Diabetes and Foot Care

You've been told by your doctor that you are diabetic. What does this mean and besides changing your diet and maybe losing some weight, what adjustments do you need to make in your life to accommodate for this new inconvenience?

An estimated 34.2 million (or 10.5%) of the American population are diabetic. Being the 7th leading cause of death in America, it is essential that preventative measures be taken before major complications including kidney failure, blindness, and limb amputations occur. For these reasons, it is vital to see a nephrologist, opthalmologist, and podiatrist annually to check before problems start.

A podiatrist will provide a comprehensive foot exam which includes checking for circulation, sensation, and for any areas of pressure that could potentially cause future ulcerations. An absence of circulation indicates peripheral arterial disease for which a vascular referral would be warranted. Loss of circulation could be detrimental being that any cuts or wounds would take longer than ideal to close, leaving you more vulnerable to infections which would be more difficult to fight with a compromised immune system.

It takes on average 5-7 years for diabetic neuropathy to start. It is well-known that the elevated glucose in diabetics attacks the nerves but this is also seen in well-controlled diabetics as well, for unknown reasons which are still being investigated by scientists. Diabetic neuropathy may start as occasional numbness and tingling and eventually progress to burning and sharp, shooting pains that wake you up at night. Neuropathy from diabetes is not reversible but can be managed with oral medication, topical pain creams, and peripheral nerve stimulators. I have encountered a few patients with uncontrolled sugars having some sensation return after their sugar becomes controlled. If diet and exercise are not bringing glucose levels down to a reasonable level, I recommend working with an endocrinologist to help bring those levels down.

It is absolutely essential that diabetics wear appropriate sized shoes to avoid areas of high pressure that could cause future ulcerations. Diabetic shoes are constructed so that they are wider and extra-depth to avoid applying excess pressure to vulnerable areas of the foot including the tops of the toes, bunions, bunionettes, and especially the weight-bearing surface of the ball of the foot. In addition, check inside your shoes to make sure there isn't anything hiding in there that could potentially harm your feet. I've found various objects like wood splinters and acupuncture needles in a couple of my patient's shoes. Oftentimes, I've noticed that patients have been hesitant when I mention diabetic shoes because they are associated with bulky, unstylish shoes (which may have been the case back in the day), but nowadays, diabetic shoes are quite stylish and much lighter in weight.

The best service you can do for yourself as a diabetic is to check your feet daily for any redness, swelling, warmth, cuts, or openings. As long as your sugar is well-controlled and you are regularly seeing your round of aforementioned specialists, diabetic complications are significantly less likely to happen.