Foot Health Awareness is vital for people with diabetes.
PEOPLE WITH DIABETES ARE 25 TIMES MORE LIKELY TO LOSE A LEG THAN PEOPLE WITHOUT THE CONDITION
Today I want to issue a timely reminder to people with diabetes who want to wear ‘Crocs’.
Last Friday, I saw a patient who “lived in her ‘Crocs’.” That was until she got splinters which penetrated the soles and stuck into her big toe, as she was walking across the university campus. The splinters were removed by her GP and today she told me there was a small remaining piece that also had to be removed. Fortunately, although she has neuropathy, the wounds are healing well.
Last Christmas, a family member (with no diabetes) also had a piece of metal go through the sole of his ‘Crocs’, whilst walking across the garden.
Previously, I have not taken a strong stand on this, but these two events have prompted me to express my opinion in the form of a WARNING.
If you have diabetes, think very carefully about wearing ‘Crocs’. If you have poor circulation or reduced nerve sensation; do not wear them outside the home.
EVERY 30 SECONDS A LOWER LIMB IS LOST TO DIABETES SOMEWHERE IN THE WORLD
Every person who has diabetes, should have an annual foot examination. Feet, along with kidneys and eyes, form the “terrible triad” as it is sometimes called in medical circles; because people with diabetes can develop peripheral arterial disease or peripheral neuropathy(feet); nephropathy(kidneys) and retinopathy(eyes). I have spent the past two days conducting the Annual Foot Examination for people who attend the Potchefstroom Centre for Diabetes (CDE).
How many people with diabetes undergo this annual examination? Who knows? What is certain is that CDE members have to comply with rules which gives them access to all the basic health care professionals they need. (CDE is a Managed Health Care network of over 250 medical practices contracted to certain medical aid schemes).
The benefit of this annual examination is that patients, families and health carers know if the feet are at risk of developing futher complications associated with diabetes. The examination involves checking vascular, neurological, dermatological and orthopaedic status. Footwear is also checked and commented on. The International Consensus for managing the diabetic foot states that early identification of vascular insufficiency and referral to the vascular specialist does save many limbs.
Worldwide of course there is evidence that smoking damages your health, but even in the group at Potchefstroom there were smokers. All of whom had diminished circulation, plus the typical signs of cool feet, absent hair, discoloured pink/blue feet – especially when hanging over the side of the examination couch – and a cough.
Checking the state of sensation is vital for good diabetic foot health. The loss of sensation – neuropathy – is often an insidious process, not being fully appreciated by the patient until they are aware of “funny feelings” in their feet. Patients describe sensations of “pins and needles,” “shooting pains,” “ants running over my feet,” “I thought my sock was folded over under my foot, but it wasn’t,” “it feels like I’m walking on cotton wool” and many others. This could be the first step to damaging the foot and developing an ulcer.
People with diabetes get all the conditions that affect the rest of us. However, if not identified and managed properly an area of callus(which indicates increased local pressure) can easily develop into an ulcer. Various nail conditions are common amongst people with diabetes, especially fungal infections and they are difficult to get rid of.
They structure of any foot affects its function and so in the diabetic foot assessment we look at the alterations in shape that could cause load increases and potential blister or ulcer sites. In addition disorders such as gout are very often associated with diabetes.
Footwear is responsible for at least 50% of foot ulcers, so this is examined very carefully. Unfortunately, many people do not have suitable footwear, so it’s important to check it and give good advice.
Diabetes is a life-threatenting disease, but modern medicine has moved to early diagnosis and treatment and an important part of this is recognition by podiatrists of the signs in the feet. However for the person with diabetes one of the simplest acts to ensuring long life is to have your feet examined annually and know your foot status or risk.
Loss of sensation and reduced blood flow to the lower limbs and feet are a well known complication of diabetes. As winter progresses, people with diabetes are at increased risk from problems associated with damage caused by trying to keep the feet warm. The lady I wrote about on May 7 is still at high risk.
Fortunately she is sticking to her care routine and the toe has stabilised. The blistered skin dried and formed a hard crust – actually this is a dry gangrenous crust – has formed over the centre of the wound, but the edges are clean and pink. The primary key to a successful outcome is control of blood sugar and that is good. Secondary is the quality of wound care and hopefully we are up to standard.
The biggest problem we have when treating diabetic foot ulcers is to keep weight off, called off-loading. Naturally, this is very difficult for a patient who knows they have a foot ulcer, but doesn’t feel any pain. Remember, pain stops us from doing further damage to an injured body part.
Here are a few WINTER FOOT TIPS FOR PEOPLE WITH DIABETES.(It’s winter in the southern hemisphere).
Keep up the daily washing and drying -especially drying
Keep up/start a daily routine of gently massaging moisturiser into your legs and feet
Remember that your shoes may become tighter because you are wearing socks and closed shoes
When you take off your shoes, check your feet for tell-tale red marks – this means dangerous pressure
Check that your shoes do fit, you possibly haven’t worn then for some months
Thicker-soled shoes will keep your feet warmer
Don’t let your boots squeeze your calf muscles and reduce circulation
Keep your feet warm at night – wear socks. NOT nylon, but cotton or wool or mixtures
Heat your bed BEFORE you get in and turn off electric blankets and heating pads. Remove hot water bottles
Try to avoid sitting in draughts – difficult, because we have houses that are designed for coolness
Wrap a blanket around your legs and feet if you are in a cold room
Never sit too close to any fire or heater – (people have fallen asleep and burnt their legs & feet)
Try to keep your excercise routine going, even though it’s darker morning and evening
p.s. Cape Mohair make excellent socks