By Brian Bailey, DPM – Body-Mind-Spirit Podiatric Center
If you have diabetes, taking good care of your feet is essential. The most basic and critical thing one can do to avoid the complications of diabetes is to control blood sugar levels. But that isn’t enough.
People with diabetes are at high risk for developing sores on their feet that won’t heal. Clinically, we call these non-healing wounds. They are defined as sores that don’t improve after four weeks or that don’t heal after eight weeks. This includes both diabetic foot ulcers and venous-related ulcerations.
Diabetics are at higher risk for developing non-healing wounds because of two common complications of diabetes – neuropathy and peripheral artery disease, or PAD.
NEUROPATHY is the medical term for nerve damage. It is characterized by tingling, numbness, or weakness in the affected area. It typically occurs in the extremities, the hands and feet, and is thus called peripheral neuropathy.
Neuropathy can make it difficult – if not impossible – for patients to feel anything, including pain, in the affected areas. For this reason, it’s recommended that those with diabetes examine their feet at least once a day for sores, blisters, redness or other signs of irritation. Many patients use a mirror during the exam, which allows them to see the bottoms of their feet and between their toes.
I can’t stress enough how important the visual exam is. If you are uncertain how to do it, or if you need assistance in learning the process, please speak with your primary care provider or call my office for an appointment. We will be happy to teach you and give tips to make it easier.
PERIPHERAL ARTERY DISEASE, or PAD, occurs when the blood vessels of the lower leg, ankles, feet or toes become narrowed or blocked, restricting or stopping the flow of nutrient-rich blood to the lower extremities. Wounds require these nutrients – and oxygen – to heal. Without sufficient blood flow, wounds to the lower extremities can take longer to heal, or not heal at all.
There is a simple test that can measure circulation in the extremities. It’s called an ankle-brachial index study. It involves taking blood pressure readings in the arms, legs, ankles and toes and comparing them.
The comparison allows us to see whether blood flow is restricted. Additional testing, such as an ultrasound, may be indicated.
Treatment for PAD typically involves an outpatient vascular procedure, called angioplasty, during which a vascular surgeon opens the blocked arteries, in the same way a cardiologist might open blocked arteries in the heart. Medications might also be prescribed to reduce cholesterol levels and thin the blood.
Some things you can do to improve circulation include drinking lots of water (64 ounces a day); stopping tobacco use (nicotine constricts the blood vessels); massaging your feet and lower legs with a foot cream designated for diabetic use; and following a healthy diet. Exercise, in the form of a 30-minute walk most days of the week, is nearly always prescribed.
When people with diabetes suffer from both neuropathy and PAD and don’t practice good foot care, the consequences can be dire. To reduce your risk of diabetes-related foot complications:
1. Practice good foot care. Inspect your feet daily. Visit the podiatrist every three months to have your nails trimmed and feet checked. Never, ever go to a nail salon to have a pedicure or your nails trimmed.
2. Wear shoes that fit, neither too tight nor too loose. I recommend shoes with a large toe box made of breathable materials. Talk to your podiatrist for specific recommendations.
3. Inspect your shoes before you put them on. Ensure that seams are smooth, insoles are in good condition and there’s nothing inside the shoe (such as a small rock) that could rub your foot and cause a sore.
4. Always wear shoes. People with diabetes should not go around barefoot, in flip-flops or other non-protective footwear.
5. Ask about having the test for peripheral artery disease. Signs that you may have poor circulation include lack of hair growth on the lower leg; pale skin coloration; pain when you walk or climb stairs that goes away when you rest; a feeling of weakness/fatigue in the legs; and cramping in the buttocks, legs, thighs or feet. If you have any of these, be sure to mention them to your doctor.
If you develop a wound on your toe, foot or lower extremity, pay close attention to it and get in to see your podiatrist right away. Signs to watch for include worsening pain; foul odor; a wound that is growing or showing no signs of scabbing/tissue development; redness, swelling; and discharge that is thick or yellowish.
Podiatrist Brian Bailey, D.P.M., sees patients at his office located at 500 14th Street in Ashland. New patients are welcome. For more information, call 324-3668.
Brian K. Bailey, D.P.M., is a podiatrist with Body-Mind-Spirit Podiatric Center in Ashland, Ky. The office is located at 500 14th Street, at the intersection with Central Avenue. New patients are welcome. For more information, please call the office at (606) 324-FOOT (3668).
Dr. Brian K. Bailey is a Podiatric Physician & Surgeon with a private practice located in Ashland, KY. He is also a Clinical Professor of Podiatric Medicine & Surgery at Pikeville College of Osteopathic Medicine and a Personal Wellness Coach & Fitness Trainer. Dr. Bailey has written several books, including: Secrets to Happiness, Inner Peace and Health, Metabolic Syndrome 2011, Nutrients for Prostate Cancer Prevention and Eradication, Breast Cancer Prevention and Wholistic Treatment, and Prostate Cancer Prevention and Wholistic Treatment.
500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT