Posted: 4/6/2016
Parkland podiatrist urges patients to prevent complications
Happy feet put a spring in your step, but hurting feet give you a gimp in your gait. During National Foot Health Awareness Month in April, foot specialists at Parkland Health & Hospital System emphasize that no one can afford to ignore their feet, especially those with diabetes.
Many of the 12,000 patients seen annually at Parkland’s Diabetic Foot Clinic have learned that fact the hard way. Parkland podiatrist Javier La Fontaine, DPM, MS, Associate Professor, Department of Plastic Surgery at The University of Texas Southwestern Medical Center, said that at least 50 percent of people with diabetes will develop neuropathy, or nerve damage, that can cause tingling, pain, burning or stinging sensations or weakness in the foot, along with numbness, or loss of feeling. Neuropathy can diminish the person’s ability to feel pain, as well as heat and cold.
Here are 12 tips Dr. La Fontaine provided for patients with diabetes to help maintain foot health and avoid complications:
- Manage your diabetes. Work closely with your healthcare provider to keep your blood glucose in target range.
- Check your feet daily. Examine your bare feet for cuts, blisters, sores and swelling. Use a mirror to check the bottoms of your feet, or ask someone else to help.
- Wash your feet daily and dry them carefully, especially between the toes.
- Moisturize your skin daily, rubbing a thin coat of lotion on the tops and bottoms of your feet, but not between the toes where moisture can lead to the development of fungus.
- Wear appropriate footwear that protects your feet and fits properly; ask your physician if you qualify for Medicare coverage for special shoes.
- Stay active. Develop an exercise and activity schedule with your healthcare provider to promote fitness and a healthy weight.
- Keep toenails trimmed. Cut your toenails straight across and file edges smooth with an emery board. Get professional help if you’re not able to do this yourself.
- Protect your feet by wearing shoes and socks. Never walk barefoot. Wear 100 percent cotton white socks that are breathable and will show blood stains if you have a wound.
- Protect your feet from temperature extremes. Always wear shoes on hot pavement or sand. Test water with your elbow before putting your feet in bathtub. To prevent burning your feet without realizing it, never use heating pads, space heaters, electric blankets or hot water bottles.
- Improve circulation. Elevate your feet whenever possible when sitting. Avoid crossing your legs for long periods and wiggle your toes and ankles several times a day.
- Don’t smoke. Smoking is bad for circulation and is a risk factor for many serious conditions, including cancer, heart disease, diabetes and stroke.
- Do it now. Don’t delay taking better care of your feet.
To learn more about foot health and diabetes, visit www.diabetes.org. For more information about services available at Parkland, visit www.parklandhospital.com/diabetes.
“Many patients tell me their feet feel fine, but unfortunately, nerve damage can make their feet numb, so they are not aware of cuts, calluses, blisters, burns or other problems. Those wounds can easily become infected if ignored and lead to serious complications, even amputation if not treated promptly,” Dr. La Fontaine said.
“A pebble in the shoe, thickened callus or a blister can go unnoticed until it causes skin break down and infection sets in,” Dr. La Fontaine said. “And because diabetes causes poor circulation to the extremities, the foot is less able to combat infections and heal normally. High levels of blood glucose in diabetic patients make it difficult for the body to fight infection.”
Foot ulcers are a common risk, affecting more than 15 percent of people with diabetes. Ulcers can lead to infections that invade the bone as well as soft tissues. Treatment may involve hospitalization for wound care or surgery, use of special shoes, braces, cast on the foot or even amputation, Dr. La Fontaine said.
Ramon Trevino, 62, of Dallas, was diagnosed with type 2 diabetes in 1994. He never had a foot problem until two years ago, when he noticed a scratch on his left heel. Within a few days he was admitted to Parkland Memorial Hospital with an infected ulcer. He spent six months in the hospital fighting the infection that invaded the heel bone and faced the possibility his foot would have to be amputated.
“Finally it began to get a little better,” he said. Surgeons eventually took a piece of calf muscle to replace lost tissue in his heel and a skin graft from his hip to cover the wound. He now uses an orthopedic boot to walk. Still unable to work, he’s grateful that he didn’t lose his foot and hopes eventually to fully recover.
“The doctors always tell you to look at your feet every day, and I did,” Trevino said. “But it was amazing how fast the infection took over. The number one thing for people with diabetes is to take care of yourself. Eat right, take your medicine and examine your feet every day.”
Another threat for people with diabetic nerve damage is dry skin. Skin on the foot can crack and peel, setting the stage for sores, wounds and infection. Dr. La Fontaine said that patients should avoid soaking their feet because their inability to perceive temperatures could result in burns. In addition, soaking can dry out the skin further. Another danger is exposure to extreme temperatures that can go unnoticed by someone with diabetes. “Their foot can be freezing in cold weather or scalding in hot water and they won’t know it,” Dr. La Fontaine said.
The American Diabetes Association estimates that 21 million people in this country have diabetes and another 8 million with the disease are undiagnosed. Preventing serious foot complications should be a priority for anyone with diabetes, Dr. La Fontaine stated. “I urge any patient with cuts or breaks in their skin, changes in foot color, shape or level of sensitivity to see a foot care specialist immediately.”