Diabetes is a major health concern
Diabetes mellitus is a chronic disease which afflicts about 25.8 million people in the United States (8.3% of the population). 7 million of whom have not been diagnosed and are unaware they have the disease. Among U.S. residents aged 65 years or older 10.9 million, or 26.9%, had diabetes in 2010. Diabetes is the leading cause of kidney failure, nontraumatic lower limb amputations, and new cases of blindness amoung adults in the United States. Diabetes is a major cause of heart disease and stroke and is the seventh leading cause of death in the U.S.
Diabetes is a metabolic disease characterized by elevated glucose (blood sugar), resulting from defects in secretion of the hormone insulin and/or defects which cause tissue to resist absorpiton of insulin. Chronic elevation of blood sugar (hyperglycemia) is associated with long-term damage to the eyes, heart, kidneys, feet, nerves and blood vessels. Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, slow-to-heal wounds and susceptibility to certain infections. Those who have any of these symptoms and have not been tested for the disease should see a physician without delay.
Individuals with diabetes are prone to many complications, both acute and chronic. About 15% of those with diabetes will develop an open wound (ulceration) on a foot during their lifetime and 20% of these ulcerations will lead to amputations. More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. In 2006 about 65,700 nontraumatic lower-limb amputations were performed on people with diabetes.
Diabetes, once diagnosed, is present for life.
The Role of the Podiatrist
At Foot Care Specialists our podiatrists our skilled in the recognition and treatment of diabetic foot conditions. Because diabetes is a systemic disease, affecting many organs of the body, ideal case management requires a team approach involving the podiatrist as well as the family physician, several medical specialists, and a dietitian. As an integral part of the diabetic treatment team we have helped hundreds of diabetic patients manage the podiatry complications of diabetes and successfully prevented amputations. The diabetic foot is one of the most serious conditions treated by podiatric physicians at Foot Care Specialists where our training stresses salvage of the foot rather than amputation.
A comprehensive approach to prevention of complications must include good glucose control, adherence to diet, an exercise program, proper medication and hygiene, and regular podiatric foot care. Those of our patients who follow their medical team's advice have a good chance of preventing or delaying the complications of the disease and living normal lives. Furthermore, with such a regimen as groundwork, it is estimated that more than half of the lower extremity amputations among people with diabetes could be prevented.
The Key to Amputation Prevention
is early recognition and regular foot screening, annually (at the very least) or more frequently, of at-risk individuals. Those individuals considered to be at high risk are those who exhibit on or more of six characteristics:
- Peripheral neuropathy. A nerve disorder generally characterized by loss of protective sensation and/or tingling and numbness in the feet
- Vascular insufficiency. A circulatory disorder that inhibits blood flow to the extremities of the body
- Food deformities such as hammertoes
- Stiff joints
- Calluses on the soles of the feet
- A history of open sores on the feet (ulcerations) or a previous lower extremity amputation
Warning Signs
For the person with diabetes who has not yet developed foot complications, there are warning signs which should be recognized and called to the attention of the family physician or podiatrist. They include:
- Color changes of the skin
- Elevation of skin temperature
- Swelling of the foot or ankle
- Pain in the legs, either at rest or while walking
- Open sores, with or without drainage, that are slow to heal
- Ingrown and fungus-infected toenails
- Corns or calluses with bleeding within the skin
- Dry fissures (cracks) in the skin, especially around the heel
Ulceration is a common occurence of the diabetic food. Poorly fitted shoes, or something as seemingly trivial as a stocking seam, can create a wound that may not immediately be seen and cannot be felt and by someone whose level of skin sensation has been minimized. Left unattended such an ulcer can quickly become infected and lead to serious consequences.
Visit a Podiatrist Regularly
For the person with diabetes we recommend a number of practices and precautions that should be employed. Regularly scheduled visits to our offices for foot inspections; not less than annually and preferably more often are recommended. During a diabetic foot check we may conduct specific diagnostic tests to assess the presence or progression of diabetic complications. Such tests may include:
- Assessment of circulation using an instrument known as the Doppler for measurement of blood flow
- Vibration sense using a tuning fork
- Sensation (light touch and deep pressure) using a plastic monofilament slightly thicker than a toothbrush bristle in what is called the Semmes-Weinstein test, and
- Foot structure using x-rays.
We also reinforce self foot care, reminding patients of previously dispenses advice. There is a sizable list of "do's and don'ts"
Properly Fitted Shoes
Shoes are at the top of the list. Poorly fitted shoes are involved in as many as half of the problems that lead to amputations in diabetic patients. Foot shape and size may change of the years; peripheral neuropathy contributes to change. Everyone, particularly those with diabetes, should be fitted by experienced shoe fitters for every new pair of shoes.
New shoes should be comfortable at the time they are purchased - they should not require a "break-in" period. It is a good idea to wear new shoes for only short periods of time at first. Shoes should have leather or canvas uppers and fit both the length and width of the foot. Make sure there's room for the toes to wiggle freely. Shoes should be cushioned and sturdy. Athletic footwear may fit the bill nicely. It's a good idea to change shoes during the day to relieve pressure areas. Do not wear damp shoes. Do not wear the same shoes every day they will become moist and infected with bacteria. Sterilize shoes occassionally to prevent the spread of toenail fungus.
Diabetic patients should avoid high heels and shoes with pointed toes. Never wear shoes with open toes or heels, including sandals, especially those with straps between the first two toes. Shake shoes out and feel inside them for rough stitching or foreign objects, such as small pebbles. Always wear socks. Diabetics who have difficulty finding shoes will find a wide variety of styles to choose from, for both men and women, at our offices. Most of our diabetic shoes can be fitted with orthotics to improve balance and gait. Whether you are a diabetic or not, our shoes offer comfort and support.
For those eligible, Medicare provides coverage for extra depth shoes or specially molded shoes and inserts for those with advanced cases of diabetes. The medical or osteopathic doctor treating an individual for diabetes can certify the need for therapeutic shoes which we can provide.
Other precautions for diabetics
- Wash feet daily using mild soap and lukewarm water. Always test bath water temperature with a thermometer or the elbow since, due to neuropathy, the feet may be unable to detect scalding temperatures. Dry feet carefully with a soft towel, especially between the toes (important for everyone in preventing fungus) and dust them with talcum powder. If the skin is dry use a good moisturizing cream daily but avoid getting it between the toes.
- Feet and toes should be inspected daily for cuts, bruises, sores, or other changes that are less obvious. If self-inspection is hampered by age or other factors, use a mirror or get the assistance of another person.
- Wear thick, soft socks. Avoid mended socks or those with seams which could cause blisters or other skin injuries. Never go barefoot even inside your own home and especially out of doors on unfamiliar terrain such as the beach or grassy areas.
- Smokers should give up the habit. The consumption of alcohol should be moderated. Tobacco can contribute to circulatory problems and alcohol to neuropathy
- Exercise is important. Walk as frequently as possible; it's the best overall conditioner of the feet.
- Good dietary habits are essential. People with diabetes are commonly overweight which doubles the risk of complications.
- Wear loose socks if feet are cold at night. Do not use heating pads or hot water bottles or other external heat sources.
- Do not use garters or elastics to hold up stockings and do not use panty girdles (Spanx) that are too tight around the legs.
- Cut toenails straight across then use an emery board to gently file away sharp corners. Do not cut into the corners.
- Never try to cut calluses with a razor blade or any other sharp instrument.
- Never use commercial preparations to remove corns or warts as they contain chemicals which can burn the skin.
Diabetes is not just an older person's disease
- Approximately 215,000 people younger than 20 years were diagnosed with diabetes (type 1 or type 2) in the U.S. in 2010
- Approximately 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 in the U.S.
Do not assume that you are too young to have diabetes. If you have some of the warning signs listed above discuss them with your physician.