Orthopedics / Sports Medicine

Keeping your (diabetic) feet in shape

The human foot is designed to take a lot of abuse. Every step you take requires your foot to withstand stress that equals about 120 percent of your body weight—and you take a lot of steps. In a lifetime, the average person takes about the same number of steps that would be required to walk three times around the world.

The feet are also farthest from the heart, so any conditions that affect the blood will often begin to appear as outward signs in the health of the feet. This can be particularly true with those individuals with diabetes.

One significant concern for diabetic patients is the gradual development of neuropathy, which is a form of nerve injury. Neuropathy can result in a loss of sensation (sensory neuropathy); a decrease in skin turgor (pliability); an increase in skin drying with resultant cracking, flaking and an ashen appearance (autonomic neuropathy); and a weakness of certain muscles most commonly about the toes leading to deformity (motor neuropathy).

Generally, individuals with diabetes will experience only minimal pain and so may neglect these skin changes and deformity. Diabetic patients may also develop calluses or ulcerations due to poorly fitting shoes or—more commonly—from not wearing shoes at all. Many diabetic patients experience swelling in their feet due to poor circulation or high blood pressure. These conditions can lead to fragility of the skin and soft tissues causing damage that in turn may lead to foot surgery.

The first step in diabetic foot care is establishing good personal habits, including wearing shoes that fit well, inspecting the feet daily for sores and injuries or changes in appearance. These include bunions; lesser toe deformities such as "hammer toes" and “claw toes;" swelling; nails that have become discolored, brittle or thick; “hot spots” (areas of redness due to shoe wear, or from stepping on an object); or the formation of significant callus or skin ulcers. Keep in mind that it only takes two hours of abnormal pressure to cause an ulcer or to develop swelling.

If you experience pain, minor or major trauma, redness, drainage, difficulty with walking, or your feet feel unusually warm, contact your physician. Do not attempt “bathroom surgery,” which can lead to extreme medical complications including an infection that ultimately will lead to the need for surgical amputation. Instead, contact your physician and demand to be seen by an orthopedic foot and ankle surgeon immediately or seek medical attention in an emergency department.

Diabetes is a serious disease and requires you to maintain a rigid adherence to monitoring the health of your feet. You should also schedule a routine foot screening at least four times per year with a specialist who is trained to help manage the unique medical concerns of diabetic patients. That physician should be an individual who listens to your concerns, taking a thorough medical history of your condition.

The examination should include a complete lower extremity examination of both extremities, not simply the one of concern. The specialist will identify options of management that are readily available to you, assist in co-management with vascular surgery, nutrition care, endocrinology as needed, and work with your primary physician to come up with a team approach that effectively helps you to manage your disease.

Originally Published in The University Doctors' MedicaLink - 07/08

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