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What is the diabetic foot?

Dr. Daniels Diabetic Foot Blog , , , ,

If you have diabetes, one of the most common issues and concerns is your foot.  Your foot is a complex structure consisting of 26 bones, 33 joints, and 120 muscles/ligaments/nerves[1].  Each structure has a unique purpose, and diabetes can causes alternation in function for any of them.

The most common problem we see in diabetics is diabetic peripheral neuropathy.  This is nerve damage that is a result of elevated glucose that is the root cause of all other diabetic foot problems.  With neuropathy, there are 3 main types; Sensory, Autonomic, and Motor.  While most people have an understanding of the loss of sensation associated with sensory neuropathy, the other two types can cause significant problems, and must be considered in any article about the diabetic foot.

Autonomic nervous system is part of your body responsible for involuntary action.  These are things like your heart beat, dilation and constrictions of the blood vessels, and secretion of natural skin oils, called sebum.  [2]  In the diabetic foot, these cause changes in the flow of blood to the foot, the amount of sweat your foot can produce, and how fast the blood flows.  These symptoms develop over years of disease progression, and the progression is enhanced under poorly controlled glucose levels.[3]

Motor neuropathy is a progressive loss of muscle tone and strength.  This results in weakness and muscle atrophy.  Most common in the upper and lower extremities, symptoms include cramping, twitching, and muscle wasting.  As in sensory and autonomic neuropathy, diabetes is a common cause, but other factors can contribute to each of these problems.  [4]  Motor neuropathy is the cause for problems associated with progressive hammertoe and bunion deformities.

When diabetes causes complications to your foot, it is related to each one of these types of neurologic conditions.  Sensory loss creates a situation where you can’t feel your foot.  Autonomic changes allow skin to become dry, atrophic, and easily damaged.  Motor neuropathy causes changes in the foot shape and mechanics, increasing pressure points, leading to the development of musculoskeletal imbalance.

I always tell my patients that when it comes to diabetes, if you live long enough, you are subject to all of these problems.  That being said, the better controlled your diabetes is, the longer and slower these symptoms progress, and the less likely to result in an infection, ulceration, or amputation.  Good quality foot care, proper shoes, glycemic control, and some education can go a long way in preventing loss of limb or life, a problem that occurs 73,000 times a year.[5]  This number is more than half of what it was 20 years ago due to proper education and better understanding of these problems.

 

[1] http://www.nytimes.com/health/guides/symptoms/foot-pain/print.html

[2] https://medlineplus.gov/autonomicnervoussystemdisorders.html

[3] https://medlineplus.gov/ency/article/000776.htm

[4] https://rarediseases.info.nih.gov/diseases/11011/multifocal-motor-neuropathy

[5] http://www.healthline.com/health/diabetes/diabetes-amputation#is-it-needed2

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Diabetes and podiatry; what’s the connection?

Baltimore Foot Doctor, Baltimore Podiatrist, Healthcare News, Healthy Feet, Healthy Feet Blog , , , ,

Foot complications in diabetes are common yet the link between the two is not very well-known. Here to tell us more about it ahead of World Diabetes Day on 14 November is specialist and author for Journal of Foot and Ankle Research Trevor Prior, with colleague Debbie Coleman.

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Winter Foot Care Tips to Keep Your Feet Healthy

Baltimore Foot Doctor, Baltimore Podiatrist, Healthy Feet, Healthy Feet Blog , ,

Whether you’re slogging through deep snow and sub-zero temperatures in the north, or contending with dampness, chill, and muddy conditions in the south, it’s important to take care of your feet all winter long. You’ll want them to be healthy and ready for action when spring finally arrives.
Most Americans will have walked 75,000 miles by the time they turn 50. Is it little wonder, then, that APMA’s 2010 foot health survey found that foot pain affects the daily activities—walking, exercising, or standing for long periods of time—of a majority of Americans?

“Each season presents unique challenges to foot health,” said Matthew Garoufalis, DPM, a podiatrist and APMA president. “Surveys and research tell us that foot health is intrinsic to overall health, so protecting feet all year long is vital to our overall well-being.”

APMA offers some advice for keeping feet healthy in common winter scenarios:

Winter is skiing and snowboarding season, activities enjoyed by nearly 10 million Americans, according to the National Ski Areas Association. Never ski or snowboard in footwear other than ski boots specifically designed for that purpose. Make sure your boots fit properly; you should be able to wiggle your toes, but the boots should immobilize the heel, instep, and ball of your foot. You can use orthotics (support devices that go inside shoes) to help control the foot’s movement inside ski boots or ice skates.

Committed runners don’t need to let the cold stop them. A variety of warm, light-weight, moisture-wicking active wear available at most running or sporting goods stores helps ensure runners stay warm and dry in bitter temperatures. However, some runners may compensate for icy conditions by altering how their foot strikes the ground. Instead of changing your footstrike pattern, shorten your stride to help maintain stability. And remember, it’s more important than ever to stretch before you begin your run. Cold weather can make you less flexible in winter than you are in summer, so it’s important to warm muscles up before running.

Boots are must-have footwear in winter climates, especially when dealing with winter precipitation. Between the waterproof material of the boots themselves and the warm socks you wear to keep toes toasty, you may find your feet sweat a lot. Damp, sweaty feet can chill more easily and are more prone to bacterial infections. To keep feet clean and dry, consider using foot powder inside socks and incorporating extra foot baths into your foot care regimen this winter.

Be size smart. It may be tempting to buy pricey specialty footwear (like winter boots or ski boots) for kids in a slightly larger size, thinking they’ll be able to get two seasons of wear out of them. But unlike coats that kids can grow into, footwear needs to fit properly right away. Properly fitted skates and boots can help prevent blisters, chafing, and ankle or foot injuries. Likewise, if socks are too small, they can force toes to bunch together, and that friction can cause painful blisters or corns.

Finally—and although this one seems like it should go without saying, it bears spelling out—don’t try to tip-toe through winter snow, ice, and temperatures in summer-appropriate footwear. “More than one news show across the country aired images of people in sneakers, sandals, and even flip-flops during the severe cold snap that hit the country in early January,” Dr. Garoufalis said. “Exposing feet to extreme temperatures means risking frostbite and injury. Choose winter footwear that will keep your feet warm, dry, and well-supported.”

Source: APMA

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REPORT: Office Visits by Patients With Diabetes Rising Rapidly in United States

Baltimore Foot Doctor, Baltimore Podiatrist, Healthcare News, Healthcare Politics, Healthy Feet Blog , , , , , , ,

Office visits in the United States for diabetes rose 20% from 2005 to 2010, with the largest increase in adults in their mid-20s to mid-40s, according to a new data brief from the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS).

Nearly 29 million people in the United States have diabetes, putting them at risk for other chronic conditions, such as heart disease, eye disease, and stroke, Jill J. Ashman, PhD, and colleagues from the NCHS note in the brief.

On an annual basis, the cost of diabetes in the United States approaches $245 billion, and patients with diabetes have medical expenditures 2.3 times those of patients without diabetes.

The researchers analyzed recent trends in office visits by patients with diabetes using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal office-based physicians (excluding anesthesiologists, radiologists, and pathologists).

They found that office-based physician visits by patients with diabetes rose from 94.4 million in 2005 to 113.3 million in 2010 (a 20% increase). Visits by patients with diabetes made up about 11% of all office-based physician visits in 2010.

The number of office visits increased during the study period for all age groups except for those younger than 25 years. The largest percentage increase (34%) occurred in people in the 25- to 44-year age range.

However, the volume of visits was higher for older adults; individuals aged 65 and older made 53.7 million visits in 2010 compared with 2.6 million visits made by those younger than 25.

The researchers did not see any marked change in the rate of office visits by patients with diabetes in any age group during the study period. The highest rate in 2010 was among those aged 65 and older (1380 visits per 1000 persons) and lowest in those younger than 25 (20 visits per 1000).

“Diabetes is not the only health concern for the majority of patients who have it, with 87% of visits being made by patients who have additional chronic conditions,” Dr. Ashman and colleagues say.

Regardless of age, they found that patients with diabetes use “extensive health resources,” making frequent trips to the doctor and often receiving multiple prescriptions.

One of the federal Healthy People 2020 goals is to reduce the disease and economic burden of diabetes. “Continuing to examine office-based physician visits by patients with diabetes is especially important given changes in standards of care that may influence such visits,” Dr. Ashman and colleagues say.

Source: Medscape

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8 Great Suggestions for Diabetic Foot Care

Baltimore Foot Doctor, Baltimore Podiatrist, Healthy Feet , , , , , , ,

1.) Maintain a blood sugar level of 70 to 130 mg/dL before your meals and less than 180 mg/dL two hours after you’ve started your meal, with a haemoglobin A1C level that is less than 7 percent. This can be achieved through regular exercise, monitoring how often and what you are eating, keeping up with medications prescribed by your doctor, and monitoring your blood sugar as often as is necessary for optimal control.

2.) Never walk barefooted. Seashells, glass, or other ocean debris can cut your skin and cause serious infections without you realizing it. Walking barefoot on a hot pavement or hot sand can also lead to severe burns or infections. Avoid wearing sandals, as sand and other foreign bodies can still get into the sandal. Podiatrist, Cyaandi Dove, advises all her diabetic patients to choose closed shoes over flip-flops and sandals to give their feet maximum protect. She says: “Insects can still have access to your feet and cause problems with bites and other infections. Rather than saying that you should never wear sandals, I would say that you should be very vigilant when you do wear them.”

3.) Be shoe wise. Wearing shoes that are too big or too small can cause blisters or calluses. Measure your feet each time you buy new shoes. It’s is normal for adult feet to change sizes four or five times during your lifetime. Weight fluctuations, changes in the weather, and poor circulation can all alter the shape and size of your foot.

4.) Be sock wise. Choose socks that have no seams. Seams will rub against your skin and cause blisters.

5.) Wash and inspect your feet and shoes daily. Give your feet a daily wash. Inspect your feet before putting on your shoes and once more when you take them off. If you are not flexible enough to see the base of your foot, use a magnifying hand mirror. Shake out your shoes before you put them on and make sure there is no debris that will rub against your feet. Although a tiny grain of sand might not be felt, it could lead to serious infection if it is not treated properly.

6.) Trim toenails. Don’t let your nails get long and overgrown. Trim them straight across, and, if necessary, file down the edges.

7.) Use skin lotion for your feet. As a preventative, Flexitol Heel Balm can reduce the risk of infections and foot ulceration in diabetic patients keeping the skin optimally hydrated. Rub a thin coat of Flexitol Heel Balm on the top and bottom of your feet, but not between the toes. Excess moisture can also lead to fungal infections, so let the balm soak into your skin for a few minutes before putting on socks on covering up your feet.

8.) Visit a podiatrist before and after your vacation. Fungal infections tend to happen a lot more when the weather is heated and increased in moisture. Your feet might also increase in calluses because you have switched to summer footwear. Do not try to remove corns, calluses, or warts on your own. Even over-the-counter products for removing corns and warts may cause burns or damage to your skin that cannot be repaired. Your podiatrist will help you manage minor infections and ensure that they do not lead to serious complications.

Sources: http://www.digitaljournal.com/pr/1282575#ixzz2sMMwFuEF, http://www.diabetes.org.uk/Documents/Reports/State-of-the-Nation-2012.pdf