Here is exactly what we asked our panel of experts:
- What tips would you give to someone who is newly diagnosed?
- Why do you think a lot of people ignore their foot care when it comes to diabetes?
Dr. Ira H. Kraus, President, American Podiatric Medical Association
A1: The most important tip I would give to anyone newly diagnosed with diabetes is to include a podiatrist in your care team. That may seem like a self-serving tip! But independent studies show that when a podiatrist is involved in caring for a person with diabetes, that person’s risk of hospitalization and diabetes-related amputations goes down dramatically. Seeing a podiatrist once a year can help you prevent diabetic ulcers, and if you do develop an ulcer, seeing a podiatrist can help reduce the risk of amputation by up to 80 percent.
I would also suggest that people newly diagnosed with diabetes simply pay close attention to their feet. Prevention can be the key. Watch your feet daily for any changes, and if you see something that concerns you, get in to see your podiatrist as soon as possible!
A2: A diabetes diagnosis can be overwhelming. It comes with a lot of lifestyle changes and a lot of concerns. Our feet are literally the furthest things from our minds, so it’s not surprising that many people overlook them as they’re growing accustomed to living with diabetes. Also, many people don’t understand the serious complications diabetes can cause in the feet, and by the time they realize there’s a problem, it is a significant problem. People do not realize that simple things that they have been living with for years like: dry skin, athletes foot, skin fissures or calluses can lead to serious complications.
The good news is that those small steps of examining your feet once a day and seeing a podiatrist once a year for a checkup can really help to prevent some of the more serious complications of diabetes.
1. Dr. Howard S. Shapiro
A1: A person who comes to me as a newly diagnosed diabetic or even someone who has been diabetic for a some time, I discuss with them the following things with regards to foot care:
- Never walk barefoot. Always wear the appropriate shoe for the activity you are performing.
- Inspect your feet daily. Making sure to check between all your toes and the sole of your feet. if you unable to bend down to see the bottoms of your feet try using a mirror or ask someone at home to look for you.
- Dry well between toes to avoid moisture build up and prevent athlete’s foot infection.
- Apply moisturizer to both feet and lower legs twice daily, avoidplacing between toes.
- Check water temperature with hand prior to bathing/showering.
- Do not use hot water bottles or heating pads to the feet or legs.
- Inspect shoes routinely to look for any torn seams, nail points, foreign objects. Do not wear garters or rubber bands to hold up socks/stockings.
- Do not wear shoes without socks or stockings.
- Do not try to cut calluses or corns with any sharp objects. Avoid using over the counter corn treatments as they can be dangerous.
- Do not try to dig out any ingrown toenails.
- Do not ignore any pains, redness or other signs of infection. Prompt attention is mandatory
- If they are smokers I implore them to quit as smoking can decrease circulation to the legs and feet which may already be impaired in diabetic patients
- Lastly, to call the office with any concerns or questions.
A2: I feel that the diabetic population who ignores their feet are the ones who never previously had any problems with their feet.
Unfortunately a large percentage of diabetics (60%) suffer from neuropathy, which is nerve damage to the feet, hands, lower legs. Most people do not look at their feet unless there is a problem.
Generally neuropathies will start with intermittent periods of numbness/tingling, a lot of times this can even go unnoticed by the patient and is first detected by the podiatrist during an examination. Diabetics who never had problems with their feet and now have a neuropathy may have problems but due to these neuropathies, absence of feeling, and absence of pain they are unaware of these problems. Unfortunately sometimes it can be too late.
2. Dr Christina Teimouri
A1: The first and best advice I would give someone newly diagnosed with Diabetes is to find a good Podiatrist. Find one who listens and actually asks what you had for breakfast, lunch and dinner. If you have no current problems, I would recommend a yearly exam.
If you have poor circulation, neuropathy, or thick deformed nails, you should be seeing your Podiatrist every other month for care. Any time you injure your foot or have a cut or blister, go see your Podiatrist immediately! Don’t wait with diabetic foot problems. This allows us to deal with them when their small and avoid all the terrible things you hear about or can imagine.
A2: A lot of people ignore their foot care when it comes to Diabetes. The primary reason Diabetics ignore foot care from my experience is fear.
They are afraid of what the Dr is going to say. They thinks if they ignore it, it will go away. But a diabetic foot infection doesn’t go away; it just gets worse and harder to care for.
So call your Podiatrist at the first sign of redness, swelling, with or with pain.
A second reason a person with diabetes may ignore their feet is apathy. Inertia is a law of physics and never is it stronger than when you know you should do something but you just don’t get around to picking up the phone. This is when you have to be like Nike and “Just do it”.
While having regularly scheduled Podiatrist appointments is very important, if a problem arises don’t wait for your regular appointment thinking you can hold on until then. Sometimes a week or two makes all the difference between getting an antibiotic prescription and going home to heal uneventfully versus going directly to the hospital for IV antibiotics and an amputation.
I advise reading the following material:
Lastly, some patients with diabetes just don’t know any better. No one ever educated them on the proper care of their feet, or the fact that their feet are different with more challenges than those without diabetes. It is imperative that Primary Doctors #1 have diabetic patients take off their shoes at every appointment and look at their feet (many can neither see nor feel their feet), and #2 refer each diabetic patient to a Podiatrist for regular foot care. This will catch many problems early and eliminate literally millions of amputations every year.
3. Dr. Paul G Klein
A1: Upon receiving a new diagnosis of foot care pathology the patient should understand first and foremost that it usually wont just disappear by ignoring it. Common sense prevails and over the counter treatments or professional medical care is needed. Simple problems require simple treatments but complicated issues require one not to depend upon internet medicine
A2: Patient with diabetes ignore the symptoms associated with their feet because it usually has been a long term progressive climb in symptoms before they become worried or concerned. Most patients never take their shoes off during years of primary care examinations. Symptoms of burning or tingling are thought to be associated with weather or arthritis to the uneducated. Feet hidden in shoes all day don’t get the attention your face or hands get.
4. Dr. Ian S. Goldbaum
A1: The first thing a patient needs to do is realize that everything is going to change in terms of how they take care of their feet. What used to be labeled as a harmless cut or blister now can become something far worse if left untreated. The first thing a newly diagnosed diabetic needs to learn is to work a foot check — the bottom, the top and even in between toes — into their daily routine. A podiatrist should also be called upon to keep tabs on the health of their feet, especially if there are any signs of infection or abnormalities. Given how diabetes negatively affects circulation, even a small scape on the bottom of the foot has the potential to turn into a serious ulcer, as your body’s ability to get a proper amount of blood flow heading to your lower extremities becomes more and more limited. For this reason, increased attention to the state of your feet is one of the key changes all diabetics need to make in order to remain healthy.
A2: A lot of the time ignorance isn’t intentional, but rather due to a lack of an education regarding diabetic foot care. When a patient is diagnosed with diabetes, typically the first thing they think of is their diet and what’s going into their body rather than how the disease is going to affect what’s already there. I’m sure if everyone were shown pictures of the effects of diabetic neuropathy, especially what an untreated ulcer looks like, they would be more aware of the attention that needs to be paid to their feet. When looking at the big picture, diabetes needs to taught as an all-encompassing condition, rather than focusing on specific area. The best thing a patient can do is be pro-active in their treatment rather than re-active, and that’s how we approach things at our offices.
5. Dr Bob Baravarian
A1: Shoes are key. Soft mushy soles cause a lot of foot pain. The stiffer the sole of the shoe, the better the support. If that is not enough, add a stable arch support. If you have diabetes, make sure to check your feet daily. If there is a blister or an opening in the skin, make sure to get it checked and taken care of as soon as possible. Also, foot pain for longer than a week is not normal and must be checked.
A2: Some don’t know they have diabetes. Those who do, think of their eyes and kidney much more than their feet. It usually takes a problem such an an ulcer to make the person wake up and really realize how risky the foot problems can be. It is essential that primary doctors and endocrinologists educate their patients as gatekeepers and refer patients who are higher risk to foot and ankle speclialists for further assessment if there is any issue.
6. Dr. Kevin A. Kirby
A1: Individuals who have been recently diagnosed with diabetes need to be told that, for the first time in their lives, they will need to start paying very close attention to their feet. The skin of their feet will likely become drier and need to be moisturized. If they develop neuropathy and lose the capacity to feel their feet, they will need to visually inspect the bottoms and tops of their feet on a daily basis to ensure they don’t have any blisters, cuts or open sores on their feet. They will need to stop going barefoot and wear at least a sandal or bedroom slipper around the house to avoid stepping on sharp objects which they may no longer be able to feel. In addition, they need to find a podiatrist and establish a relationship with them so, in case they do have a foot problem, they can be immediately seen and treated. They also need to understand that taking proper care of the feet is important in diabetics, due to the many complications including bone infection, partial or complete amputation of the foot and leg that can occur regularly in patients with diabetes. Proper foot care in the diabetic can be the difference between life and death.
A2: Individuals with diabetic neuropathy, where the nerves of the foot gradually stop functioning properly, are at a distinct disadvantage since they often can’t feel painful stimuli from injuries to the foot that would occur from events such as rubbing a blister on their toe from a tight shoe, stepping on a thumbtack or breaking a bone within their foot. Because of this numb-foot sensation, diabetics are lulled into a false sense of security since for all the years they have lived before developing diabetes, they have only paid attention to their feet when their feet became painful.
Now, with diabetes and the inability to feel pain anymore, individuals with diabetic neuropathy typically ignore their numb feet thinking that without pain, there can be no injury or infection. Patient education on diabetic neuropathy is the key to saving the feet and lives of diabetics.
7. Dr. Pedram A. Hendizadeh
A1: What tips would you give to someone who is newly diagnosed in regards to their foot care? They need to check their feet daily. Check for blisters, corns, calluses, areas of irritation or any breaks in the skin. It is very important to check between their toes to ensure there is no signs of athletes foot or break in the skin.
A2: Why do you think a lot of people ignore their foot care when it comes to diabetes? May diabetics ignore their feet because they can not feel their feet as well as non diabetics due to diabetic neuropathy (loss of feeling) Since they don’t have pain they assume all is ok. Additionally many diabetics are overweight and it is hard for them to reach their feet and care for them.
8. Dr. Anthony R. Hoffman
A1: Foot care tips for a newly diagnosed diabetic patient includes a daily foot exam looking at toes, between toes, tops/sides and bottoms of feet for any signs of blisters or open sores. If they cannot see the bottoms of their feet, they should use a mirror or have a family member do the exam. They should wash their feet daily and use a cream based moisturizer to prevent dry skin that can crack and become infected. Also, trimming toenails with toenail scissors (instead of clippers) straight across and leave a little length to the nails and not cut the corners at an angle. If the toenails are damaged or fungal then a Podiatrist should be seen for proper care. I prefer they leave the calluses alone and have a Podiatrist shave these down. The salicylic acid patches burn normal and callused tissue and I have seen a lot of infections from these products. They should buy their shoes at the end of the day when there may be a little swelling so the fit will be better. Also I recommend they go to a shoe store with trained employees on shoe fit otherwise they may wear a shoe that is too tight or narrow and if they have neuropathy (numbness) in their feet these will cause blisters that progress to foot ulcers and infections. They should have annual eye, heart, kidney exams as well as annual diabetic foot exams unless they have a problem that would require a more frequent visit.
A2: The biggest reason I feel patients ignore their feet when it comes to diabetes is that they because they may have numbness they feel everything is normal and neglect problems sometimes until it is too late. Also, unfortunately, a lot of diabetics are obese and physically can’t see their feet or even reach their feet to see if there is a problem. Also, they do not realize that Podiatrists are the feet experts that take care of these issues and are the best resource for diabetic foot education. We are also suppliers of diabetic shoes and accomodative insoles to prevent foot problems. I always tell my diabetic patients if there is a new problem with your feet whether it is skin or the shape of the foot I would want to see it and take care of any problems before they become a life changing situation (amputation).
9. Dr. Sarah Burns
A1: If you have been recently diagnosed with diabetes, there is a lot of new information to absorb and lifestyle changes your doctors may be asking you to make. It can be overwhelming! After diet changes, exercise, eye checks, and heart health, the last thing on your mind may be foot care. However, knowing some simple information about how diabetes can affect your feet can help prevent many problems. Try to establish good foot care habits now, so that if things change, you are aware of them.
Diabetes can cause numbness in the feet. This numbness can happen slowly, so you don’t notice it. Because of this possibility, a good habit to form is visually inspecting your feet every day – don’t trust that you will feel pain if there is a problem. If you can’t see the bottoms of your own feet, place a mirror on the floor, so the bottoms of your feet are reflected up to your eyes. Or, recruit a loved one to inspect your feet. You are looking for changes to the skin – cuts or scrapes, especially if they aren’t healing; blisters; open wounds; redness, swelling, pus or bleeding; callus.
With your daily foot check, apply a moisturizing lotion to the top and bottom of each foot, not in between the toes (it gets too moist). Avoid foot soaks; shower and dry in between your toes instead. Water should be warm, but never hot. Never walk barefoot, even at home or on the beach. Athletic shoes or firm-soled slippers are preferred to prevent stepping on something or getting a cut. Cut your toenails straight across and file rough edges – avoid bathroom ‘surgery’ for in growing nails, corns or callus.
Lastly, have your feet checked at least once a year. A podiatrist can provide this, but recruit your other physicians as well. If you are seeing your primary care doctor – take your shoes off, without waiting to be asked! If your shoes are off, they can easily see if anything needs attention. These steps can help to prevent problems – specifically wounds on feet and infections that can lead to amputations.
A2: (No comment for this)
10. Dr. Thomas M Rocchio
A1: When a diagnosis of diabetes is received there is a tremendous amount of information thrust onto the patient. Much less today than in years past, the effect on the lower extremity is not an immediate focus by the primary care doctor. This could lead to devastating results. I believe that one of the most dangerous effects of diabetes is the progression of peripheral neuropathy. Negative outcomes associated with neuropathy are complicated in their presentation. Many times unrecognized by the patient, neuropathy has been associated with foot deformity, ulceration, and eventual amputation. I am very aggressive with conservative prophylactic treatment that starts with patient education. Working with the primary care doctor on close blood sugar control is vital. Exercise and diet cannot be minimized in this patient population. Over the past 10 years I have prescribed neuropathic supplements to my diabetic patients. These medical foods have shown benefit in reduction in the negative effects of neuropathy by the patient. Folic Acid, Alpha Lipoic Acid, B6, B12, and D3 are my ‘go to’ medical foods. With my surgical specialty of diabetic limb preservation and reconstruction, it is impossible for me to fully review the potential effects of diabetes on the lower limb in one article. A newly diagnosed diabetic needs to form a group of specialist that will help educate, identify, and treat problems as they arise.
A2: (No comment for this)
11. Dr. Richard M. Cowin
A1: When someone is newly diagnosed with diabetes mellitus, I believe they should see a podiatrist immediately for a complete foot examination and counseling appointment. During that appointment, the podiatrist should review the patient’s medical history with them and then perform a complete foot examination which would include checking the skin, nails, circulation, nervous system, as well as general orthopedic an biomechanical evaluation.
The skin should be checked for texture, the presence of any skin lesions, cracks, sores ulcerations, or bacterial or fungal infections. The nails should be checked to see if there is any ingrowing of the toenails or any fungal infections of the nails as well as to determine whether or not the toenails are being trimmed correctly.
Many doctors believe that when a person develops diabetes, their vascular system ages at twice the normal rate. So, for example, a 50 year old person who has been diabetic for 15 years may have the vascular system or a 65 year-old individual. Both the arteries and veins are checked in a podiatric vascular examination.
Also, many people with diabetes, especially those whose diabetes is poorly controlled, suffer from neuropathy. Utilizing a Semmes-Weinstein filament, the podiatrist can determine whether or not the patient’s feet have lost feeling/sensation in their feet and, if so, how much has been lost. Some diabetic patients actually lose protective sensation in their feet so they could literally be walking on a nail and not be aware of this. In recent years, more accurate testing of the small nerve fibers has also become available.
Finally, a check for common foot problems like bunions, tailors bunions, hammertoes, flat feet (pes planus) and high arched feet (pes cavus) is performed.
The counseling portion of the podiatric visit involves recommendations from the podiatrist as to proper shoe gear and shoe inserts, the use of diabetic socks, proper nail trimming techniques, the treatment options for any foot problems identified in the exam, and the proper method for self-examination of the feet on a daily basis by the patient. I frequently suggest certain vitamin supplements to support the nervous system of my diabetic patients. If vascular or neurological problems are identified, it may also necessitate a referral to a vascular specialist or neurologist.
A2: The reason that most people who are newly diagnosed with diabetes ignore their foot care is because they are in denial of the reality of the profound effects diabetes can have on the human foot. In many cases, diabetic patients, especially women, do not want to be told that it is medically necessary for them to give up their fashionable dress shoes. Another common reason that diabetic patients choose to ignore their foot care is that since the feet are usually covered by shoes and socks, they are “out of sight and out of mind.
12. Dr. Kyle Perry
A1: The greatest piece of advice I could give would be to work yourself into a regular routine of checking your blood sugars, both at home checking your BGLs and with your GP for your HbA1c. By checking these scores a patient with diabetes limits the chance of developing Peripheral Neuropathy. Peripheral Neuropathy is the reduction or total loss in both sensation and/or blood flow and is the leading pre-cursor for lower limb amputation. Peripheral Neuropathy can be assessed at any time and is recommended that you seek an appointment with a podiatrist as soon as you are diagnosed so your risk factor of developing Peripheral Neuropathy can be monitored and controlled. You should be meeting with your podiatrist at a minimum of twice a year for regular neurovascular testing.
A2: Personally I believe there is a lack of public appreciation for the full impact that diabetes can have on your overall foot health status. Australians have a very “she’ll be right attitude” when it comes to health in a lot of cases and foot care is unfortunately one of those. The harsh reality of uncontrolled diabetes and foot care is ulcerations, infections and ultimately amputations. Without a doubt not an issue to take lightly. With appropriate foot care the fear and risk of lower limb amputation becomes a very distant reality, so talk to your podiatrist, check your feet regularly and you can really limit and control the issues associated with diabetes. You can’t look after your diabetic control alone, use the amazing community of podiatrists we are afforded and take control of your foot health along with your overall diabetic health.
13. Agnes Osei
A1: Newly diagnosed diabetics need to ensure they have connecting information centres such as nurses to advice them on their nutrition, lifestyle changes and arrange for regular 6-12 months screening and foot care education information.
Aim to keep blood sugars and lifestyle and general health under control to aid reduction in further damage that can occur to the body’s blood vessels and nerves which further reduces the quality and amount of peripheral circulation, sensation to the lesser extremities.
Any deficit in blood flow reduces the body’s ability to heal and repair in case of injuries such as stepping on sharp objects, scratches from cutting nails and skin or general skin dryness.
Damage in nerve and circulatory systems can affect muscular and skeletal systems cause bone and muscle changes which can cause more friction or pains in shoes and on walking.
Due to these, regular daily foot checks, moisturising, daily hygiene and wearing protective clothing on the feet are always advised.
Regular visit to a podiatrist or qualified persons for regular foot review and assistance in cutting nails and removal of hard skin or any other foot or skin problems, especially in those with poor eyesight and manual handling.
They can also give advice in best footwear for you and offer Inserts into footwear to relieve painful walking. Podiatrist can connect with nurses and doctors and other professionals who can help address a diabetics complications better and more holistically.
A2: Some may seem like they ignore their feet because they probably don’t feel there’s anyting wrong with their feet. Or they don’t know what to do regarding where to go for help if there’s a problem there or simply unaware of the kind of problems to be aware of.
Loss of peripheral sensation is the major reason advising people to pay more attention to their feet is important and visit for their regular diabetic review to ensure any changes in their health and feet/legs can be spotted and treated and any ongoing health promotion, education in their condition to be issued.
14. Dr. Richard Mendelsohn
A1: I always recommend to primary physicians when they diagnose their patient as diabetic that they get a foot evaluation base line. Many of these patients have never paid attention to their feet and when they are diagnosed with diabetes it becomes imperative they do. A visit to their local podiatric physician will document their foot condition at their diabetes diagnosis. By evaluating the dermatological, neurological, Vascular and Orthopaedic condition at this juncture, any changes will be picked up on their yearly evaluation visits. This visit will give the physician time to discuss with the patient proper preventative diabetic foot care. In addition, any problems found at this visit can be treated before they progress. We advise patient to check their feet daily, especially between the toes. The use of a mirror can be used to examine the bottom of their feet. I also advise them to make sure their shoes fit by going to a local orthopedic shoe store. If they have a pair of well fitting shoes, they should always place their hand in them before putting them on, to make sure there is nothing in them. Any overly worn shoes should be replaced. Socks should be materials that wick away moisture from their feet and do no have any raised seams. I always advise my patients to avoid soaking their feet in water unless someone else can check it to make sure it is not too hot. As far as preventative care goes, I do NOT recommend they cut their own nails or remove corms with over the counter products. Something as simple as a skin cut can turn into a serious infection. A routine visit to their neighborhood Podiatrist can save them problems in the future.
A2: I refer to the old adage , “Out of sight, out of mind” for most patients including diabetics. We cover our feet with socks and then put them in shoes. Many diabetics tend to be overweight and have issues getting down to their feet. Hygienic care tends to be a source of many of their problems. When you add on neuropathic problems, the patients have no alert that a problem is starting. In addition, some diabetics are terrified of foot problems that they ignore warning signs until it it too late.
15. Dr. Jennifer S. Sartori
A1: We educate all our newly diagnosed diabetics on the effects diabetes can have on the feet including poor healing potential, decreased sensation and circulation. We advise patients to check their feet daily and to call immediately if they are concerned about an area. We do not advise diabetics soak their feet especially if they have decreased sensation. We have our diabetics moisturize daily but avoid applying moisturizer between the toes.
A2: I believe diabetics ignore their foot care because they are not educated on the effects of diabetes. They are not aware that diabetes also affects the feet.
16. Dr. Jennifer Nicole Falk
A1: There are multiple complications and co-morbidities of diabetes that can show up in the lower extremities, including peripheral neuropathy (loss of sensation), vascular disease, and foot deformities. Therefore, it is vital that persons with diabetes closely check their feet on a daily basis and they receive routine (annual or more frequent) evaluations by a specialized healthcare provider.
Things to look for:
- Skin discoloration – Increased redness can be a sign of infection. Purple or black can be a sign of poor circulation and skin necrosis.
- Blister – Do not pop any blisters. Instead, closely monitor for signs of infection (e.g. increased redness, swelling, pus drainage) and notify your doctor right away.
- Open wounds/sores – Keep the area(s) covered/protected and notify your doctor right away.
Things to do:
- Look at your feet daily, or have a family member (or friend) do it for you.
- Never walk barefoot.
- Wear white socks so you are more likely to notice any drainage coming from your foot.
- Look inside, and shake out, your shoes before putting them on.
- Use moisturizer on your feet to keep them hydrated, but avoid putting it between your toes as it can make it too moist and actually cause the skin to break down.
- Visit your foot care specialist at least once a year to get a thoroughly foot evaluation.
- Ask your doctor if you qualify for custom diabetic inserts and diabetic shoes
- Contact your primary care doctor, or podiatrist, if you notice anything unusual and go to the emergency department immediately when signs of infection (increased redness, swelling, pain, pus drainage) or symptoms of infection (nausea, vomiting, fevers, chills) are noted.
A2: Many people, whether they have diabetes or not, habitually ignore their feet and routine care for them. If something does not hurt, they tend not to think about it or feel the need to see a physician. People still do not think about going to the doctor for preventative care. They only go when it is necessary, which can be too late in certain cases. This mentality needs to change, though, especially for those with diabetes.
As we know, diabetes is oftentimes associated with other medical conditions, including peripheral neuropathy, vascular disease, and foot deformities, all of which can increase the likelihood of foot problems, including the risk of lower extremity amputations. Fortunately, many persons with diabetes qualify for preventative routine foot care, so it is important for these people to take advantage of this service. It is even more crucial for them to be educated on diabetes and how it can affect their feet so they understand the significance of checking their feet on a daily basis and, even more so, the importance of seeing their primary care provider and their podiatrist, routinely.
17. Dr. Nicole Freels
A1: We see a lot of apathy at first with a new diagnosis. Our culture has led us to ‘walk it off’ and ‘play through the pain’ when it comes to our feet. We just don’t see them as a priority. So, when a newly diagnosed diabetic becomes a first time patient in the clinic, we have to cut through the clutter a bit to ensure they understand the significance of the possibilities. For example, without trying to use a shock value tone, we gently take them through the scenario of what it might be like in 10 years to have no legs or be dependent on a wheelchair if they don’t quit smoking. These are the scenarios they need to picture themselves in and work backwards to avoid that outcome. We have to make sure that preventative maintenance is not just something that we’re preaching; we have to explain WHY it’s important and set the expectation if they don’t comply. Pardon the pun, but we don’t ‘sugarcoat’ our diabetic education.
A2: Here are a couple reasons why we see the lack of compliance in regards to diabetes in our office. Sometimes the patients are too heavy to see their feet easily. Out of sight, out of mind. Others are arthritic and daily checks aren’t that easy to perform. Some have neuropathy and don’t feel any pain, so they assume all is well. And yet for others, it can be a mental thing, combined with other socio-economic factors.
I mean, if you’re struggling to make ends meet, sometimes getting the proper exercise feels like a luxury instead of doctors’ orders. Sometimes our diabetic patients have so many other problems that start to snoball in conjunction with the diagnosis. They may have additional health issues or financial struggles that compete for attention.
18. Dr. Benjamin W. Weaver
A1: Diabetes is not a death sentence. If the patient and I work together as team they can live a long healthy life. It is my job to educate the patient to inspect their feet daily. Inspect their shoes on a daily basis, looking for foreign objects in them.
You can see in the first attached picture, there is a roofing nail that goes straight through the shoe causing an ulcer. The patient never knew it was there only saw blood on her sock.
A2: The biggest thing is if people cannot see it or feel it, then it is not a problem. That is why my job is important to educated the patient on what can happen to their feet. I have to give them the tools to survive.
The second attached picture was another diabetic that came to my office with diabetes, neuropathy and poor vision. You or I would have been miserable with the pressure on our toes, he felt nothing. The patient just bought bigger shoes.
19. Seth Stinehour (no longer a licensed podiatrist) A1: My tips for someone newly diagnosed with Diabetes would be to make an appointment and get to know a Podiatrist in the area, so you have someone you can go see and trust in case of emergency. The big key is prevention, stop walking barefoot, inspect your feet daily if you can. If something seems unusual or does not seem right about your foot ask a Podiatrist or your general practitioner about it. Remember the earlier a problem is detected the better the chance of it being rectified. A2: I think people ignore their foot care with Diabetes is because Diabetes is hard, maintaining a blood sugar takes a lot of times every day. Additionally, so many things that you need to be vigilant about from your eyes to your feet are thrown at you that sometimes foot care just gets lost in the weeds. I don’t think its intentional its just a product of a disease that strikes so many places at once.
20. Dr. Dyane E. Tower
A1: As a newly diagnosed diabetic, you should keep a close eye on your feet. There are a few serious things that can happen to your feet as a result of having diabetes. When sugar levels are high in the blood, it can affect the way your nerves work; this is called diabetic peripheral neuropathy (DPN). DPN frequently results in numbness, tingling or burning sensations and can result in losing your ability to feel what is going on with your feet. There are also structural changes to the feet, or deformities thatcan result from the neuropathy. With changes in the structure of the foot and the inability to feel them, minor trauma (cuts, scrapes, or even repetitive activity like walking) can result in an open sore (ulcer) on the feet.
As with any break in the skin, you could get an infection. High blood sugars make it easier to get an infection and reduce your immune system’s ability to fight that infection. If the infection gets out of control, hospitalization and an amputation (removal of part or all of the foot) may be the best treatment option. Also, diabetes increases the chance of hardening the arteries in your legs, which makes healing a sore or fighting an infection even more challenging. Keeping your blood sugars under control can help reduce the chance of these complications, or at least delay the onset of them.
- Check your feet every day. If you can’t reach your feet to see the bottoms, use a mirror or ask a friend or family member to help. Don’t forget to check between your toes. You are looking for changes in the color, temperature, and consistency of the skin and also for any cuts, scrapes, bumps or bruises.
- Dry well between your toes after bathing.
- Wear clean and dry socks, preferably white. With white socks, you are more easily able to see blood or drainage if there is a problem.
- Do not walk barefoot. Always have your feet protected and wear appropriately sized and shaped shoes. Check inside your shoes before you put them on.
- Avoid extreme temperatures (don’t rest your feet on heaters or hot/cold surfaces).
- If you smoke, quit. Ask your doctor about resources to help you quit.
If you can’t feel your feet, see a podiatrist for routine foot care (cutting your nails and checking your feet).
- Add a podiatrist (DPM) to your healthcare team.
A2: I am not sure people with diabetes ignore their feet per se. Some people with diabetes have peripheral neuropathy, which is the inability to feel their feet. It frequently results in numbness, tingling or burning sensations to the feet and legs. When people can’t feel their feet, they may just not pay as much attention to them. It is important in these instances to pay more attention to the feet to prevent serious complications such as open sores (ulcers), infection, hospitalization and amputation.
21. Amy Leverett
A1: Get to know your feet well-wash, dry and inspect your feet every day, and seek treatment early if you do get a foot injury. Be sure that your health care provider checks your feet at least once a year – more often if you have foot problems. Your health care provider should also give you a list and explain the do’s and don’ts of foot care. Most people can prevent any serious foot problem by following some simple steps and by seeking more information about how to care for your feet from a podiatrist or credentialled diabetes educator.
A2: In the clinic, I regularly see clients who are unable to see, feel or reach their feet. Early on, when these changes are happening in your feet, you might not notice the diabetes symptoms in your day-to-day life, which is one of the reasons why someone might ignore the subtle signs and hope they go away. Often these issues starts out at the tips of the toes and like a glove pattern, it goes up to the arches, heels, ankles and leg. It is important to remember that diabetes is a condition that has to be respected otherwise the implications can be life changing.
22. Dina Gohil
A1: People newly diagnosed with diabetes should ask as many questions as possible about their condition and how it can impact the body especially the feet. Always check your footwear and your feet; if you are unable to cut your own nails, notice any callus , corns or any discomforts and pain. Then see a podiatrist to have safe regular treatments. The appointment will also check for vascular and neurological status of both feet.
A2: It is easy to forget about your feet since they are the further away to reach and with everything new required to be implemented but remember they are the best foundations your body has. So look after them well.
23. Daniel Gibbs
A1: Your feet are very much in danger of being affected by Diabetes, and account for the majority of Diabetes-related amputations. This is because high sugar levels in the blood can affect nerve and blood supply to your feet, which means you might feel strange sensations or numbness, and cuts or grazes may not heal as quickly as they normally would. A cut that goes unnoticed can become infected, and you can end up losing a toe – or worse, the whole foot!
Get into the habit of checking the skin on your feet regularly, and notify your foot doctor (Podiatrist) if you start to feel any numbness in your feet, or anything unusual. Protect your feet by wearing shoes when outdoors, moisturize the skin on your feet every day with a moisturizer containing Urea, and wear diabetic socks which are usually elastic free to promote better circulation to your feet.
A2: People ignore their feet because they can be hard to reach, or because they don’t feel them as much due to the nerve damage. The changes can be gradual or rapid, and often people don’t realise there’s a problem until it’s too late, which is why Diabetes sufferers should have their feet checked by a Podiatrist regularly. A Podiatrist will perform quick, painless tests to monitor the nerves and blood supply to the feet, and help prevent problems developing.
24. Dr. Jeffrey Miller
A1: The first question is a very broad one to answer. I treat individuals from infancy to geriatrics with conditions that vary from foot and ankle deformities, sports injuries, fractures of the foot and ankle, bunions, hammertoes, warts and ingrown or fungal nails. Each one has a unique set of instructions that is specific to their condition and age. Overall I do an assessment of their condition, review x-rays if taken, and order additional testing ie lab work vascular testing and MRI’s. They leave my office with a clear understanding of what comes next from either a non surgical or surgical perspective and treatment plan. If necessary foot hygiene and shoe gear are discussed.
A2: The diabetic patient is always a challenge when it comes to compliance. I call it the diabetic mental neuropathy. They seem top be in denial about their disease. I feel we have been told since childhood that if we are good we can have an ice cream or candy and now they have to curtail their sugar intake. So its almost like a punishment to follow a more strict diet. Lastly many diabetics have peripheral neuropathy and do not have any feeling in their feet. They don’t check their feet and inside their shoes regularly and sometimes don’t discover the trouble they are in until they notice a foul smell from their feet or a stain on their socks.
25. Caron Orelowitz
A1: There are a few things you can do to care for your feet—here are some helpful tips:
- Keep your diabetes under control. Be sure to maintain your blood sugar in the range that your doctor recommends. Work with your healthcare team to manage diabetes and prevent complications
- Check your feet daily. Look for calluses and corns, blisters, dry skin, cracks, redness or swelling and infected toenails. Heel calluses can crack and become infected. Don’t forget to check the space between your toes. If you have trouble checking your feet, use a mirror or ask someone to inspect them for you
- Make sure your feet are always clean. Wash your feet in warm water, using mild soap. And dry them very well, especially between the toes
- Keep your skin smooth. Apply a thin layer of lotion to your feet to keep them soft
- Trim your toenails. If you are able to see them, trim your nails straight across, or use an emery board to file them. If you are unable to do this, ask someone to help you
- Protect your feet from the extreme hot or cold. First test the water with your hands or elbow before putting your feet into hot water to avoid burns
- Avoid walking barefoot. Wear shoes and socks to protect your feet
- Wear shoes that fit. Buy shoes that are comfortable and provide enough cushioning and support
- Keep blood flowing to your feet. Wiggle your toes for about 5 minutes about 2 or 3 times a day, move ankles up and down. Keep your feet up while sitting, and avoid sitting for more than an hour.
- Also avoid crossing your legs. Stand up and walk around whenever possible
- Stop smoking (if you smoke). Smoking can contribute to poor blood flow
- Seek professional advice if you notice any changes or develop problems
A2: Here are some helpful tips:
- Have not been educated as to the implications or complications of the disease
- Lack of understanding of disease and implications and complications
- Because the feet are so far away from the rest of the body they don’t feel they are important
- Feelings of isolation
- No family, peer support
- Lack of resources
- Socio-economic factors
- Financial – lack of finances
26. Dr Tea
A1: Daily foot checks especially the bottom of the feet and in between the toes. Patients with diabetes will suffer from drier skin than normal. This will lead to skin sores and cracks, possibly infection as well. If you spot changes in your skin, like a callus, blister or crack, it would be a good idea to establish care with your local podiatrist.
- If you cannot see your feet, have a family member help inspect daily. Number one reason for amputation is not catching these problems early.
- Wearing white socks will help if you accidentally step on something and it bleeds. The white sock will collect blood and be easier to see.
- Change your socks daily with fresh clean socks. This allows the feet to air out and prevent fungal infections.
- Avoid barefoot walking, even in the house. Have a separate pair of house shoes so that you don’t accidentally step on sharp objects that can injure your feet.
- After showering or bathing, dry in between the toes. A collection of moisture in between the toes can cause the skin to break, another source of infection. Also avoid applying lotion between the toes for this reason. Make sure feet are dry before donning on socks.
A2: A lot of people do not know the importance of good foot hygiene because they just don’t know. It’s a body part that we rely on everyday but is taken for granted until something serious takes it away from us. I think people with diabetes have to deal with a lot of general medical issues so the feet are the last thing they want to think about. Some people are afraid to lose their feet so avoid podiatrists overall. People in general think feet are gross too! And it can be if you let it.
The problem I see with people who have advanced diabetes is that they will have other issues such as difficulty seeing or loss of sensation in their feet (neuropathy). So if they were to accidentally step on something that causes an infection, they do not have the protective sensation signaling the patient that something is wrong until it’s too late. Plus, it may be difficult to see the bottom of your feet, whether from retinopathy or bending over. Just like dental care, feet need the same attention and I recommend routine foot evaluation every year for newly diagnosed diabetics, more often if they have additional co-morbidities like neuropathy, wounds, a history of amputations or a new problem. I hold tight relationships with high-risk patients because the last thing I want to see is an amputation. There are additional problems once they head down this road.
27. Dr. Jon Sherman
A1: I have taught many newly diagnosed diabetics the main tips are to keep their blood sugars as close to Normal as possible. They are to not ignore foot wounds or injuries which are not getting better. A small infection can quickly turn into a full blown infection and possibly lead to amputation. We always fit in any diabetic with a foot problem ASAP at Kentlands Foot and Ankle Center Diabetics deal with 2 main problems in their feet- Neuropathy-Or loss of feeling in their feet. And Angiopathy- Decreased circulation.
Due to the toes being the end of the line/furthest from the brain and heart the infection can be harder and slower to heal vs. a non diabetic.
Daily foot inspection is important to catch small infections before they become a big infection. A mirror is very helpful to place on the floor if the patient is unable to see the bottoms of their feet. Select shoes carefully and check with their podiatrist to see if they are eligible for a free pair of diabetic shoes and inserts to prevent blisters, ulcers from the start.
A2: They ignore their feet because it is under cover all the time in a sock and hides in a shoe so unless there is pain patients just think all is fine. In the Diabetics who have Neuropathy a few days of not inspecting the feet can lead to a ulcer very quickly. Corns and Callouses are a sign that there is too much weight and pressure to that area and need to be evaluated by their podiatrist to prevent them from becoming an ulcer.
A lot of Diabetics are in denial and too busy with so many other health issues that the feet come last.
The feet are easy to ignore until there is a problem. They give us many years and miles before they begin to start talking back with common problems.
A simple problem like a cut is easy to ignore until it becomes infected.
28. Dr. Daniel T. Hall IV
A1: The first thing I tell my newly diagnosed patients with diabetes about their feet is that daily inspection is required. I recommend purchasing a small mirror to inspect the bottoms of their feet on a daily basis. It’s affordable, effective and it only takes a few minutes. These patients must be keenly aware of any changes that are occurring because this is often the first sign of a problem. Research has shown that 80-90% of patients with diabetes will develop neuropathy in their lifetime. Neuropathy, simply stated, is dysfunction of the nervous system causing symptoms of pain, tingling, numbness and/or burning.
Eventually, neuropathy will progress to decreased sensation or the inability to ‘feel’ . Patients may develop imbalance and mistake these changes as clumsiness or step on a sharp object and have no idea it punctured the bottom of their foot. Inspection and early recognition are key. 70% of lower extremity amputations can be avoided with appropriate podiatric care.
A2: I think too many people, those with and without diabetes, take their feet for granted. It is the most neglected portion of the human body because it is usually covered or easily hidden and protected. Many people suffering from diabetes have decreased or altered sensation to their feet. If they do not have or cannot sense pain, foot care often becomes an after thought. Some may have co-mordities such as obesity or arthritis that makes it difficult to perform and maintain adequate foot care and hygiene. Others are unaware of the potential dangers associated with diabetes. More than 30 million people in the United States have diabetes, 1 in 4 of those people do not know they have it. The estimated cost of diabetic ulcer care is $11 billion dollars annually. Early diagnosis and appropriate referrals to qualified foot specialists is how we better educate patients, substantially decrease the risk of unneccesary amputation and improve our patients quality of life.
29. Alaa Razak
A1: It is dependent on whether it be a biomechanical condition or dermatological condition. Since I specialize in biomechanical I will answer that one.Many podiatric conditions, include pain in certain parts of the foot. The pain is usually associated with either a muscle or tendon problem or a bone injury. If diagnosis included bone injury, the key tips for foot care is rest and immobilization from the area (common areas are heel or the balls of the feet). Rest and immobilization also includes avoiding strenuous work activities or extensive sporting activities.If it were a muscle or tendon involvement then, there is a healing strategy that all health and medical practitioners use called ‘POLICE’. It stands for Protection, Optimum Loading, Icing, Compression and Elevation. This a rehabilitation strategy for patients to apply when they are healing from muscle or tendon injuries. It allows speeding up recovery and reduces inflammation associated with pain in the feet.
Other tips that I recommend when being diagnosed with a podiatric condition, is for the patient to re-frame their thoughts around finding ways to reduce the impacts the condition has on their life. Where it minimally impacts on their current lifestyle – including social, family and work. This involves gaining as much advice from your Podiatrist as possible. Particularly on various ways you can rehabilitate without it effecting your life too much. Gaining that clinical support from your Podiatrist; within the comfort of your own environment.
A2: Diabetes is scary word. With the condition being considered high risk on the foot due to micro and macro vascular affects (as well as peripheral neurological affects), people are highly warned about it. For patients it is the fear of the risk! Hence they take on a ‘ignorance is bliss’ approach. Thus, not wanting to inform themselves on what they need to do for their foot care.Also, Diabetes is a complex condition with other bodily impacts and so the feet being at the end of the body, it is easily forgotten.
30. Dr. Harley Kantor
A1: Regarding a diagnosis of Diabetes, a primary care physician will usually refer the patient to a Podiatrist for an evaluation of their foot and ankle. The primary care physician (internist) will manage the medication and dosage to control the patient’s blood sugar levels. It is important for the patient to see a Podiatrist because many of the symptoms of Diabetes can manifest themselves in the foot. Diabetes can negatively affect the nerves in the body causing neuropathy. This nerve damage can cause burning or tingling pain and loss of sensation in the foot.
With loss of sensation comes the ability to not notice a wound that has formed. Dry skin and calluses are more likely to form, which can lead to ulcers on the bottom of the foot. Ulcers can lead to infections and amputations. Diabetes causes blood vessels in the foot to narrow causing poor circulation. Poor circulation leads to poor wound healing and increased chance for an infection.
A Podiatrist will assess the nerve function, circulation, and skin changes in the feet. It is important for someone who is newly diagnosed to make sure they are seeing a Podiatrist annually for an assessment. Patients should also make sure they are seeing their primary care physician regularly for diet control tips, blood work, and medication management. Primary care physicians and Podiatrists should be working together to manage the Diabetes of their patients.
A2: Many people can ignore their foot care for several reasons. Many of them are not educated on the foot manifestations of Diabetes. They are unaware of all of the effects (from above) that can occur. They are also preoccupied with the total body aspect of having Diabetes. Finding the right primary care physician can be daunting.
Sometimes it takes several different dosages of different medications in order to manage the blood levels correctly. Patients make that the priority usually. Many of them also need to check their fasting blood sugar levels daily. Sometimes it can take a long time for Diabetes to manifest itself in the foot. It may just start with some toe numbness or tingling. For this reason, patients may not be concerned with seeing a Podiatrist initially.
31. Dr Kel Sherkin
A1: My standard mantra is ” the foot is the most used and abused neglected part of the body. It is constantly taken for granted.” I always tell my patients that ‘one pair of feet must last a lifetime’. Over the course of the treatment plan I give to the patient, I also include tips on how to prevent potential foot problems.
Simple hygienic tips on how to take care of one’s feet include daily washing with soap and water, taking care to dry well between the toes. Always inspect the skin and nails. If the patient is suspicious of any problems, they should then contact their local podiatrist for an appointment. I explain the difference between a corn and a callous.
In my explanation I inform them that medicated corn/callous pads should never be used especially if they are a diabetic patient. In my discussion with them I show them how and when to buy shoes and explain the difference between a dress and casual/athletic shoe.
I stress the fact the the Podiatrist should be the first professional they should contact if any foot and lower extremity problems occur or are suspicious.
A2: With regards as to why I think diabetics ignore their foot care, I think that these patients are not fully educated as to the effect of diabetes on the lower extremities and like the general population they dismiss their needed proper foot care. They take note only when foot complications arise and by then it may, in many instances, be too late to salvage their infected foot.
32. Dr. Sue Summers
A1: With a newly diagnosed diabetic, we would always take the time to advise them on the correct foot care. As Podiatrists, it is our job to assess their feet for problems or any signs of changes due to diabetes. We would perform a vascular and neurological foot check, to see if there is any loss of sensation (neuropathy) and examine their feet for any pathology (soft tissue, bony or foot functional issues).
We would prepare a treatment plan, where necessary, and give advice leaflets with reference to caring for their feet in diabetes. I believe that often diabetics ignore their foot care, as they are not aware of the link between diabetes, foot pathology and neuropathy with the increased risks of foot ulceration and amputation.
A2: It is our job, as a podiatrist, to inform, treat and therefore prevent foot ailments from progressing to the devastating point of amputation, since the mortality rate following diabetic amputation is as high as in some cancers.’
33. Simon Miles
A1: Take this condition seriously, but you don’t have to panic. In many cases lifestyle changes can have a very positive effect on the condition, reducing carbohydrate intake and increasing exercise are very simple changes anyone can make that reduces the negative effects of diabetes on the body. If you have Pre-Diabetes (a state of change where you are in the very early stages of the condition), lifestyle changes might be enough to flip you back to being able to control your blood sugar again, essentially making you NOT diabetic. There is a phrase in medicine that goes like this ” if you know diabetes , then you know medicine “, this is essentially saying that diabetes effects almost all the organs and body systems, so, taking this into account for a newly diagnosed patient, patient vigilance and education about diabetes is essential.
If we focus specifically on the feet, usually in the early stages the foot issues are minimal. However as the condition progresses, loss of sensation, reduced blood flow and reduced immune response are of great concern pertaining to the foot. My advice is, get to know you feet, check with a mirror regularly the underside,make a mental note of any changes that occur. Get into good habits now so its second nature when it matters. Simple routines like drying between toes, using emollient with urea in it, having corns and callous removed, and making sure you have regular sensation testing. If your foot posture changes and you notice you are moving differently go and get checked out. Always wear good quality footwear and steer away from shoes that don’t look like a foot should go in them!
A2: In short, out of sight out of mind, foot care is often the last thing to beaddressed by most people unless they are going on holiday or have had problemshistorically. Most of the time people cut their own nails and have very fewissues. As a result if someone is diagnosed with diabetes they would have to a)understand the possible foot related complications associated with the condition, and b) have a regular change of routine. I believe that education is key here,in that if someone has a better understanding then a by-product of this isintrinsic motivation to avoid the nasty complications that might occur.
34. Dr. Thomas Silver
A1: People with diabetes are always being told to take good care of their feet, but it is not always understood why this is so important. What is so different or special about the feet of someone with diabetes?
Diabetes can cause different and more serious foot problems. These problems are often the result of changes in circulation and sensation caused by diabetes.
Circulation changes with diabetes:
Diabetes is considered a “small vessel disease” in that capillary walls can become thicker and weaker over time, reducing blood flow. This can affect the small capillaries in the eyes, the kidneys and in the feet. The small capillaries in our feet bring those substances to the surface of our skin that is needed for healing and for fighting off infection. When these small capillaries become thicker and weaker, then any break in the skin of our feet (even a small blister, scrape, cut or crack) can be slower to heal and more prone to infection.
Sensation changes with diabetes:
Fluctuations in blood sugar can “eat away” at the coating on the nerves (called demyelination) in our feet causing diabetic neuropathy. Neuropathy is any change in sensation…increased, decreased, absent or abnormal sensations. Increased sensation is often manifested by burning, shooting, tingling, ice cold or hot feelings in the feet and can make life absolutely miserable. Decreased or absent sensation can make it difficult to tell when something hurts, such as when a toe is rubbing against the shoe, knowing when you have stepped on something, or being able to tell if something is too hot or cold. This makes you much more susceptible to developing sores that slow healing or become infected, or skin ulcerations (an open hole in the skin), with some requiring hospitalization, amputation or months of treatment in a wound care clinic. Some people may even develop a combination of numbness along with terrible burning pain in their feet. Neuropathy can also affect balance and sleep.
A2: Fortunately the risk of infection, ulceration, amputation and other related foot problems can be greatly reduced with good diabetes control and regular diabetic foot care.
Foot Care Treatments, Services and Products available for diabetics:
- Routine foot care: the non-infected care of corns, nails and calluses on a regular basis
- Neuropathy testing and treatment
- Circulation testing and treatment
- Correction of foot deformities-often with minimally invasive procedures
- Wound Care and Foot Infection Care
- Fitting for shoes and inserts (often covered by your insurance once a year)
- Custom-made prescription foot orthotics and ankle/foot orthotic brace (AFO)
- Compression stockings and special diabetic socks
- Special foot creams and many reusable gel pads, cushions and toe protectors
By taking advantage of the many services available by a podiatrist specializing in diabetic foot care, you can maintain healthy feet and hopefully prevent any disabling foot problems. Remember, you only have one pair of feet and they need to last a lifetime!
35. Stavroula Christaki
A1: Diabetes is a lifelong condition which can cause foot problems. It can either affect the nerves, the feeling in your feet (Peripheral neuropathy) or the circulation, damaging the blood vessels in your feet (ischaemia). There are different types of Diabetes such us Type 1, Type 2 and Gestational. Available treatments to treat diabetes are medication, insulin or diet control. There is no such term as “border-line” diabetic patient. You either are diagnosed with diabetes or not.
These changes can develop gradually and are not always noticeable from the beginning. Diabetes is a silent enemy because there is no physical pain, but when it is uncontrolled a number of areas in the body can be affected such as the eyes, kidneys, arteries, nervous system, blood vessels and lower limbs. High blood sugar can result in a number of health problems. People with Diabetes who have high blood pressure or cholesterol, lack of exercise, increased body weight and are smokers increase their risks of developing complications like heart disease, stroke, nephropathy, retinopathy and lower limbs complications.
The college of Podiatry in collaboration with their special advisory group Foot in Diabetes UK and the British Association of Prosthetics and Orthotists have created two apps based on NICE (National Institute for Health and Care Excellence) and SIGN (Scottish Intercollegiate Guidelines Network) guidelines to enable the knowledge around complications of feet and Diabetes. The Diabetic Foot Screening app for Health Care Professionals and theDiabetic Foot Screening app for people with diabetes.The apps provide detailed and practical information on how to look after your feet. Search for the apps on Google Play and Apple stores using the term diabetic foot screening.
- Have your feet screened every year by the GP, Diabetes nurse or the podiatrist.
- Take regular physical activity
- Check your feet twice per day
- Quit smoking
- Apply emollients on a daily basis not between the toes as there is increased risk of developing Athlete’s foot
- Wash your feet and change socks daily, dry feet very well especially in between the toes
- Avoid low or high water temperature
- Get your feet measured
- Always try on both shoes
- Shoes should fit comfortably, according to the width of your foot and enough space in the toe-box
- Well fitted shoes trainers or boots with laces or strap fastening will give the best support, keep foot firmly in place and will prevent rubbing
- Natural materials are strongly recommended like soft leather or expandable materials
- Always cut nails straight with nail clippers and file the sides round with a metal file
- Avoid walking barefoot
- Never use over-the-counter corn remedies, you will probably end up with burnt skin and the corn or the hard skin will be still there
- Do not buy sock with bulky seams or tight-elasticated tops as they can affect the blood circulation or increase rubbing on the toes
- Do not cut down the sides of your nails as you may create a “Spike” which could result in an ingrowing toe nail
- Do not cut toe nails with pointed- curved scissors, there is increased risk to cut yourself or to create a spike and end up with ingrowing toe-nail
- Do not burst blisters, keep them dry and covered with a sterile dressing, if they do not heal within few days and notice signs of infection contact the GP or the podiatrist
- In the presence of hard skin or corns use a foot file to reduce the thickness and apply emollients, if it persistent you should see the podiatrist, do not use any sharp instruments to remove them
A2: Here is a list of things:
- Walking becomes difficult
- Applying shoes become more difficult
- A part or all of your foot becomes swollen
- Your foot becomes noticeably red or has other unusual discoloration
- A part of your foot becomes much hotter than normal
- There is a discharge of any kind from your foot
- If you notice an unusual smell
- There are open sores or blisters
- You feel generally unwell with nausea, vomiting and high temperature
- You have general difficulty keeping your blood sugar under control
Facts and Figures:
- Diabetes is the most chronic disease in the UK, 3.5 million people diagnosed
- 10 billion is being spend on Diabetes every year
- 700+ people learn they have Diabetes every year
- Worldwide Diabetes related complications result in the amputation of a lower limb every 30 SECONDS
- Many amputations are preventable through access to good quality STRUCTURED CARE and IMPROVED AWARENESS amongst people with Diabetes
- 24,000+ people die prematurely because of Diabetes every year
- 60-70%of those with Diabetes will develop peripheral neuropathy, or lose sensation in their feet
If you discover any problems with your feet, contact your GP, diabetes nurse or the podiatrist. Feet are the base of our body, we need to treat them with respect and not take them for granted.
36. Ben Westaway
A1: Having some knowledge about good foot care is important for everyone, but even more so for those with diabetes. Diabetes can cause changes in the feet that are important to have an understanding of. There are three major things to know:
- Diabetes can impact the health of the nerves in your feet.
- Diabetes can impact on the blood flow to your feet.
- Diabetes increases the risk of infection of cuts or sores on the feet.
Having a good understanding of this, there is then a few tips that will help maintain good foot health over the lifetime:
- Daily foot checks
Check over your feet daily. Look on the sole, and in-between toes. Look for little cuts or sores. The changes in nerve health mean that you might not always feel them, get into the habit of checking daily
- A treatment plan for any small cuts or sores
Dress any of these little spots with an antiseptic, and cover. Monitor it as it heals. If healing is not occurring after a few days, see your podiatrist.
- Regular moisturiser
Find a moisturiser that works with your feet. Cracked heels are a portal for infection, and should be treated seriously.
- Annual Podiatry assessment
Your podiatrist should perform a neuro-vascular assessment at least annually. With this you can track foot health over time, and pick up on changes in nerve or blood flow health early.
If you need assistance with nail care, callous or corns, you will likely see your podiatrist more regularly.
A2: A lot of people ignore good foot care in the entire population, not just those with diabetes. A lot of people normalise pain, particularly low level chronic pain. The “sore feet is just part of life” type of mind set. A message I give all of my patients is – don’t put up with pain. Don’t just accept pain. See someone who specialises in treatment of your symptoms, and get to the bottom of it! For your feet and ankles, a Podiatrist is a good place to start.
37. Rebecca Tatterton
A1: It is important to pay attention and look after your feet if you have diabetes. If poorly controlled this disease can affect the blood supply to the feet and cause a loss of feeling. This may mean foot injuries do not heal well and you may not notice if you have injuries to your feet.
Foot care tips if you have diabetes:
- See an NHS or private podiatrist at least once a year
- Keep your feet clean and free from infection
- Wear shoes that fit well and no not rub
- Never walk around in bare feet
- Cut and file your nail regularly
- Get any corns or hard skin treated by a podiatrist
A2: Diabetes is a life long condition. If left untreated it can cause serious health problems. It can be overwhelming understanding, controlling and managing your diabetes.
Taking the following steps with your healthcare team will help you stay in control:
- Be honest about your health and how you are feeling
- Understand your responsibilities in managing your diabetes
- Attend all diabetes check ups and check your feet for any changes in-between appointment
If you are struggling with your diabetes or have any questions seek advice from your GP, podiatrist and ask for further assistance.
38. Dr. Alec Hochstein
A1: 4 Tips For Someone Newly Diagnosed With Diabetes
When a person is diagnosed with diabetes, they will quickly learn that there are a few new precautions they must take in order to keep themselves healthy, even with the diagnosis. One of the most important things a person with diabetes must be aware of is their foot health. If you have diabetes and are not sure of what needs to be done to properly care for your feet, take a look at these four helpful tips.
Check Your Feet on a Daily Basis: One of the complications of diabetes is nerve damage which makes it harder for a person with diabetes to feel soreness or cracks in their feet. That is why it becomes important to inspect your feet on a daily basis if you have diabetes. You want to look for cracked skin, dryness, sores, or any change in color. To do this, you can place a mirror below your feet to get a thorough look at everything to make sure your feet’s health is in good shape.
Be Careful Around Hot Water: People with diabetes want to be quite cautious about stepping into hot tubs or drawing an extra hot bath. When people with diabetes develop neuropathy or nerve damage, it becomes very difficult for them to be able to tell just how hot the temperature of water is when they step in with their feet. This presents the danger of exposing your feet to scalding hot water which could create blistering and open the door for infection. So before you get into a hot bath or the shower, check the temperature with your elbow to make sure you won’t be putting your feet and overall health at risk.
Don’t go Barefoot: You probably are not walking around your neighborhood or the local park without the proper footwear, regardless of whether or not you have diabetes. But people with diabetes need to be extra careful about being barefoot…even in their own home. When you walk around your house without your shoes, you will be putting your feet at greater risk for cuts, scrapes, and other minor injuries. All of these open wound injuries can lead to infection, which could create serious problems for a diabetic. If you have nerve damage, it becomes even harder to tell if you cut your foot on something in the house, therefore it could be days later when you realize you injured yourself and now have an infection. This problem can easily be avoided by wearing comfortable, clean shoes in your house.
When You Have a Foot Problem, Get it Treated Right Away: If you notice that your feet are suffering from callouses, bunions, blisters, corns, hammertoes, or any other aggravating condition, it is best to get those problems addressed right away if you are a diabetic. Leaving this issue untreated can lead to an infection so as soon as you spot something, make an appointment with your podiatrist. It may be tempting to try to treat the problem on your own with some over-the-counter medication or topical remedy, but in some cases, the treatment can just end up further irritating the skin on your feet. This irritation is not just a matter of making you uncomfortable if you have sensitive skin, it could increase your risk of developing an infection.
Looking for more tips on ways to properly care for your feet as a diabetic? Don’t hesitate to contact us today. Our team of podiatry specialists is dedicated to helping everyone with all kinds of foot conditions get the proper care and treatment needed to maintain optimum health and lead a happy life.
A2: (No comment for this)
39. Dr. Miguel Cunha
A1: People with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort. If some sensation is lost in the foot because of nerve damage, pain may not alert you to that damage has occurred. Diabetes may also reduce blood flow to the feet, making it even more difficult to heal an injury or resist infection. Poor circulation will subsequently compromise the flow of oxygen, nutrients, and white blood cells necessary to fend off infection. Because of these problems, you may not notice a foreign object in your shoe. As a result, you could develop a blister or a sore that could lead to an infection or a non-healing wound subsequently putting you at risk for an amputation.
Many people neglect foot care especially the diabetic population.
Our feet are the most neglected part of our body which is amazing considering the fact that the average person takes more than 10,000 steps a day. Our feet and toes are the most distal point of our body and most of us just pay attention to our feet in the morning when we shove them into our socks and shoes and then again only in the evening before going to bed. Having diabetes increases the likelihood that we may neglect our feet even more so because of nerve damage and the inability to feel referred to as diabetic neuropathy.
As mentioned above, a person may not be aware of a minor wound that often times progressively worsens leading to serious consequences such as non-healing ulcers that may subsequently put you at risk for an amputation or even a life threatening infection.
Foot care tips if you have been recently diagnosed with diabetes:
- Check your blood sugar daily and maintain proper health through diet and exercise. Do not smoke.
- Inspect your feet daily for minor cuts, sores, blisters, or changes in color and texture of the skin. Have a friend or family member help you. You may use a mirror to help you if no one is available to help you.
- Wash your feet daily with warm water and anti-bacterial soap. Make sure you check the temperature of the water before you place your feet in a tub to avoid burning. Dry your feet thoroughly in between your toes.
- Trim your toenails each week or when needed. Trim your toenails straight across and file the edges with an emery board or nail file.
- Keep your feet soft and smooth. Use a pumice stone to gently smoothen corns and calluses. Apply a thin coat of skin lotion over the tops and bottoms, but not between your toes.
- Maintain proper circulation to your feet. Elevate your feet when at rest, avoid prolonged crossing of the legs and exercise regularly.
- Wear socks and comfortable foot wear including custom molded orthotics and/or diabetic shoes that fit well and protect your feet at all times. Inspect your shoes thoroughly before placing them on each time to make sure the lining is smooth and there are no objects inside.
- Never walk barefoot and protect your feet from extreme temperatures. Wear shoes at the beach or on hot pavement. Wear socks at night if your feet get cold.
- Visit a foot specialist on an ongoing basis to ensure proper foot health. Prompt treatment for any foot problem is important and you should visit your physician immediately if you suspect any issues with your feet.
40. Dr. Joel W. Brook
A1: When a patient has newly diagnosed as a diabetic, the most important thing is to become educated as to have the disease can affect multiple systems. There’s an entire body connected to their feet. I need to learn the most important thing to do is type maintenance of their blood sugars.
With regard to their feet. I need to get into the habit of checking their feet daily for wounds, skin conditions, signs of infection and swelling. They need to become aware of whether or not they have cramps and their legs while walking or rest or changes to their sensation, either burning or numbness.
A2: When people are first diagnosed I don’t think it’s a matter of them ignoring their feet as much as they are on a custom to paying attention to their feet. That is why education is so important.
41. Dr. Nancy Kaplan
A1: For those who get a new diagnosis of diabetes there is a lot to think about. When it comes to your feet it is a good idea to get a baseline examination. The physician examining your feet should check your ability to sense a small amount of pressure with an instrument called a Semmes-Weinstein filament to make sure there is a certain amount of “protective sensation”. The ability to sense that something is wrong will send you to the doctor to get help.
For those, newly diagnosed with diabetes, who cannot sense that something is wrong with their feet (like an infection, ingrown nail or foreign body) regular foot inspection and care of nails and callouses need to be done by a medical professional such as a Podiatrist.
A2: It is common for people newly diagnosed with diabetes to go through stages of acceptance. This may include denial. Feet that are numb or unable to sense that something is wrong due to diabetic neuropathy develop an out of sight, out of mind mentality. Unfortunately, if you ignore your feet when you have diabetes they may go away. Many complications that lead to amputation can be avoided with vigilance and getting the advice of a medical professional. Podiatrists are well trained and a great source of advice and services.
42. Dr. Jeffrie C. Leibovitz
A1: The easiest way to address problems is never left them develop. This is so important with diabetes and related foot complications. If you develop great habits to maintain glycemic levels you will greatly reduce or avoid neuropathy and vascular problems. One simple habit that will provide great protection is a daily foot exam. This involves a 30 second investment of time to inspect the bottom of the feet and areas between the toe. If the gift the pain is lost you will not get a early warning of problems. This would include redness, swelling, drainage, and changes in skin. And most importantly, contact your podiatrist or diabetologist if any of these problems develop.
A2: Feet and eyes are perhaps the most neglected parts of the body. They go unnoticed until there is a problem. These parts will work well for decades and people assume they will work well forever. Since most foot deformities are very, very slow in progression (they may take 5– 10 years to show any significant change) they can be easily ignored. Add impaired vision or difficulty in bending over and a perfect storm develops for problems. Feet and Rodney Dangerfield have something in common. They get no respect and they are missed when they are gone.
43. Dr. Marcin Vaclaw
A1: BECOME EDUCATED. READ ONLINE, take the advice the doctor gave you and put it against other sources. You may find other opinions or reinforce the one your doctor gave.
A2: IT SEEMS A LOWER PRIORITY. They focus on the larger organ damage. The feet seem to get ignored until they are a major problem, which is why hospitalizations amongst diabetics are commonly for infected foot wounds.
44. Dr. Jennie Chau
A1: Typically, their primary physician will refer a newly diagnosed diabetic pt to a Podiatrist for a first time evaluation. From there, I will perform a thorough lower extremity examination. In office, gait analysis, baseline x-rays are performed, and depending on their examination, additional tests may be entertained such as punch nerve biopsy to evaluate for neuropathy, PAD/CVI studies to evaluate for arterial and venous flow, referral to Endocrinologist, DM educator/nutritionist, neurologist/vascular doctor, even physical therapy. We also offer diabetic therapeutic shoes for our Medicare pts or even custom orthotics with the benefit of providing protection and stability of their feet.
I’ll usually explain to a patient systemic risks of diabetes, the importance of maintaining proper glucose control and diabetic foot care. We’ll cover what fasting blood glucose level and HbA1c percentage is considered normal.
I’ll discuss diabetic foot care including checking feet daily especially before going to sleep (use a floor mirror if they can’t bend down), continue applying lotion to prevent cracks/fissures (as dry skin is common after several yrs of having DM), importance of proper shoe gear. Encourage patient to maintain low Na diet, incorporate exercising. I always tell patients that they can always call if they have any questions and if they experience any redness, warmth, swelling and/or pain unexpectedly of their feet/legs to make an appointment immediately. Lately, I’ve been referring my patients to local supermarkets as they have in house nutritionist to help them evaluate their diet.
A2: Diabetes is a complicated disease. Balancing a low sodium diet, checking sugar levels daily, and incorporating exercises can be difficult at times even financially. For some, it’s frustrating to know that even though they are doing everything right, the numbers don’t add up. Most patients who have Diabetes also have other co-morbidities to manage.
Patients at times think that it’s normal to have pain/numbness/skin and nail changes secondary to diabetes. It’s amazing that patients who have feet problems will see their primary physician first before even considering seeing a Podiatrist. To this day and within certain cultures, even having an amputation of the lower extremity secondary to diabetes is considered normal.
There’s also a misconception that “feet pain will go away eventually.” They’ll typically note that their pain is due to their lifestyle/work but there might be a structural issue with their foot that they don’t realize. I always get the response of “don’t get old,” but patients don’t realize feet/gait change over time.
Besides other factors such as lack of insurance, financial difficulty, lack of transportation, or even having a Podiatrist within the vicinity, there’s also a sense of fear. Fear of what other friends or family members have experienced in the past or just having someone evaluating their feet. I can’t tell you how many times I come into a room and patients are still apprehensive to taking off their socks.
45. Dr. Marc A. Borovoy
A1: People tend to overlook foot care as their feet remained covered up for most of the day. Most Diabetics will develop neuropathy in their life time resulting in diminished sensation in their feet. So it’s natural not to pay attention to them.
A2: My advice to a new diabetic is to avoid all forms of barefoot walking, especially at home where most foreign body injuries occur. And to visually inspect their feet In the morning and evening to insure no changes are seen. Any change in color or any sore may be a sign of infection that they may not feel. If changes are noted call your Podiatrist ASAP.
46. Sohail Siddiqui
A1: For someone who has recently been diagnosed with diabetes, I would make the following recommendations:
The first step is to educate one’s self about the disease process. Understanding why you have the problem can lead to steps you can take to help keep the condition under control and prevent it from distressing other systems in your body. Diabetes can affect many different parts of the body – your eyes, kidneys, peripheral nerves, immune system, and your feet.
At the very least, schedule a yearly comprehensive lower extremity examination by a Podiatrist. As a Podiatrist, I work with my medical colleagues in other specialties such as primary care, internal medicine, family medicine, vascular surgery, and endocrinology to both prevent and treat the disease. Our goal is to minimize the more serious manifestations of diabetes that can lead to amputation or loss of limb.
It is important for a patient with diabetes to take a proactive approach and examine their feet daily. You can enlist a family member or use a mirror if you have physical limitations that prevent you from getting down to check your feet. Look for warning signs such as wounds that do not heal within a reasonable period of time or redness of the feet that does not go away.
Numbness, burning, and tingling sensations can be indicative of peripheral neuropathy (a condition in which the protective sensations that everyone has is diminished). You will be at a much greater risk of developing wounds that could cause other serious side effects (including amputations and loss of limb) if you have neuropathy. Maintaining proper foot hygiene, regular foot exams, and wearing proper foot wear can help prevent the incidence of ulcerations which again can lead to more serious complications or life threating infections.
Above all the most important thing you can do is to make sure that you work closely with the physicians taking care of you to follow a tailored treatment plan that is comprehensive and incorporates the advice of all of the specialists taking care of you to help assure that you have the best quality of life possible.
A2: I think that for the most part, people do not ignore their foot care. Many Diabetics may have other comorbidities and conditions that could be an impediment to them when seeking proper podiatric evaluation and care.
Some Diabetics may also have social or economic considerations which lead them to put a low priority on proper foot care and hygiene. Additionally, peripheral neuropathy, one of the manifestations of diabetes can mask underlying problems. “If I don’t feel anything, then I should be fine,” is a common sentiment. This could lead to patients not addressing issues immediately when they pop up.
So again, it is not that people are purposely ignoring their foot care, it is a combination of many different factors. As physicians, we must be vigilant with our patient’s care and encourage them to take a proactive role in caring for themselves, encouraging and reward positive actions regarding their health. This is where I feel that a multi-disciplinary approach works best with various physicians working together to recognize warning signs to ensure that our patients get the best possible care and education they need. All of the healthcare team caring for Diabetics have to constantly make an effort to remind our patients that not taking care of their feet can lead to sometimes serious consequences.
47. Dr. Kenneth J. Donovan, DPM
A1: The reason diabetic patients have foot problems, has to do with improper blood sugar control. Excessive sugar in the blood causes nerve damage (ie Diabetic Neuropathy). This can lead to numbness in the feet, excessive dry skin, and poor circulation. So my number one tip would be to keep your blood sugar in check. However, for patients that already have symptoms of diabetic neuropathy, I recommend daily foot inspections to check for blisters. It is important to moisturize the feet daily (but keep between the toes dry). Lastly patients should wear proper fitting shoes and regularly see their podiatrist for routine check ups.
A2: I think a lot of people don’t realize how serious diabetes considering its the 8th leading cause of death worldwide. Digging deeper, 2/3 of diabetics have peripheral neuropathy with 25% of those patients ending up with a foot ulcer at some point in their lifetime. Half of those patients will require hospitalization and half of those patients will require an amputation. The media also does a poor job of educating the public about the disease. We are all aware of cancer awareness months with their various colored ribbons, but if your diabetic and have had an amputation, your 5 year survival rate is less than those patients with breast and prostate cancer.
Disclaimer: The views and opinions expressed in this article are those of the contributors and do not necessarily reflect the official policy or position of TheDiabetesCouncil.com.