Foot Care Is Essential With Diabetes

From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.

You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.

1. Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says Dr. Weaver. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.

2. When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Weaver. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.

3. Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. At CKPA we advise looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.

4. Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.

5. Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” When the skin has excess moisture it will break down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can use Ameriglel lotion to moisturizer and help prevent dry, cracked skin — just avoid putting it between your toes.


6. Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.

7. Wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at Central Kansas Podiatry Associates, or you can visit with Dr. Weaver for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is slow healing and to help prevent..

8. People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.

9. The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Dr. Weaver. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,”

10. “There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. Weaver. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.

11. Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to call us and come see Dr. Weaver before your next regularly scheduled check-up.

Oudin will need a lot of what her U.S. Open shoe says

Last year, Melanie Oudin "believed" her way into the quarterfinals of the U.S. Open. This year, the 18-year-old will try to break out of her recent slump with some "courage."

Oudin will take to the court at this year's Open with personalized adidas shoes emblazoned with the word "COURAGE." Last year, her "BELIEVE" shoes became one of the major stories of the tournament, thanks to their folksy orgin, bright colors and Oudin's magical run to the quarters. This year, she and adidas opted for less mantra and more fortitude:
"The reason I chose the word COURAGE is because in order to believe you have to have the courage to do so. Courage to me means playing with no fear and going for it no matter what. You can believe in yourself so much but unless you have the courage to go on the court and put yourself on the line every time you won't make it. You need courage and belief to make it to the top."

Oudin is going to need all the courage she can get in Flushing Meadows. She's just 18-23 since last year's Open run and a first-round loss could drop her as far as No. 90 in the rankings. Barring a deep run at Flushing Meadows, Oudin's ranking will drop far enough where she'll be forced to play qualifiers at most major tourneys.
Maybe the shoe should have said "MIRACLE" instead.

Yao Ming is contemplating retirement

'Twas less than a week ago that the Houston Rockets introduced Brad Miller(notes) and his camouflage shorts as the newest member of their team. We applauded the great fit, and not just because of the abundant hunting opportunities. Not only would Miller be playing in a system that values his skills — passing, perimeter shooting, other things that start with "P" — but he'd also be stepping into a low-pressure situation where he could excel in limited minutes. It was all good, baby bay-bay.

However, it turns out we might be seeing a lot more of Brad Miller in the next few years. Because not only is Yao Ming(notes) unsure about how he will perform this coming season, he's also contemplating ending his career if his foot doesn't heal right. From the Associated Press:

In comments to Chinese state media Monday, Yao sounded far from optimistic about his future and also made a rare criticism of China's national basketball program.

"If the foot injury does not heal next season, I might choose to call it quits," he said. [...]

Yao, who has been in China to promote some of his charity events, all but ruled out playing in the 2012 London Olympics.

"The chance is very small," the 7-6 center was quoted as saying by the official Xinhua News Agency. "The foot injury will not allow me to play so many games anymore. Like I said before, I will quit the national team and the sport one day. It's what happens to every athlete."

Leave it to Yao Ming to be completely OK with his impending basketball mortality even though it's five years too early. It seems like just yesterday that Yao was sporting the pinstriped Rockets uniforms made famous by Matt Maloney, and now he's all but telling us he's almost done with the NBA. Somebody grab me some tissues.

Of course, there is a chance that Yao's foot will be fine this season. Zydrunas Ilgauskas(notes) went through a similar injury and surgery early in his career, and has played eight seasons since then. He was 23 when he broke his foot, which makes healing a lot easier than recovering from the same injury at 30.

I guess all we can do now is hope that Yao's foot turns out to be no big deal. Well, size 18 kicks are pretty large, but I meant "big" in a metaphorical sense. At the very least, the Rockets have the most enjoyable center ever signed for the next four years. It'd be tough to lose Yao, but those next three years would be filled with so many hearty laughs.

Popular Flip-Flop Sandals Linked to Rising Youth Heel Pain Rate

Many of us wear flip-flop sandals throughout the year; however, their popularity among teens and young adults is responsible for a growing epidemic of heel pain in this population.

We’re seeing more heel pain than ever in patients 15 to 25 years old, a group that usually doesn’t have this problem. A major contributor is wearing flip-flop sandals with paper-thin soles everyday to school. Flip-flops have no arch support and can accentuate any abnormal biomechanics in foot motion, and this eventually brings pain and inflammation.

Wearing sandals with reasonably strong soles and arch support is recommended. Especially for girls and young women, thicker soled sandals with supportive arches might not be considered stylish, but if you want to wear sandals most of the time, you’ll avoid heel pain if you choose sturdier, perhaps less fashionable styles.
It is estimated that 15 percent of all adult foot complaints involve plantar fasciitis, the type of heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes. Tight calf muscles and wearing inappropriate footwear are common contributing factors.

The pain is most noticeable after getting out of bed in the morning, and it tends to decrease after a few minutes and returns during the day as time on the feet increases. Not all heel pain, however, is caused by plantar fasciitis. It also can occur from inflammation of the Achilles tendon, bursitis, arthritis, gout, stress fractures, or irritation of one or more of the nerves in the region. Therefore, diagnosis by a foot and ankle specialist to rule out other causes is advised.
Initial treatment options for heel pain caused by plantar fasciitis should include anti-inflammatory medications, padding and strapping of the foot and physical therapy. Patients also should stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, use over-the-counter arch supports and heel cushions, and limit the frequency of extended physical activities.

Most patients with plantar fasciitis respond to non-surgical treatment within six weeks. However, surgery is sometimes necessary to relieve severe, persistent pain. To find out what is happening with your child feet don’t wait to see your foot specialist at Central Kansas Podiatry Associates today.

Diabetes Patients NEED More Prevention Services

It has been found that there is a distinct lack of appropriate prevention programmes for foot ulcers and amputations for patients that are suffering from type 2 diabetes, and it has been recommended that improved prevention services could significantly improve the high rate of amputation for diabetes patients.

Researchers have used information taken from electronic medical records to identify 150 patients on dialysis and 150 patients with a previous foot ulceration or amputation from 2000 to 2006. Factors such as patient education, podiatry care and the use of therapeutic shoes and insoles were monitored over a 30-month period. Despite 92.3 per cent of the overall population of the study having type 2 diabetes, only two patients in the dialysis group and none in the ulcer group were reported to be offered formal diabetes education.

In the study, 65 per cent of patients were seen by a podiatrist, of whom 70 per cent received care after developing a foot ulcer. This is compared with 42 per cent of patients in the dialysis group, and only 18 per cent of patients in the ulcer group received preventive care from a podiatrist.

It was noted that "Prevention services for the diabetic foot are simple to establish and can be made easily accessible through organized multidisciplinary care. These data provide further evidence that preventative foot care is not regularly provided, even among patients with the highest risk for lower limb complications. It also highlights an opportunity to improve prevention services for the diabetic foot with simple protocols for evaluation and referral."

Surgical site infection risk in patients with diabetes

Surgical procedures are often unavoidable in patients with diabetes, and can even help reduce future risk of ulceration. But high postoperative infection rates in this patient population pose additional challenges to practitioners.

With 7.8% of the United States population (~23.6 million people) estimated to be diabetic, one can see how diabetes has become an increasing challenge for the medical community. It has been estimated that nearly a third of these patients are unaware of being diabetic. This prevalence will rise, as nearly 25% of adults over 60 are diabetic and there are increasing numbers being diagnosed in younger patients. Approximately 366 million people will have diabetes worldwide by the year 2030, most of these in developing countries. Foot disorders such as ulcers, infection, Charcot neuroarthropathy and peripheral arterial disease (PAD) are the most common causes of hospital admissions in diabetics. As diabetes mellitus is considered a lifelong condition, one can see the true impact on the healthcare system overall.

Peripheral neuropathy is one of the most common complications found in diabetics, prevalent in anywhere from 14-60% of the diabetic population. Peripheral neuropathy leads to sensory, motor and autonomic dysfunction, and this loss of protective sensation often causes these patients to fail to seek timely medical care for their conditions.

Foot surgery in patients with DM can be elective or preventative. Due to concerns with increased infection rates and slow healing of skin and bony structures in diabetics, elective surgery is performed with extreme caution. Prophylactic or preventative surgery is performed in those diabetics with pre-ulcerative areas, bony prominences and stable, non-infected ulcers. The purpose is to prevent ulcerations due to these bony prominences or to assist in healing of current ulcerations. Multiple types of surgeries can be performed based on the underlying bony deformity found, including hammertoe repair, bunion repair, metatarsal osteotomies, bone resections, Achilles tendon lengthenings for ulcers in the forefoot area and many more. Fracture repair is often required in diabetic patients. Those patients with Charcot foot deformity not treatable with bracing may require surgical intervention also.

It has been noted that diabetic patients without neuropathy can be treated with standard surgical technique and post-op care, but those who are neuropathic should have more fixation, be seen more often and remain non-weightbearing for approximately double the time period.

Peripheral arterial disease can also complicate the surgical site in diabetics, especially those with an insensate foot. Lack of blood flow to the surgical site not only affects the patient’s ability to heal the site quickly, but can also lead to an inability to fight off potential infection at the surgical site in the diabetic patient. Surgical site infections are infections that occur with 30 days of a surgical procedure, or within 1 year if an implant was inserted and is related to the surgery. One study found that by controlling factors such as hypothermia, blood glucose levels, removing hair from the surgical site and administering procedure-specific pre-operative antibiotics for an appropriate time frame, infection risk can be decreased.

One study showed a post-op infection rate of 6.7% in diabetic patients with neuropathy but no open wound undergoing forefoot surgery. A recent study was performed to examine wound infection rates involving 57,183 patients with ankle fractures undergoing repair. This study showed that non-diabetic patients had an infection rate of 1.4% after surgery. Diabetics without neuropathy or other comorbidities had a rate of 3.55% and diabetics with neuropathy or other comorbidities had an infection rate of 7.71%. Other reviews have found similar percentages, indicating that there is an obvious increased risk of infection in diabetics undergoing foot and ankle surgery. This implies that foot and ankle surgeons must have appropriate protocols in place to lessen these infection rates in their patients. First and foremost, comorbidities such as peripheral neuropathy and peripheral arterial disease must be diagnosed and managed prior to preventative surgery.

New Study Demonstrates Dramatic Impact of Podiatric Care

Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.

The study, sponsored by APMA, examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. James Wrobel, DPM, presented the results at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.

"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."