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Diabetes affects every part of the body, even when the disease is under control. Diabetics have fewer defenses against everyday wear and tear, especially where the feet are concerned. They also heal less quickly and are prone to infection. Diabetes affects the feet in the following ways:
1. The sugar affects the nerves of the feet, causing peripheral neuropathy. Peripheral neuropathy is a disease which can produce anything from strange feelings in the feet (burning, tingling, numbness, etc.), to a complete loss of sensation. The lack of sensation makes the diabetic more likely to injure their feet without knowing it. This makes the diabetic more susceptible to infections; fractures which are not felt, and do not heal properly; and severe bone and joint disease which changes the contour of the foot.
2. High blood sugar also affects the smaller blood vessels in the feet causing peripheral vascular disease. This decreases the amount of blood, nutrients, and oxygen that are brought to the skin, fat, muscles, joints, and bones of the feet. This causes tissues to be reabsorbed by the body and it causes an inability to properly heal anything from small cuts to broken bones.
3. Re-absorption of the natural protective fatty pad on the bottom of the feet. This is due to P.V.D. and/or the natural aging process. When the fat pad becomes thinned or completely absorbed, it cannot protect the skin properly from normal bone pressure. This puts tremendous stress on the skin which underlies these bones, and can cause inflammation, calluses, and eventually skin ulcers which may become infected. These problems may become worse without the diabetic knowing it, if peripheral neuropathy is present.
To sum up, the diabetic foot is "at risk," even when the blood sugar is controlled. In my practice, I have found that 'diabetic' custom-made orthotics will greatly reduce the risk of foot disease. These special orthotics act as a replacement for the thinning fat pad on the bottom of the feet, thus protecting the skin from excessive bone pressure. These orthotics will also gently support the arch and all the bones and joints of the feet. Our orthotics are made of durable, comfortable, space-age materials. They are lightweight, and will fit in most shoes. Custom-made orthotics are the diabetic's "ounce of prevention" that may eliminate a "pound of cure" later on.
Other risk relievers:
1. Examine your feet daily including the tops, bottoms, and between your toes. Look for inflamed areas, cuts, peeling and breaks in the skin, rashes, and swelling. Press on your nail to see if they are painful or ingrown. Touch your feet and make sure the temperature is the same in both, and that they are not cooler then the rest of your body. Test to see that you have good feeling in the bottom of both feet, by gently moving your finger from heel to toes. If any of the above is abnormal, see a doctor immediately.
2. Wear properly fitted shoes, with uppers made of soft materials. The toe box (the area where the toes lie in the shoe) should be deep and wide to reduce pressure on the toes, and the heels should be no higher than 3/4 inch. Seamless socks and shoes cause less problems then those with seams. Always wear shoes and socks; they protect the feet from injury. Do not walk barefoot!
3. Wash your feet daily, with warm water (not hot). Dry well, especially between the toes. Cut your nails straight across, do not dig in the corners (if the skin around the nail is red, swollen, moist, or painful, you may have an infection, see a doctor immediately. Before sleep, apply a moisturizing cream into your feet to prevent dry skin and cracks. Do not use chemical corn and callus removers; they usually contain an acid, which can burn sensitive diabetic skin. And most importantly, see your family doctor regularly to help keep your diabetes under control.
What to do?
An assessment by Dr. Pisarek at Advanced Healthcare will help to determine the 'state' of your feet. Simple hygiene advice along with stretches to exercises in order to mobilize and strengthen the muscles of the lower limbs and feet will be of benefit to improve one's mobility. Dr. Pisrek will also consult with your physician and/or endocrinologist (diabetic specialist) to determine and make sure that your diabetes is properly managed.
Also of great benefit will be the use of a 'Footmaxx' computerized custom foot assessment to determine if custom-made 'diabetic-type' orthotics would be of benefit.
Finally, nerve irritation in the lower back can often cause lower limb instability and weakness in the legs. Therefore, Dr. Pisarek at Advanced Healthcare will also assess the spine.
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.