It wasn’t too many years ago when the diabetic foot was poorly understood. The person with a diabetes related foot problem went from doctor to doctor searching for someone that could manage their problem. The “go to” treatment by the majority of physicians at that time was to automatically recommend an amputation. In that way, the “damaged part” was removed because no one knew how to manage it.
Fortunately, that is no longer the case. During the past 10-12 years, there has been vast improvement in both the understanding of the disease as well as the management. We have gained tremendous knowledge as well as experience with this difficult patient population.
Diabetes may be the only disease that exists today where the patient has 100% control of their future regarding their feet. That control begins with education. Every one of the “complications” that develop on the foot of a person with diabetes is avoidable. A solid understanding of what to look for, what to wear, and how to manage is completely under your control.
What connects every single person with a diabetic foot problem (100%) is the loss of feeling in the feet. When you have normal sensation, meaning feeling in your feet, we call that “protective sensation”. Protective sensation is the ability to feel pain in your feet. We grew up being told that pain is a bad thing, but in this case, it is a good thing. For example take someone with feeling- they have the ability to feel when they step on a thumb tack, or a pebble, or when a shoe is too tight. That is they have the sensation to protect their feet. Now, take the person that has no feeling, or the loss of “protective sensation”. That person no longer has the ability to register ouch, I stepped on something that is painful. When that occurs, in most cases, that person continues to have that painful stimulus present. The thumbtack, or pebble or shoe is not bothersome to them because they can’t feel it. In many instances, that is the first step in the downward cascade towards a problem. They don’t know, what they don’t know, or in this case-feel.
How is this problem avoided? Unfortunately, once you have lost the feeling (we call this neuropathy), it can not be restored. Therefore, it is IMPERATIVE that every person with diabetes be examined by a podiatrist to determine whether there is a loss of protective sensation. If not, great. If so, then you must develop good habits. Good habits means that you or a person that you live with examine your feet every single day. You must look between your toes, look at the skin on the soles of both feet, look at the skin on the edges and tops of your feet. What you are looking for are changes; redness, swelling, heat, and openings in the skin. The significance of making this a habit is that if you check every day, and you find one of the changes listed above, and you examined yourself yesterday and it wasn’t there, then worst case scenario it has only been present for 24 hours. Virtually none of the more serious conditions like infection or ulcers manifest in under 24 hours.
The second part of this is to re-train your brain. In other words, we grew up being told if something doesn’t hurt it can’t be that bad. WRONG!!!! This is where everything is avoidable. If and when one of those changes occurs (opening in the skin, swelling, redness, heat) you must call to make an appointment immediately. DO NOT WAIT. It is never going to hurt you; it is not going to be painful. Tell the person on the phone when you call for the appointment that you are having a problem and need to be seen that day. No ifs, ands or buts…. This is the most important lesson that you need to learn. It is NOT going to hurt, and you must make an appointment immediately. If you do that, you have taken a giant step in managing your own care and avoiding more serious problems.
Good nail care is essential when neuropathy is present. Do not cut your nails yourself. You will not feel it if you knick yourself. Your toenails should be managed by a podiatrist. Properly fitting shoes are also critical. Shoes that rub on a bunion or a hammertoe can lead to a break in the skin. Our practice has a certified orthotist and a certified pedorthist; someone that will properly fit, and provide shoes and orthotics (custom prescription) insoles for your shoes.
By developing good habits you have taken a huge leap towards healthy feet. No one needs to suffer the serious complications associated with diabetes and the diabetic foot.