Diabetics Need to Take Special Care of Their FeetBy Amit Bhanti, CPO

If you or a loved one has diabetes, you are aware of the severe complications that can occur when the disease is not managed. Uncontrolled diabetes can result in damage to organs and impairment of the immune and nervous systems. Almost all aspects of the body can be affected, from the heart, kidneys and nerves to the eyes, skin and feet.

Impact of diabetes on feet

In individuals with diabetes, the pancreas produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose, or sugar, builds up in the blood and passes out of the body. As a result, the body loses its main source of fuel even though the blood contains large amounts of sugar. The retention of this high blood sugar over the long term affects your blood vessels and nerves, particularly in your feet.

Steps in the wrong direction

Those with diabetes are at risk of developing a number of conditions. Some, though they may seem minor, can grow into larger, more serious problems.

Neuropathy. People with poorly managed diabetes are at risk of a serious condition known as neuropathy. This condition causes nerve damage that makesyou unable to feel your hands or feet normally, which can range from numbnessor tingling to a lack of any sensation at all. Therefore, if your shoes are rubbing or causing blisters, you may not experience any warning signs. Or you may be oblivious to heat, cold or even pain, which could result in serious damage.

Vascular disease. The elevated blood sugar can restrict your blood vessels, resulting in impaired circulation. This can cause a number of issues, including pain, swelling, and the improper healing of wounds. This risk increases if you smoke, have high blood pressure, or elevated cholesterol levels. Physical activity such as walking can improve your circulation.

Foot deformities. Because of conditions like neuropathy, the bone structure of the foot can actually change. This change may affect the normal pressure distribution, resulting in corns and calluses. Over time, the joints in the foot may become deformed, causing hammertoes. If left untreated, hammertoes can cause the foot to become more rigid and surgical treatment may be necessary.

Ulcerations. Because of the reduced sensation and nerve damage that diabetes can cause, calluses and corns as well as minor cuts, bruises and blisters can go undetected. Over time, these wounds can worsen and develop into ulcers. Ulcerations of wounds can be serious due to the possibility of developing

gangrene, which is a decay of the foot tissue. If these ulcerations get to the point where they cannot heal, amputation may be necessary. According to the Centers for Disease Control, an estimated 86,000 individuals require lower limbamputations as a result of diabetes each year.

Diabetes is a disease that should be taken seriously, especially when it comes toyour feet. Talk to your doctor about the special considerations you need to takewith your feet, from conscientious care to proper footwear.

Keeping pace with your diabetes

The American Diabetes Association estimates that one in five people withdiabetes who seek hospital care do so for foot problems. To ward off many of thefoot problems mentioned above, appropriately fitting and/or custom footwear can go a long way to good foot health.

In many cases, your primary care physician can refer you to an orthotist, who issomeone who is certified to measure, design, fabricate, and fit orthoses. He orshe can evaluate your feet and prescribe either custom molded shoes or insertsbased on your specific needs.

Orthotic footwear has come a long way over the years, and is available in dress,casual, work and athletic styles to fit your lifestyle. Medicare Part B patients withdiabetes now qualify for a partial reimbursement of orthoses including depth and custom molded shoes, shoe inserts or modifications. Check with your primary care physician to see if you qualify for these benefits. If you do, your physician will sign a Statement of Certifying Physician for Therapeutic Shoes form, then you will receive a footwear prescription to be filled by a qualified orthotist.

According to the National Diabetes Information Clearinghouse, a comprehensivefoot care program for those with diabetes can significantly reduce amputationrates anywhere from 45 to 85 percent. Maintaining proper foot care and foot wear on a daily basis can go a long way to promoting your diabetic health.

How to care for your diabetic feet

• Wash and dry daily, using a mild soap and warm water. Use lotion to prevent cracking, but avoid the area between your toes.

• Check your feet regularly for corns, calluses, ingrown toenails, blisters, cuts, sores or redness. If you notice any of these, contact your physician before using any at-home treatments.

• Cut your toenails after bathing.

• Avoid walking barefoot. In the winter, take special precautions to ensure that your feet are protected.

• Wear socks of a natural fiber (cotton, wool, or blend).

• Make sure you have comfortable shoes that have been fitted by a qualified individual or orthotist. Avoid shoes with heels and pointed toes.

Shoe-shopping tips• Shop for shoes in the afternoon, when your feet are at their greatest expanse.

• Bring the socks you intend to wear with the shoes with you when you try them on.

• Since shoe size can change with age and weight, measure your feet. If one foot is larger or wider than the other, buy the size that fits the larger foot.

• Stand upright and wiggle your toes to make sure you have enough room. Presson the top of the shoe gently – there should be least a quarter to a half-inch ofspace between your longest toe and the end of the shoe.

• Make sure the shoe is wide enough and that the ball of your foot doesn’t feel compressed.

• Feel the inside of the shoe for anything that might rub or cut your foot, such as

a tag or seam.

• Examine the soles of the shoes to see that they provide adequate cushioningand protection.

• Walk in the shoes on both carpet and hard surfaces to make sure they don’tpinch or slip. Don’t assume you can “break in” a shoe that doesn’t fit well in thestore.