How to keep from slowing down
If your feet don't hurt, you may not give them a passing thought. No pain, no problem, right? Actually, people with diabetes often suffer from a type of nerve damage that causes them to gradually lose sensation in their feet. Could danger lurk within those strappy Ferragamos of yours?
Consider the gentleman who recently showed up at a Chicago-area emergency room with a nail in his foot. The patient, a foreman on a construction site, had been walking on the nail for six days without knowing it, says David G. Armstrong, DPM, PhD, a professor of surgery and director of the Center for Lower Extremity Ambulatory Research at Rosalind Franklin University of Medicine and Science in North Chicago, IL.
'And it wasn't, by the way, until he'd heard the tap, tap, tap on the linoleum that he realized it,' Dr. Armstrong adds.
More than 20 million children and adults in the United States have diabetes, nearly a third of whom are living with the disease and don't even know it, says the American Diabetes Association.
If you or a loved one has been diagnosed with diabetes, you probably know how important it is to keep blood glucose levels in check. If the disease is not well controlled, it can cause loss of kidney function and may lead to blindness. It is a major risk factor for stroke and heart attack. But Armstrong says the most common reason that someone with diabetes ends up in the hospital is for an infected foot.
Nerve damage, or 'neuropathy,' is a major cause of foot problems in people with diabetes. It can dull a person's sense of hot, cold and pain, creating an environment in which injury can strike without notice. When you can't feel your feet pounding the pavement, you risk forming blisters or calluses that can become infected.
Poor circulation is another culprit. Without proper blood flow to the feet, it can be difficult for the feet to fight infection and heal. And because of skin changes in people with diabetes, the feet can become dry, causing the skin to crack and peel.
And that's just the tip of the iceberg. All too frequently, an open sore, or ulcer, that becomes infected leads to amputation of a toe, a foot or a limb. According to the International Diabetes Federation, people with diabetes are 15 to 40 times more likely to lose a leg than people who do not suffer from the disease. Every thirty seconds, someone in the world loses a lower limb due to diabetes. In the United States alone, 82,000 people with diabetes lose a foot or leg each year.
'This is an almost entirely preventable problem,' Armstrong insists. 'If patients were able to identify problems early, I would say, to be conservative, we could reduce half to two-thirds of these problems.'
Joseph M. Caporusso, DPM, a trustee of the American Podiatric Medical Association (APMA), stresses prevention when he sees patients in the largely Hispanic and Mexican-American community of McAllen, Texas. Because people of color are at higher risk for diabetes than non-Hispanic white Americans, many of the individuals who come to see him have diabetes-related foot problems but don't understand how the disease affects their feet.
'We try to educate them at every visit, and we give them information in both English and Spanish,' he says. 'We explain to them if they wait too long for pain to come about, they'll be too late.'
The APMA is doing its part to raise awareness through an educational campaign cleverly titled 'Knock Your Socks Off' that urges people to remove their socks and shoes at every doctor visit. A simple foot screening could help to diagnose diabetes earlier and catch potential problems before they flare up, the APMA says.
People with diabetes should be evaluated by a podiatrist at least once a year, and more frequently if there is a problem or if a person needs special care. For example, if you suffer from nerve damage or poor circulation or have other physical impairments such as poor eyesight, obesity or arthritis, you shouldn't attempt to trim your toenails, smooth a callus or remove a corn. You should see a podiatrist for your routine foot care
On the other hand, there's plenty that people with diabetes can do on their own to ward off foot trouble. 'No physician is going to be with them 24 hours a day, seven days a week,' notes Caporusso, 'so they need to take an active role.'
Podiatrists say people with diabetes should inspect their feet at least once a day for signs of trouble. If you suffer from this disease and cannot reach or see your feet, have a loved one help you. Look for redness, swelling, blisters or wounds that won't heal. Any of these can be an indication of trouble. So can a foot that is misshapen or warmer or colder than usual.
And don't forget to examine between your toes for anything usual. A case of athletes' foot, say, can cause cracks in the skin that can harbor infection.
To keep your feet healthy, wash them daily and dry them well, especially between the toes. A bit of moisturizer applied to the tops and bottoms of your feet can help prevent cracking and drying. But to prevent fungus from growing, don't use lotion between your toes.
Caporusso recommends that people with diabetes wear shoes that have some cushioning, are thick enough to protect the bottoms of their feet and are 'appropriate' for their feet. 'Lots of times I tell my patients: Take a piece of paper, draw your foot and, if you can't, have your grandchildren draw your foot?- the outline?- on a piece of paper, and then draw your shoe. If your foot's a lot wider than your shoe, that's not an appropriate shoe.'
Does that mean trading in the Nicole Millers for comfortable flats? 'Women are a little more susceptible to wearing those pointy, nice-looking shoes,' Caporusso observes. 'So, yes, you need to be a little bit careful with that.'
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