“Hi, this is Dr. Silvester, and I’m going to talk to you today about taking care of your diabetic feet. Diabetes affects the feet in really two different ways. The first way, and the way that most people associate with diabetes is circulation. They think, “If I have diabetes, my circulation is going to get bad, and that’s going to cause me to have foot problems.” That’s true in some people, but in most people that’s really not the case. The majority of people with diabetes have problems with their feet because of neuropathy, which is numbness or tingling or burning or an electrical sensation. The numbness is the thing that causes difficulties.
What the usually scenario is for a patient with diabetes that we see who gets in trouble with their feet is, first of all, they’ve had diabetes for quite a few years – maybe ten years. Sometimes they haven’t been very good at controlling their blood sugar, so this causes some toxicity to develop in the nerves and they don’t feel their feet very well. There’s also damage to their circulation o some degree. Subsequently they get a callus on their foot from either a pressure point or a deformity, and they end up with a callus that forms pretty thickly, and underneath that it starts to bleed a little bit. The skin gets compromised and it breaks down – which is a diabetic foot ulcer. All of that can be avoided using three techniques.
The first thing is inspection.
What that means is that every day, if you have diabetes, you should take a really close look at your feet. Now, if you can’t see your feet, you should get some help, or you can get a mirror to look at your feet. Look between your toes, on the outside of your foot, which is tough to see for most of us, the bottom of your foot – any place that you see a callus or something, you should probably start paying attention to that and get some help. The next time you see your doctor, ask him about your feet.
The second thing is protection.
Make sure you wear good shoes. I remember an experience when I was in LA county hospital – we had a patient come in for a regular diabetic foot check, who had a little toy in his shoe. That gentleman was so numb that he couldn’t feel the toy in his shoe. He subsequently lost his leg due to not being able to feel his foot. So, protection involves wearing a good shoe, looking at your shoes before you put them on, and wearing a sock that’s soft. Make sure your shoes fit well and never depend upon how the shoe feels. You have to measure the shoe, or even better, get an x-ray of your foot taken while wearing your shoes to make sure they fit well and aren’t altering your feet.
The third thing to do is intervention.
If you see any kind of a callus – especially one with some bleeding or discoloration, get to your doctor as soon as possible (preferably be a podiatrist, because they are often better equipped to handle these types of situations than family doctors). You’ll need to get the pressure off that area as soon as possible. If you need to, you may have to wear a special shoe or boot to get that to heal.
If you can prevent a foot wound by doing inspection, protection, and intervention, you’re going to be miles ahead and avoid many of the difficulties of diabetes and your feet.”