Diabetes and the Foot

Definition of  “metabolic disease”  a syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to an increased risk of cardiovascular disease and type 2 diabetes often called also insulin resistance syndrome. From Merriam-Webster Dictionary      http://www.merriam-webster.com

“Metabolic syndrome” – is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together, increasing your risk of heart disease, stroke and diabetes. From the staff at the Mayo Clinic    http://www.mayoclinic.org

“Neuropathy” – means nerve disease or damage and affects the nerves in your toes, feet, legs, hands, and arms.

“Peripheral neuropathy” A common, often misdiagnosed disorder that results from damage to the peripheral nervous system. Symptoms include numbness, weakness, tingling and/or burning in the toes or fingers. https://www.foundationforpn.org

Why does nerve damage from diabetes usually start in the feet? These nerves travel the farthest from the brain and spinal cord.

There are too many types of peripheral neuropathy to list. We are going to concentrate on “Sensory Neuropathy” because this is most likely the first one that a person with diabetes will develop. Sensory neuropathy affects the nerves that control what a person feels, like pain or an itching sensation. Again we will pertain to the feet since it will most often occur there. Some symptoms that a person might feel are: Numbness and tingling of the feet, Loss of sensation, like poking the bottom of the foot with a pin and not feeling pain. Loss of balance, especially in the dark.

Why do diabetics tend to get foot problems?

In the diabetic foot, glucose reacts with the collagen in the connective tissue. The short version is it causes both inelasticity and toughness in the foot’s connective tissue. This creates stiffness and weakens the muscles in the foot. Pressures on the foot that used to dissipate throughout the foot while walking are now accumulated to specific areas, causing blisters sores and ulcers.

Serious problems can begin when the diabetic foot or areas of the foot becomes numb. The diabetic skin cracks easier and if goes unnoticed can easily become infected. There are many people who started out with sores, blisters and have ended up with an amputation.

“I’m Pre-Diabetic” or “I have Type II Diabetes”.  Unfortunately it doesn’t matter, there is equal prevalence in types I and II. Only 5 percent of the diabetics in this country are type I. However time does matter – people are most likely to develop diabetic foot problems with over 20 years of being diabetic. Approximately 15% of the people with diabetes have consequential foot problems but that’s still millions of people, there’s @ 29 million people with diabetes in the USA.

Let’s not talk about preventing diabetes. You could fill a library with the books that have been written and I’m sure you have read that about 9 cases in 10 could be avoided by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking (I’m talking about type II diabetes). Please don’t Google “Diabetic Foot Photo” unless you have a strong stomach, although the pictures will probably do much more for change in lifestyle than all the books written?

Care for diabetic neuropathy in the foot:

Clean Daily – Soaking of the feet should be avoided, use lotion to moisturize the feet, avoid letting lotion seep between the toes.

Cut Toenails: We don’t want a sharp edge to cut another toe. Cut and file appropriately and gently file calluses

Wear Shoes/Slippers to Protect the Feet: Wearing thick, soft, seamless socks can help prevent skin irritation.

Shoes: Wear ones that fit well and allow the toes to move (Ultra Depth/Therapeutic Shoes Preferred). Break new shoes in gradually.

Use Diabetic Shoe Inserts: they are smooth and less likely to rip the skin. They are soft which will help prevent skin from cracking. There are generally two types to consider. A flat diabetic insert (Generic) or a custom made diabetic insert (Molded). A diabetic insert is made of a special material that allows the foot to settle downward, into the insert. This allows the pressure points in the foot to settle so that surrounding areas that did not bear weight before, will now, creating a more even weight distribution. This is extremely important to a diabetic because neuropathy can prevent the feeling of pain. Diabetic Inserts have been proven to greatly reduce the development of Diabetic foot complications such as ulcers and lesion’s. When more severe Diabetic Foot Symptoms exist: loss of foot padding, thin skin, sores, Hammer toe, Claw’s Toe, Morton’s Toe, Bunions, Calluses, Red Spots, Blisters, Extreme Foot Neuropath, Diabetic with a Charcot foot, Metatarsal Pain (pain in the ball of the foot), etc., then Custom Molded Inserts should be used. These have been scientifically proven to reduce Metatarsal Pressure by increasing weight distribution and pressure onto the Plantar (Arch) area of the foot. Since they are custom molded to each foot, they supply ample arch support.  There are mixed reviews about relieving pressure stress in the heel area, although they are much thicker and softer than a flat prefabricated diabetic insert and will allow all pressure points to settle further.  That being said, pain is diabetic foot complications generally start in the mid to forefoot area.

If pain, sores, ulcers, etc. develop: See a Podiatrist!

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