to heal well, and what is left of the third toes on both feet is healthy and shows no signs of problems. However, she has since developed an ulcer on the fourth toe of the right foot. Again, because of the severe contracture of the toe (also known as a hammertoe), excessive pressure on the end of the toe has caused the skin to break down and ulcerate. So, we are back to fighting the battle to save her toe.

I gave this example to illustrate why surgery in diabetics is sometimes not only permissible, but can turn out to be a way to prevent more drastic complications at a later date. In the case of this patient, my plan now is to perform surgery on the remainder of her hammertoes in order to straighten them. This is not so that her feet will look better (although they undoubtedly will will better), but rather to remove deformities that are causing excessive pressure and make her prone to ulceration, infection, and potential amputation.

So, when can and should a patient with diabetes have surgery? In my mind, diabetes in and of itself does not mean that surgery is not possible. Rather, I look at the patient as a whole and determine if he/she is healthy enough to withstand the surgery, and heal properly afterwards. Things that your podiatrist will look for when contemplating foot surgery include the status of the circulation to your feet. This may involve not only an examination, but also non-invasive testing as discussed by Dr. Wishne in a prior post on this blog. In addition, your podiatrist will want to know how healthy you are in general. How is your heart functioning? How are your kidney's functioning? How well is your diabetes controlled? These and many other factors will be considered before surgery is contemplated.

Your podiatrist has had the advantage of seeing many patients who have developed diabetic foot ulcerations, and he knows the types of feet that are prone to develop such ulcerations. If your podiatrist feels that you are at an increased risk for developing a foot ulcer because of your foot deformity (including hammertoes, bunions, bone spurs, ingrown toenails, etc.), he will be doing you a big favor in recommending procedures that can prevent later complications. Every procedure in medicine has potential risks and benefits. The trick is to determine if the risk of surgery is less than the potential benefits that the surgery will offer. For most patients, pain is a major motivating factor to proceed with surgery. In a diabetic patient who may have neuropathy, prevention of future complications rather than the presence of pain is the main reason to proceed in many instances. This is a decision to be made jointly by you and your podiatrist.

Friday, May 8, 2009

Why Do My Legs Hurt?

Peripheral arterial disease (PAD) is becoming more and more prevalent in America. Our love of fast food and convenience has lead to almost 10 million Americans to be diagnosed with PAD. Our body naturally starts forming plaques in our arteries. This is part of the aging process. Unhealthy lifestyles though cause abnormal increases in plaque and as we get older, these high levels of plaque hardens and causes narrowing of the blood vessels. Arteries supply the body with blood rich in oxygen. If the vessels narrow, the body is not getting the appropriate amount of oxygen to the organs and muscles. Thus, those with PAD are four times more likely to have a heart attack and almost three times more likely to have a stroke.

Who is at Risk? Those with diabetes have a significant risk in developing PAD. So much so, that the American Diabetes Association recommend everyone with diabetes over the age of 50 should be tested. Other high risk factors are high blood pressure, high cholesterol, family history of heart disease, or being overweight. Smoking will also increase your likelihood of developing PADS by four times.

The first signs and symptoms of PAD are often first seen in the legs and feet. This is why we highly encourage high risk patients to pay close attention to pain, discomfort or open lesions in the legs and feet. One will often feel like their legs get tired or painful when walking or climbing exercise. When experiencing this pain, it will go away with rest. This is termed intermittent claudicating and is a sign that your muscles are not getting enough oxygen. One may also feel numbness or tingling, coldness, changes in color, hair loss on the legs and feet. These are all be signs of a serious problem, but some people who have PAD do not appear with any of these symptoms. Thus it is very important to still get tested if you are at risk.

How to get tested? If you are experiencing any of symptoms above or are at high risk of getting PAD, you should consult a health care provider. Testing for PAD is noninvasive, pain free, quick and easy! The examiner will either use a standardized machine or manually take your blood pressure on your arm, ankle and other areas on your leg. Significant changes in your blood pressure in your legs and or ankle is diagnostic of PAD.

What to do if you have PAD. It is important to take the steps to adjust your lifestyle to prevent the progression of the disease. It is advised that patients stop smoking, lose weight, and exercise to improve blood flow. All treatment plans should be thoroughly discussed with your doctor to know what options are right for your body. The doctor may prescribe blood pressure medication, encourage physical therapy, and in critical conditions, surgery may be necessary.
Those suffering from PAD are at an increased risk of having several foot issues including non-healing ulcers. PAD patients should visit a podiatrist regularly for foot screenings and management of foot and ankle problems. A growing number of the American population are having foot and leg amputations due to the effects of diabetes and PAD. Many of these amputations are highly preventable when people take the appropriate steps to care for their feet and consult a podiatric physician when suffering from any foot and leg pain or abnormalities.

Thursday, April 23, 2009

Obtaining Proper Shoes Through Medicare

Over the years, I have found that unfortunately, one of the best kept secrets among patients with diabetes is the Medicare Therapeutic Shoe Program. People with diabetes are instructed that they need to make sure they wear proper shoes. This is a program that makes this possible! Per Medicare guidelines, patients who qualify can receive one pair of shoes per calendar year, and three pair of accomodative inserts. Three pair of inserts are allowed because over time, they lose their ability to cushion the feet. By dispensing three pair, patients can change the inserts every 4 months, thus insuring that they always have proper cushioning and support in their shoes. While not every diabetic patients on Medicare qualify for this program, the truth is that many do qualify, and there are many who qualify who are not taking advantage of this program.

For a shoe to qualify for the Medicare Therapeutic Shoe Program, it needs to meet certain criteria. These include:

  • Have more interior depth than a normal shoe, which allows for at 3/16" accomodative insert.

  • Must be made from leather or a material of equal quality

  • Must have some form of closure (usually laces or a Velcro closure)

  • Must be available in full and half sizes

  • Must be available in at least 3 widths.

Many diabetic patients are concerned that the shoes will be big, heavy or unattractive to wear. This is simply not the case. The variety of shoes styles available means that it is extremely rare not to be able to find a pair of shoes that meets your need, both medically and aesthetically. On top of that, the shoes are designed to be comfortable!

To qualify for shoes, you need to be examined by your doctor to see if you meet Medicare's guidelines for receiving the shoes. Once it's determined that you qualify, a letter will need to be received from your primary care physician who will certify that you are diabetic and would benefit from receiving the shoes. This is one of the few programs that Medicare offers that is intended to be preventative. Studies have shown that by wearing proper shoes, the risk of developing an ulceration in the foot can be greatly reduced. In other words, you don't have to already have had a foot ulcer to qualify, you just need to be at risk of developing an ulcer. You also do not have to be on insulin to qualify.

Most offices will do a fitting, then order the shoes for you. Once the shoes are shipped to the office, you will be contacted for shoe dispensing. In our office, we recommend that you wear the shoes indoors until you are certain that they are right for you. If for any reason they are not, they can be returned for a more appropriate size or style.

If you have not taken advantage of this program, talk to your podiatrist & see if it is something that you would benefit from. And if you have received a pair of shoes in the past, perhaps it's time for a new pair. Your feet will thank you!

Tuesday, April 21, 2009

Keeping the Elderly Walking

As we get older, our health continues to weaken. Every time we take a trip to the doctor’s office we pray nothing new comes up. Time and time again we hear the same old story, “you need to make sure you exercise to stay healthy.” Whether you have hypertension, diabetes, or high cholesterol, your doctor is going to prescribe exercise! So how does an elderly person stay fit? Walking is everyone’s favorite activity! It is often the safest and easiest type of physical activity to participate as we age. Here are a few tips to help you stay healthy and safe while walking.

Walking Tip #1: Warm up and Cool down

It may seem silly and useless, but taking time to warm up and cool down before walking is very important. It allows an increase of blood flow to your muscles. This increases the oxygen levels available to your muscles. As you exercise, your muscles use the oxygen to create energy. If the oxygen is depleted, your body creates lactic acid which causes pain and your muscles to get tired faster. A warm up will help prevent this from happening. Stretching is an import part of a warm up and cool down. Having tight muscles can cause many different problems and can be painful. Stretching can also help prevent injuries.

Walking Tip #2: Buy a good pair of shoes that fits!

We all want to watch our budget, but walking shoes is not a place to cut corners. You should shop for your shoes in the afternoon. Your feet will swell throughout the day; thus, to ensure you have a properly fitted shoes you should avoid buying them in the mornings. Also make sure you have ample space in the toe box. You should be able to wiggle your toes around in your shoes. Try on several different brands and different sizes and walk around with them on both feet. This is the only way to find a comfortable shoe!

Walking Tip #3: Your feet should not hurt!

You may experience some pain when you begin your new walking schedule. You should pay close attention because this is not a normal occurrence. Self treatment may lead to more significant problem. You should contact a podiatric physician who will be able to accurately asses your pain and treatment options.

Walking Tip #4: Walk on softer surfaces!

As we get older, we lose our protective fat pad on the bottom of our feet. This increases the pressure on our bones and may lead to stress fractures. These types of injuries are more common in women but can also occur in men. Try to walk on grass, or dirt paths rather than hard cement if possible. Through softer ground may be better for stress fractures, make sure the ground is even to prevent ankle sprains or falls.

Walking Tip #5: Make a plan and get a friend!

Changing your lifestyle to include exercise is a huge undertaking. It is not easy to always stay motivated. It works best to build a plan and schedule that you can adhere to the best. Talk over your plan with your doctor to make sure it is appropriate for your health concerns. Find a friend or local walking groups to join. This will make the experience more enjoyable and rewarding!

Thursday, April 16, 2009

Have Diabetes? No Bare Feet on the Beach!

People with diabetes are hammered with things they shouldn't do. Always high on the list is not to go barefoot. We always tend to over-analyze such recommendations, often to our own detriment.

In our own house? Well, yes. I've pulled all sorts of crazy things out of people's feet. Pet hair, pins, staples, glass, a toothpick. No joke! Some, of course, knew that the foreign body was in really hurt! There are those with diabetes who don't have any sensation due to peripheral neuropathy. These folks can step on a foreign body and not have any idea. They may notice bleeding on the carpet or in their shoe and find out that way. For others it can be days or more before they discover the problem.

The most universally accepted place to go barefoot is the beach. No problem, right? Wrong. Let me count the ways...

First of all, sand gets very, very hot. For those who have full sensation in their feet, they'll realize it and will protect their feet with shoes, flip-flops, Crocs, etc. For those who don't have sensation, they will have no idea about the heat of the sand. Severe burns can (and believe me often do) result. If you have any decrease in sensation, always protect your feet on the beach.

Add the heat of the sand to the multitude of foreign body's unique to the beach. Seashells can be sharp and cut into the foot easily. Coral and other natural growth can scratch and do the same. This is more dangerous than your household foreign bodies. On the beach, there are bacteria that you won't find anywhere else. So along with the danger of simply stepping on something and not feeling it, you can add the risk of infection which, of course, is exacerbated by the diabetes depressing the immune system.

So the take home message is, always be careful and always protect your feet. You need to always think about where you are and what dangers may be lurking. Even in a comfortable situation, like a day out at the beach, being proactive in protecting yourself will always keep the memories of the day pleasant.

Friday, April 3, 2009

Diabetics are losing feeling in their feet! Why?

According to the American Diabetes Association, about 15.7 million people (5.9 percent of the United States population) have diabetes. Nervous system damage (also called neuropathy) affects about 60 to 70 percent of people with diabetes and is a major complication that may cause diabetics to lose feeling in their feet or hands.  Foot problems are a big risk in diabetics. Diabetics must constantly monitor their feet or face severe consequences, including amputation.


Diabetics lose feeling in their feet.  This is called diabetic sensory neuropathy.  Grossly simplified, the nerves do not conduct sensations as well as they can.  This is due to a variety of factors, but commonly a higher level of sugar in the blood stream diminishes the nerve action potential.  Direct metabolic damage then occurs to the nerves, which results in neuropathy.  There are three types of neuropathies a diabetic can have.  Sensory, motor, and autonomic neuropathies are all possible. 

Sensory neuropathy, the most common type, usually presents as the first type before motor neuropathy.  It is classically described as a sock and glove distribution.  This means than the loss of sensation occurs in the same distribution as a sock.  That is, all feeling is lost or diminished below a certain level just above the ankle joint, in the same area where a sock would be around the lower leg.  A diabetic will not be able to detect sensation or will have difficulty detecting two points of discrimination.  A person can also have an absent protective threshold.  In other words, a diabetic may not be able to feel hot water when checking drawn bath water, whereas a non-diabetic would jump, pull their hand back reflexively, and say “ow!”  This example also clearly illustrates the lack of temperature discrimination.  Another sequella is diminished vibration sensation. 

Lastly, proprioception can also be affected.  Proprioception is the ability of the body to know where a limb is in space or what movement is being performed.  For example, when you close your eyes while walking over a curb, your bodys’ own sensing system takes over.  It knows just how much height is required to lift the foot over the curb.  It also knows when to expect your foot to land onto the ground above the curb and at what force should be expected.  We are able to perform this complex task because of small receptors that line our joints and detect tiny movements made by us.  These movements are interpreted by our brains like movement in space. 

Motor neuropathy is a deficit of motor coordination affecting the intrinsic muscles of the foot leading to biomechanical and structural changes of the foot.  These changes predispose the diabetics feet to ulcers and subsequent infections. 

 Another type of neuropathy that can occur is autonomic neuropathy.  The autonomic nervous system is responsible for regulating body temperature among other things.  It does this by creating sweat and directing blood flow to or away from an extremity.  Poor control would lead to reduced blood flow, lack of sweating, and other conditions.  It also is responsible for hair follicles reacting to reduce heat or gather warmth. 

Wednesday, April 1, 2009

Your 4 Keys To Reducing Your Diabetic Complications

People often worry about the complications that come with diabetes. Here are 4 keys to helping reduce your complication risks.

1. The best way to limit complications of diabetes (all the complications) is strict blood sugar control. You should be monitoring your blood sugar and seeking to have a A1c of 6 or lower. Spikes in blood sugar are not recommended at any time, as this provides opportunity for the complications to start. As you talk with your doctor, you can get an aggressive program to keep blood sugars managed.

2. Exercise helps control blood sugar. Exercise in a diabetic is an important part of your self care. This program should be under the direction of your physician and should include adjustments in medications as necessary, diet changes and carefully monitored exercise. Some key points include not exercising when blood sugars are highest, 30 - 60 minutes after meals and additional carbohydrates may be required to reduce hypoglycemia (low blood sugars). Talk with your doctor and get an exercise program that will work for you.

3. Examine your feet twice a day. The American Diabetes Association recommends you examine your feet daily for new areas of redness, new calluses, blisters, or skin changes. Since you are putting shoes on and taking them off, I recommend checking your feet twice a day. This provides you information on if a certain shoe or activity is causing any of these changes. If changes are noted to the feet, your feet should be checked by a foot and ankle specialist to help improve the problem before it becomes a bigger problem. As you examine your feet, you are performing the most important exercise to reduce wounds, infections and amputations.

4. Play an active part in managing your disease. No matter how good your doctor is, you are the key to good diabetic control. Learn all you can and work to reduce your diabetic foot complications (as well as other complications).

Remember in each of these keys, YOU make the difference. Preventing complications is a process not a destination and must be worked at on a regular basis.

Click here for additional information on diabetic foot complications.

Monday, March 30, 2009

So I’m diabetic. Why do I need to see a podiatrist?

I think it is a wonderful thing when I see a diabetic for their first foot check. Most diabetics are oblivious to the fact that every diabetic should be seen once a year for a check up by a podiatrist. It is surprising that so many diabetics have been diabetic for years and never been to a podiatrist. So many times they tell me they have burning pain and tingling in their feet. But many times they don't and wonder why they need to see me "if nothing is wrong with my feet". Inevitably they come in wearing a regular shoe and tell me that they have a relative who has had an amputation of part of their foot or even their limb.

So why see a podiatrist if you are diabetic and have no symptoms that you can perceive?
The answer is simple. Prevention, Prevention, Prevention! You take insulin or medication or if you are lucky, maybe just control your diabetes through diet alone. Why do you bother? You bother because you have learned that if you don’t, you will slowly deteriorate your organs, your body and this will, over time, kill you! Just as you control your sugars with the help of your primary care physician to maintain your body health, you need to see your podiatrist to maintain your foot health. Diabetes is a team effort. Believe it or not, allowing your feet to deteriorate can kill you too! I have seen diabetics who have neglected and infected wounds on their feet; the infection gets into their blood stream and kills them.

These people were once like you. They all started out with no problems with their feet. Having diabetes can lead to numbess (neuropathy) in your feet through the slow deterioration of the nerves that give sensation to your feet. And diabetes is sneaky. The destruction comes on so slowly that most people with this disease don’t even realize they have it. And by the time they do, it is often too late. You need to see a podiatrist BEFORE you develop the numbness, burning or tingling. Do not take the risk of waiting for these symptoms to come on before coming in. Even a small scrape or a blister can be difficult to heal in a diabetic. These small and seemingly harmless injuries are the ones that can just as easily end up in amputations as do so many of the major ulcerations. Calluses may have wounds you may not feel festering underneath. An inappropriate shoe triples the risk of amputation. Allow us to get that importance baseline evaluation and educate you on the imperative information you need to know to keep your feet and limbs for the rest of your life. Amputation rates are ever increasingly closer to 100,000 per year in diabetics. Statistics show that the loss of your limb means the loss of your life in as little as 5 years.
Make your appointment today!

Wednesday, March 25, 2009

Dryness and Cracks in your Feet?

It has been winter for a while and our feet have been safe and snug in our socks and shoes where nobody could see them. The seasons are changing and as we get ready to display our feet for the first time this season...

We wonder why are my feet so dry?? And are those cracks on my heels?

Cracks also known as fissures can lead to infections which can lead to amputations. This is how it works. A diabetic patient is more prone to have dryness in their feet. It is one of the early signs of the disease. When you have a cracks in your feet due to excessive dryness, bacteria are able to get into your body and cause a skin infection. At this time your chance of amputation has just increased.

How do we treat/prevent this from happening?

1) Most importantly you want to check your feet on a daily basis. Always look in between your toes and feel the bottom of your feet. If you cant see your feet, have someone else look at them for you.

2) Moisturize. Not all moisturizing creams and lotions are the same. The best ones to look for are creams that have a percentage of urea in them as well as Vitamin E.

3)Use the cream daily, all over the feet and heels, do not put in between the toes. Wear socks after you put the cream on to help the cream absorb into the skin.

4) Most importantly if you notice any open lesions, any drainage from the fissures or an increase in redness to the area you need to see your podiatrist. For more info on Diabetic Feet click here.

Tuesday, March 24, 2009

Diabetic Foot Infections Can Kill You!

Diabetic amputations can be avoided. View this short video public service announcement from Dr Crane at Foot & Ankle asssociates of North Texas in Grapevine, TX.

Podiatrists Save Diabetic Feet...It's Just What We Do

I had an experience yesterday that almost moved me to tears. In December I wrote about a gentleman who was incredibly close to losing his leg, if not his life (Here's the original post). Within a short time frame of days, he went from having a "minor" ulcer treated to a major infection of the foot which ended up with him losing two toes, but has retained the functional foot. Before the first operation, I had a conversation with the infectious disease physician caring for him who was insistent that my surgery was futile and he needed an amputation above his knee to save him. The patient and I discussed this and agreed that we wanted to try anyway.

During the first operation, I experienced an infected foot like I'd never seen before, even in my training. It was very apparent that the surgery didn't get rid of the infection like it should have. A few days later, another surgery with a toe amputated. The following week a third surgery with a second toe amputated. Then the miracle...

His fever dropped to normal, all the color came back into his face, his appetite returned. He looked healthy. He made a commitment to his wife, me, and most importantly, himself, to take this horrible time in the hospital and take charge of his diabetes. He did everything right to lower his blood sugar to normal levels. We sent him for Hyberbaric oxygen treatments which helped the residual minor infection to resolve and started to promote healing. As he was discharged, we put a negative pressure "VAC" dressing on his foot to further promote healing.

Our initial hope was to get the wound to the point that we could use a skin graft to close it. Yesterday, that changed. He is doing everything right, including being vigilant about controlling his diabetes. The bottom of his foot is close to healing on its own...without a skin graft! This is ideal, since that would make the skin much thicker and would minimize the risk of breaking open again. Thinking where we were just a few short months ago, I'm staggered to think that soon he'll be back to wearing shoes and even back to work with two functioning feet.

Good thing we decided not to take the easy way out by amputating the leg, don't you think?

Diabetic Foot Care Tips

The most common reason diabetics are hospitalized in the United States is foot infections. I know that’s hard to believe, but true. Diabetes can be dangerous and devastating to your feet.

The most common causes of these foot infections are improperly cut toenails and poorly fitting shoes. Yes, something as simple as a visit to the podiatrist to have your toenails cut and shoes custom fitted can avoid many amputations. Add poor circulation and lack of feeling known as peripheral neuropathy, and you have the prescription for disaster for diabetic feet.

What is a diabetic to do to protect their feet from a sore that can lead to infection and amputation?

1. Inspect your feet daily. If you can’t see your feet, have someone else look at them every day for redness, cuts, swelling, blisters, bruising, or nail problems.

2. Wash your feet daily. Sounds simple, but many people do not bathe their feet daily. Make sure to clean in between your toes and dry them thoroughly.

3. Moisturize your feet daily. Again, a simple habit to get in to, yet most people fail to upkeep their skin every day. Diabetes can cause very dry, flaky skin, so extra moisture is needed.

4. Cut nails carefully, and straight across. If you can see and reach your toes, be careful to cut your toenails carefully, taking time not to nick yourself or cu them too short. When in doubt, visit Healthy Steps Pedicure salon for a therapeutic medically supervised pedicure or see the podiatrist at least every 10 weeks.

5. Never trim corns and calluses. And absolutely no corn or callus remover! The package says, “don’t use if you are diabetic” for a reason. Have the podiatrist trim them when they are thickened or red.

6. Wear clean, dry socks. And change them daily…..

7. Avoid tight or bulky socks. Tight socks can reduce circulation to you feet and bulky socks can bunch up and cause a blister or sore.

8. Wear socks to bed. If your feet are cold, wear clean socks to be. Never use a heating pad or hot water bottle, you can burn yourself before you realize it!

9. Shake out your shoes and inspect them before you put them on. I have taken everything from a pebble, piece of basket and a doll house chair out of the bottom of diabetic feet after they walked on them all day. Easy thing to avoid!

10. Keep your feet clean and dry. No puddle splashing or snow drifts for your feet!

11. Never, never, never go barefoot. Not even at home on carpet. You can step on something easily and get an infected puncture wound.

12. Take care of your diabetes! Multiple studies have shown the complications of diabetes can be diminished by keeping your sugars under control. Keep that HgA1c under 6 if you can. Work with your doctor and nutritionist for optimal care.

13. Don’t Smoke! Stop smoking if you do. Ever cigarette decreases the circulation to your feet and increases your chance of a non-healing wound.

14. Get periodic foot exams. The recommendations are to have a foot exam at least once a year by your doctor and more frequently if you have neuropathy, a foot deformity, poor circulation, or have had a history of a foot ulcer.

Diabetes can be life’s annoyance or it can kill you. It is your choice! Take care of your feet so they will carry you for a lifetime.

For a free copy of Got Diabetes? Help Us Save Your Soles, click here!