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  Guidelines for Diabetes

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ARTICLE OF THE MONTH

FOOT CARE 101

By: PETE DELA PEÑA, MD

As Leonardo da Vinci once said – the human foot is a masterpiece of engineering and work of art. Thus it is saddening if we see one`s foot damaged by a foot ulceration.

Foot care can easily be one the most ignored things on our health checklist.

Why is foot care important?

The natural progression of diabetes that entails in our feet usually gives pain or loss of feeling (numbness, tingling). Sometimes there are changes in the shape of your feet or toes. There may be sores, cuts, or ulcers on your feet that do not heal.

Diabetics have a lifetime risk of a foot ulcer. This may go as high as 25% risk for foot ulceration. Several risk factors are predictive of ulcers and amputation. Patients with neuropathy and peripheral vascular disease are at risk. There may be cuts, sores or ulcers on your feet that do not heal.

Preventive foot care is very important for all patients with diabetes. This should be taught to any patient at risk for the development of ulceration.

We must work with our health care team to try avoid foot problems. The team usually includes a doctor (endocrinologist), a nurse, a diabetes educator, and a foot doctor (podiatrist) and other specialist who can help manage diabetes.

If we take care of our feet, we can lower the chances of losing a toe, foot or leg.

Here are simple tips to prevent foot ulcers:

  1. Check your feet everyday. Examine your feet for blisters, cuts, color changes, swelling and open sores. (Use a mirror to see the soles of your feet). Check your feet each evening when you take off your shoes.

  2. Wash your feet every day. Before bathing, test the water to make sure that it is not too hot. (Use a thermometer (32 to 35 C is safe). Do this by using your elbow. Always wash your feet with soap and water. Take care to wash between your toes. Dry your feet carefully, especially between the toes. Use oil or lotion to keep your skin soft. Use talcum powder instead or cornstarch to keep the skin between your toes dry to prevent infection.

  3. Take care of calluses and corns by trying to make them smooth. Ask your foot doctor for help. Do not cut corns and calluses. Do not use blades, corn plaster and callus removers. Wrong use might damage your skin and may lead to infection.

  4. Trim your toenails with nail clippers after you wash and dry your feet. But remember to call your foot doctor to trim your nails if: you cannot see or feel your feet, you cannot reach your feet or your nails are too thick. Avoid pedicures especially when addressing an ingrown toe nail.

  5. Always protect your feet. Wear suitable footwear inside and outside your home to avoid injuring your feet.

  6. Check inside your shoes for stones, sharp objects and rough places before putting your shoes on.

  7. Buy new shoes late in the day. This is because feet become more swollen towards the end of the day and you can be sure that your shoes are not too tight and fit well.

  8. Wearing padded socks can help prevent injury. Make sure they are neither too tight nor loose. Make sure they have no holes.

  9. Be more active. Keep the blood flowing to your feet.

  10. Have your feet checked periodically by a healthcare professional.

After learning the basics of foot care, one must remember to wear the right shoe.

Wearing the right type of shoe is important. Do not wear shoes because it is fashionable, wear shoes because it fits you and you are comfortable!!!! Athletic shoes/walking shoes are good examples of a good shoe. Here are some pointers for a good shoe.

Diabetic shoes for women and men should be deeper and wider than regular shoes (one size larger). This is ideal because you have room for padded socks or insoles. The shoe should also be lightweight and seamless to prevent repetitive stress that may contribute to calluses, blister and infection.

Make sure they feel good and have enough room for your toes. Do not wear shoes with high heels and are pointed, they exert much pressure on your feet leading to an ulceration.

We recommend shoes that are designed for diabetics. The shoe should have proper ventilation. This allows the feet to “breathe”. This allows the feet to reduce dampness and heat. Sweat on your feet is an ideal environment for bacteria/fungi to grow. Knowing these characteristics will ensure your feet safe for any risk factor that might aggravate a foot ulceration.

But how about feet that are biomechanically challenged? Those are feet that are at a high risk for ulceration due to neuropathy and peripheral vascular disease. In this special circumstances, we employ the use of orthosis.

Orthotics by definition is a science that deals with orthoses for external control, correction and support. Orthosis is an appliance used to support part of the body or perform a function. On the other hand a splint is also an appliance used to support or immobilize a part of the body.

The real functions of orthoses are:

  1. prevent deformity

  2. correct deformity

  3. maintain correction

  4. control instability

  5. relieve weight bearing

  6. facilitate ambulation.

How about people already missing a limb? This situation entails the use of prosthesis. So again by definition prosthetics is a science that deals with functional and cosmetic restoration for all or part of a missing limb (artificial limb). Prosthesis therefore is an appliance to replace part of a body. This can be outside (exoprosthesis) or inside (endoprosthesis). What is important in a prosthesis is it should restore the function of a limb and will also be used for cosmetic function. Ideally when choosing for prosthesis, we should think for patients` consideration such as – level of function, lifestyle, total weight of of the orthosis/prosthesis, mental capacity, manual dexterity, and of course the skin and soft tissue condition. Whether we choose an orthosis and/or prosthesis it must be at least functional, well fitting, lightweight cosmetically acceptable, locally manufactured and with easy maintenance.

All said and done the bottom line is still prevention!!!!!

The time to act is now – better foot care through education and prevention! After all small steps when added make a giant leap. You simply have to put one foot in front of the other and keep going.