Diabetics Must Pay Extra Attention to Care of Feet and Legs

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I like this campaign, knock your socks off,  for the very simple reason that it’s an essential part of diabetes care that is often overlooked.   The campaign is spearheaded by the American Podiatric Medical Association (APMA) who encourages “everyone with diabetes and those at risk for the disease to remove their shoes and socks and inspect their feet and visit a podiatrist for a foot exam.”

I admit doing research for lower limb or foot problems makes me squeamish, but it is a significant issue for the diabetes community. Keep in mind, problems don’t occur when proper care, vigilant self-management and consistently good blood sugars are a way of life.  If not, some problems related to the feet and diabetes are due to poor circulation caused by neuropathy.   Neuropathy can cause numbness, or swing over to extreme pain, depending on the stage of the nerve damage.  The numbing or tingling sensations can often mask or numb pain caused from sores, or blisters which can spread and lead to more serious infections. There is good reason to be fastidious when it comes to caring for our feet.

I have often assumed that the number of amputations related to diabetes must be higher (relative to population incidence) in type 2 populations, but I was unsuccessful finding a study to support my assumption. What I did learn is the risks are just as high for type 1 as for type 2. One study (Johannesson et al) assessed a general population aged ≥45 years, and found the incidence of vascular Lower Limb Amputation (LLA) was eight times higher in diabetic than in nondiabetic individuals.  In another study (Jonasson et al), more than 31,000 patients with type 1 diabetes were examined over a 10 year period.  The study concluded that by age 65, “the cumulative probability of having a nontraumatic Lower Extremity Amputation (LEA) was 11.0% for women with type 1 diabetes and 20.7% for men with type 1 diabetes.”  The study did propose that the risks seemed to decline over the course of the study (1998-2008) – likely because technologies, such as insulin pumps, are better at supporting patients and therefore resulting in more successful outcomes.

Learning about foot care is fundamental for preventing future glitches.  I distinctly remember the emphasis doctors made on foot care when I was diagnosed in the 1970s, and even though the doctor’s delivery threatened and terrified me,  if you don’t care for your feet, you might lose one, it worked. While I don’t condone motivation by fear, I believe that caring for feet is an important preventive measure and worth discussing.  From an early age (10), I followed these simple steps, and have added more as the years have gone by:

(Ahem, for any men reading – this applies to your feet too)

-After bathing or showering, always towel drying my feet  – especially between toes

-Keeping toenails clipped in order to avoid painful in-grown nails that might lead to a more serious problem

-However tempting it might be, never walking barefoot outside of the house – even in the garden

-Buying quality (over quantity) shoes or sandals, always ensuring the fit is right. Before a new purchase, I make sure my feet are comfy (soft leather) and if I have trouble walking – I don’t buy!  Sometimes the WOW factor for fashion might be sacrificed, but not always.  Better brands feel nicer.

-Wearing natural fibers (cotton, wool) and limiting exposure to nylon socks and stockings

-Preventing or paying attention to blisters or callouses caused by dry skin, or heat.  Days when a lot of time is spent on your feet are an issue too.  Moisturizing and exfoliating feet at home is essential – especially for adults. Pedicures are a part of my regime, and while they are deemed a luxury, I consider them essential for good preventive care. One pointer: I never allow any spa or salon to cut, or shave callouses or cuticles.  Why?  One, the cutting could be too deep and two, the cleanliness of the tool (cuticle remover for example) is never guaranteed.  If I am cutting my cuticles myself, I do it gingerly at most.

With these basic steps in caring I have actually found that my feet are in great shape and I have only been to see a podiatrist once, about 14 years ago – during my “pounding the pavement” New York City days when I walked along Broadway or Park to get to work (Union Square).  It’s amazing how forgettable our feet are – until something happens and it becomes nearly impossible to get around.  It was winter when the pain started; ironically winter is hardest on feet because they have less airing out or breathing time and because they are covered up, we don’t notice them as much.  I realized I had an in-grown toenail – ouch.  The podiatrist took care of me with an in office procedure and I felt safer and more confident with professional care in a sterile environment. Foot problems can be scary, but not if you are proactive before conditions worsen. I advise anyone with serious foot pain, swelling, cuts, or blisters to see a doctor and get a referral for a podiatrist if necessary rather than using home remedies or ignoring the problem.  One last thing – every time you see your endocrinologist or general physician for a check-up, your doctor should be routinely asking you to: lay with your feet just hanging off the examination table or some similar position, and close your eyes – the doctor should proceed to lightly tap the end of your toes with a needle or other tool to see if or how your nerve sensations are changing.  The doctor should also check your reflexes.  If not, ask why and if there isn’t a good answer – ask the doctor to do it… for your well-being and health!