what's hot

october 2002

The beginning of August brought the searing sun and my six month visit to the endocrinologist. That went well as my previous blood work had been done. We all know that these visits are pleasant except when the doctor suggests a visit to another health care professional and then we know we are developing one more complication. I certainly have gone through tests at my share of specialists, but this time my friend and endocrinologist suggested I begin going to a podiatrist.

Now, I have to fess up that I started ballet lessons well before I should have, and toe lessons four times a week under the staff of a strict Russian teacher did not help my feet. They are just plain ugly and calloused. The prescription read "remove calluses and smooth corns". Sounded like a plan and so I made an appointment with a friendly man who had served on the ADA Board with me and who saw many people with diabetes. If someone was going to examine the 52 bones in my two feet, plus the nerves, ligaments and blood vessels, I wanted somebody I knew was in tune with what diabetes can do to someone. After all, it is estimated that 15% of all diabetics will develop a serious foot complication at some point in time. To tell the truth, I had put this off because I knew my feet were not exactly advertisement material, except maybe to warn parents about ballet lessons and tight but cute shoes for four year olds. The big day arrived last Thursday and I went, knowing what podiatrists do, as my uncle, who had two Ph.D.'s was also a podiatrist and he treated my parents. So before I tell you about my session, which was pleasant, please begin to breathe again. Podiatrists, according to their professional organizations, treat corns, calluses, toenails, bunions, heel spurs, and arch problems; ankle and foot injuries, deformities and infections: and foot complaints associated with diseases like diabetes. To treat these problems, podiatrists prescribe medications, order physical therapy, set fractures, and perform surgery. They also fit corrective inserts calls orthotics, design plaster casts and strappings to correct deformities, and design custom-made shoes. The one's my uncle designed for every adult in my family looked like large boats. Wonder why I never let him work on me? A force plate may be used to design the orthotics. This means that you walk over a plate connected to a computer that "reads" your feet picking up the pressure points and weight distribution. From this print out the correct design and treatment can be formulated. To diagnose a foot problem, a podiatrist may order x-rays and laboratory tests. The foot may be the first place to show signs of serious conditions such as arthritis, diabetes, and heart disease. For example, diabetics are prone to foot ulcers and infections due to poor circulation. Many podiatrists specialize just as MD's and DO's do. My friend specializes in surgery and is boarded in that field. He is the podiatrist that gets the referrals from the largest endocrinology groups in town, because of his interest in the field and his excellent treatment. If you read these What's Hot articles every month, you know we wrote about foot complications of diabetes before. Do reread that article to get a firm background on the subject. Here we want to go over what you can do to protect your feet. The truth is that type 2 diabetes is a problem of obesity and advanced age, even though we are seeing more children and adolescents with this disease. What this means is that our feet have had years of abuse. It also means that examining our feet may not be an easy task. Type 1 diabetes is a disease of a usually younger population. As the mother of two, I can state clearly, that getting my son or daughter to examine their feet daily would have been a difficult to impossible task at various times during childhood and adolescence. As we reported before, there are three main complications associated with diabetes. These are neuropathy, poor circulation, and decreased resistance to infection. Our physicians have told us and we have read about how these can affect us. From neuropathy we can develop sharp shooting pains in the feet as well as muscle weakness. We can develop a foot drop as well as calluses, corns and bunions. Vascular disease can cause cramps in the calves. The temperature of the skin may decrease thus changing the color of the skin. Decrease of blood flow can mean decreased oxygen and nutriments to the foot, thus leading to impaired healing. Diabetics have higher levels of infection. That is due to difficulty in fighting off bacteria when they get a cut. High glucose levels impair normal immune responses to bacterial infections. When you visit the podiatrist, he will ask you about calluses, blisters, and minor infections, all of which can lead to ulcers. These are usually painless sores on the bottom of the foot. They can be under a corn, callus or blister. Sometimes neuropathy can cause an ulcer to develop without you knowing it because there is no associated pain. If you have poor circulation you can develop an ischemic ulcer. Podiatrists treat these depending on when they developed. They can be padded to redistribute pressure away from the ulcer. Sometimes, when the problem is more difficult to treat, a cast is used to redistribute weight. Certainly, keeping calluses and corns under control, treating small cracks in the skin and prescribing the interventions necessary including dressings, medications and orthotics can save you from developing gangrene, which as we know may lead to surgery. Now let's get back to my appointment. When you have a chronic disease like diabetes, you get to see the inside of many waiting rooms, and the longer you have diabetes, the more offices you wait in. Visiting the podiatrist was quick and easy. While I waited, I noted some patients coming in with bandages from foot operations. I also noted some patients who limped and those whose balance was obviously impaired. However, for the most part, the patients looked healthy, but overweight. During my stay in that waiting room and taking note on my way out, I did a very unscientific study, and I and an elderly gentleman were the only two people who were thin. During that time I counted eight other people coming out of the office, coming in or waiting. When it was my turn I was seated in a comfortable chair that moves up and down. The podiatrist came in after his technician came in to go over the history I had filled out. She had also softened the calluses on my feet with a lotion of some kind. The podiatrist and I exchanged "hellos" and filled each other in on what was happening in our lives, and then came the question, "Why are you here?" My endocrinologist was concerned about the build up of even more calluses on my feet and he wanted them gone. Done. With instruments that are obviously very sharp, my corns and calluses were dispatched. My toe nails were trimmed properly and then after a goodbye the tech returned and went over the areas with mechanical pumice. My nails were also sanded and then she covered the bottoms of my feet where the calluses had been removed with pads. The same was true for the corn removal areas. I was ready to go. No pain, no fear, just a qualified man who asked me to come back four times a year for an appointment. Bless him. He told me my feet were not the ugliest dancers' feet he had treated and, with appointment card in hand, I left. Those pads are supposed to stay on for some time, but mine came off after a few 6 mile runs. My feet underneath the pads looked fine; in fact good enough for my husband to make an appointment for his feet. That's a recommendation for you. What do podiatrists say is the best way to care for our feet if we have diabetes? I present a list compiled from various lists presented to the public from podiatry professional organizations. Some of these are common sense, but all will cut your chances of developing complications that affect our feet. It goes without saying that checking your feet daily is a must. If you can't see your feet, make sure someone else does. If you have to stand on your feet for long periods of time, make sure to examine them when you can. If you have on new shoes, check to make sure your feet are not sweaty as this can lead to a fungal infection. If you have new shoes make sure you are not developing blisters or areas of rubbing. Keep your toenails short and neat. It's easiest to do this after a shower or bath as the nails are softer. Note any thickening or discoloration and report these to your doctor. If you are uncomfortable doing this task, get a referral to a podiatrist. Do not have a manicure or pedicure before you are cleared to have one. Cutting cuticles in a salon may not be what the doctor would order. See your doctor at the first signs of a fungal nail infection. This is a persistent problem and if not taken care of, the infection can invade the toes and feet through broken skin. Do not try to treat or remove hard skin, corns, calluses, or warts by yourself or with home remedies or chemical compounds. Have these taken care of safely by a professional. Wash your feet every day and dry them well. Use warm, not hot water and a mild soap. Do not soak your feet for very long periods of time. Dry, especially between the toes. This is very important to remember so that you leave no area for fungal infections to grow. Change your socks and hose every day. Change after you have stood, walked or exercised a while to control sweating. Purchase socks without a seam on the toes as these can chafe or cause cramps. Avoid woolen socks that can shrink and impede circulation and also avoid cotton socks as they tend to keep moisture on the shin. If your skin is dry, use an unscented moisturizer like baby oil or petroleum jelly, but never put on socks or hose unless your feet are dry. Again, moist feet can help fungal infections start. Avoid baths or showers that are too hot. Neuropathy can impede our ability to feel pain so you might burn yourself if you step into a hot tub. Don't go to bed with an electric blanket on or heating pads and hot water bottles. These too can burn feet that no longer sense pain. Avoid going barefoot. This leaves us vulnerable to injury and possible infections from mold spores and other organisms. When you go to the beach if the sand is hot, keep your shoes on. Make sure you wear shoes that will keep the hot sand from burning any part of your skin. If you get a sports injury, don't tape your feet or ankles, as this could compromise circulation. Get professional advice. When sitting, avoid crossing your legs, as this also compromises circulation. If your feet are cold at night, seek medical advice. This will depend on if you have neuropathy. Exercise. As you know from reading this site, exercise is a very important part of treating diabetes. It improves circulation and makes all of us healthier. Speaking of healthy, when you decide to exercise, make it a dual decision to stop smoking if you still light up. Diabetes and smoking is a dangerous combination. Finally, lose weight if your doctor has told you it is important that you do so. Being over weight doubles your chance of developing complications. Take care of your feet; you only get one pair for life. BSP