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Care for Diabetic Feet

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Bottom Line/HEALTH: For most people, a blister or a boo-boo is just a boo-boo, but if you’re a person with diabetes, that little cut or sore can turn deadly in no time. So here’s what you need to know.

I’m Sarah Hiner, president of Bottom Line Publications, and this is our Conversations With the Experts, where we get the answers to your tough questions from our leading expert.

Today I’m talking to leading podiatrist and foot surgeon Dr. Johanna Youner, who is in private practice in New York City and a regular contributor to Bottom Line Publications. So welcome, Dr. Youner.

Dr. Johanna Youner: Thank you, Sarah. It’s good to be here.
Bottom Line: How vulnerable, really, are diabetics’ feet?
Dr. Youner: Diabetics are very vulnerable to foot problems if you take the top three problems that they have—circulatory, neurological (the nerves can be affected by high sugar), and their immunity is low. These three—loss of circulation, loss of feeling and a lowered immunity—will lead to foot injuries.
Bottom Line: Let’s walk through that. In a normal healthy person, if I get an injury, my blood circulates, it clears it out. So what’s happening, just the least little injury, to a diabetic’s foot?
Dr. Youner: The least little injury to a diabetic—say you get a cut on the bottom of your feet. If you’re a diabetic who has had diabetes for 20 years or more, you may not be able to feel that cut because your nerves will have been affected by the high sugar. That cut will get infected.

Say you’ve been a diabetic for 10 years and your circulation is affected—you won’t have enough blood to heal that injury. If your diabetes is completely out of control, if you haven’t been very careful with your sugar, your immune system may be compromised, and you won’t be able to fight off infection.

Bottom Line: Got it. Is it a problem that develops over time, one that gets worse over time?
Dr. Youner: The problem with foot injuries in diabetics worsen based on the length that one has had diabetes. So if you’ve been an insulin-dependent diabetic for 10 years or more, you are much more vulnerable to foot injuries.
Bottom Line: And is it the same issue whether you’re a Type 1 or a Type 2 diabetic?
Dr. Youner: No. A Type 1 diabetic is a child or somebody who doesn’t have their own insulin, so they are already behind the eight ball—they’re already in trouble. They must be very careful with their feet. Type 2 diabetes is controlled with diet, so their body is making insulin—they are a lot safer.
Bottom Line: So they need to keep everything in check, but be aware that there’s an issue to pay attention to.
Dr. Youner: Yes. With a Type 1 diabetic, I would like them to come to the office every two months to be checked, no matter what. Just come in. Even if it’s nothing there, I look at your nails, trim them—we have a lovely chat.

If you are a Type 2 diabetic, every six months may be good. But I also need to know what your sugar is doing. If your Hemoglobin A1c, which determines your long-term sugar, if your blood sugars have been high, I need to know that. I need to keep you safe.

Bottom Line: So for example, let’s take a look at, I’ll call it a benign injury, because I think people don’t even know what to be aware of. Here’s something. It looks like a little blister. Even something like that? What does a diabetic need to do with that?
Dr. Youner: A diabetic needs to make sure that this is seen by their doctor. This needs to be cleansed with peroxide and a topical antibiotic, and the doctor needs to know about it. This can lead to an entire cascade of problems. One small blister…one small scrape.
Bottom Line: So no matter what. They shouldn’t feel embarrassed, they shouldn’t be shy, they shouldn’t be anything. It seems like, “Oh, I just have a little blister, no big deal,” but for a diabetic, no matter what, the doctor sees it.
Dr. Youner: The doctor can tell you it’s not a problem. Let the doctor assure you. You don’t have to assure yourself. The doctor has seen everything. There’s no judgment. This is a disease—this is not a judgment. Just make sure you get to the doctor so he or she can fix it, make it better and protect you next time. Maybe recommend shoes that aren’t hurting you. Sometimes your shoes need to be changed. Sometimes you need padding.
Bottom Line: What kind of steps should a person with diabetes take on a regular basis—some kind of self-defense—to avoid getting themselves in trouble?
Dr. Youner: A diabetic, every day, no matter what, should examine his feet. If you can’t bend down to see the bottom of your feet, you put a mirror on the floor and check the bottom of your foot in a mirror. If you can’t see for yourself, have your loved one check your feet.

If you wear black socks and you notice something, God forbid, wet in your shoe, wear white socks. See if there’s something draining from your foot. If you have anything—draining, hurting, an odor—get to the doctor. If there’s a red streak coming up your feet, get to the emergency room.

Bottom Line: But even, as you said, even the smallest little blister, they should still go in and get it checked.
Dr. Youner: An injury with a diabetic can go south in a day.
Bottom Line: Really, a day?
Dr. Youner: In hours. A bedsore takes four hours to get in a hospital. Four hours. That means if something started at 9 a.m., by 1 p.m., it may be a hospital-admission injury. It’s that fast. If you don’t have the circulation to support a problem, it’ll end up with dreadful consequences. You don’t need it. Not in these days.
Bottom Line: Is there anything that they should do in terms of their footwear that they should change, to minimize the risks of getting an injury?
Dr. Youner: If your shoes look like your feet—square, high enough toe box—that’s a good thing. Medicare covers diabetic shoe gear, so if you have Medicare and are diabetic, go to your podiatrist. Get your free pair of shoes. It will protect you. They give you free insoles. It is understood that health-care dollars are wasted if you can just buy the right shoes. And if Medicare is giving them to you, that’s fine. They’re giving them to you to protect you.
Bottom Line: Should they be coming to a podiatrist regularly to get their feet checked?
Dr. Youner: A diabetic should see a podiatrist every two to six months. If your blood sugar is high, every two months is good. If it’s manageable, if you’re very well-controlled, if you see other specialists, every six months is OK. But every six months should be the limit.
Bottom Line: What should they expect at that foot check? What goes on?
Dr. Youner: The doctor will check your feet, check in between your toes, make sure your nails are fine, anything ingrown, any rashes, lumps or bumps that shouldn’t be there, infections. Check your neurological status. Diabetics can become neuropathic. That means that the sugar can get into the nerves, and you won’t be able to feel. So the doctor will be checking that.
Bottom Line: I’m assuming the answer to this is going to be “stay away,” but should a diabetic not go to the nail salon for any kind of pedicures?
Dr. Youner: There’s no need. Podiatrists do medical pedicures now, so you can go to a podiatry office and get a sterile pedicure—without the polish, but you can get your nails done and have a friend paint your nails. It is not safe to put your diabetic feet into somebody else’s dirty water. It is not safe.
Bottom Line: Thank you, Dr. Youner. The bottom line—if you’re a person with diabetes, the least little wound on your foot, the least little blister, you need to go and have that professionally reviewed by a doctor. Not only that, you should schedule regular appointments with a doctor so that you can stay on top of any wounds and be sure that your feet stay healthy. A minor injury can turn into a deadly infection within a matter of hours. Don’t let that happen to you.
 
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Source: Johanna S. Youner, DPM, a podiatric surgeon in private practice and attending physician at New York Downtown Hospital, both in New York City. Dr. Youner is a board-certified foot surgeon and a Fellow of the American College of Foot and Ankle Surgeons. HealthyFeetNY.com Date: October 6, 2014 Publication: Bottom Line Health
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