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Dreaded Diabetes Complication: 5 Secrets to Avoiding Foot Amputation

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Feet are easy to ignore…unless they hurt. That’s one big reason many people with diabetes are at risk for losing their feet—their disease has robbed them, to a large extent, of what doctors call “the gift of pain.”

Here’s what happens: Diabetes damages nerves, which can lead to a loss of feeling. This means that an ill-fitting shoe or an ingrown toenail can start a silent cascade of injury, leading to a foot ulcer (open sore or wound) and infection.

Many people with diabetes also have poor blood flow, and that can allow an infection to fester—raising the risk that an unnoticed cut or blister could lead to the loss of toes, a foot or even an entire lower leg. Such amputations happen nearly 75,000 times each year in the US.

Even worse danger: Once a person with diabetes has a foot ulcer, his/her chance of dying in the next 10 years doubles. If the foot ulcer leads to amputation, the five-year risk for death is 70%.

But those tragic complications don’t have to happen to you. Here are five simple steps to help prevent foot ulcers and limb loss…

STEP #1: Watch your blood sugarand more. If you maintain good control of your blood sugar, your heart and kidneys will thank you—and so will your feet. Of course, you need to take your medications, watch your diet, and if your feet are still healthy, use them to stay active—walking is good preventive medicine for your whole body.

Warning: If you already have nerve damage in your feet, talk to your primary care doctor or foot doctor (podiatrist) about the right dose of walking for you. There may be times when you have to stay off your feet to save them.

STEP #2: Be smart about your shoes and socks. You need to wear both—whether you’re inside or outside your house. (If you’ve lost sensation in your feet, don’t walk around the house barefoot! At least wear house slippers.)

In choosing your socks, start with a clean, lightly padded pair with no irritating seams. Choose well-fitted, supportive shoes with plenty of room for your toes (no pointy-toed shoes!)—and get in the habit of checking inside for foreign objects before slipping them on. Even though high heels aren’t recommended, women with diabetes may want to wear moderate heels (no more than two inches) for special occasions.

Buying tip: It’s widely known that you should shop for shoes late in the day, when your feet may have swelled a bit, but this is vital for people with diabetes so that they don’t buy shoes that are too tight. And stay away from cheap plastic and vinyl shoes—they may be less expensive, but they don’t breathe enough, which causes your feet to perspire, increasing the chance for a blister to develop.

If diabetes has already caused changes, such as neuropathy and especially a previous blister or wound on your feet, talk with a podiatrist about the best shoes and inserts for you. These supportive shoes can be pricey (more than $100), but insurers often cover at least one pair per year—though you may want more so that you can allow your shoes to air out for a day between wearings. Also: See your podiatrist at least once a year to make sure your feet are healthy and you’re wearing the right shoes.

STEP #3: Knock your socks off! You need to do this every day to get a good look at your feet. Carefully examine the tops, the soles, the heels—and between your toes, where moisture and friction can lead to trouble. Use a mirror (or ask a family member to help if needed).

Goal: Get to know your feet so well that you will notice changes from day to day. Any new redness could signal trouble. Look for swelling, calluses, sores, blisters or ingrown toenails, and let your primary care physician or podiatrist know about these warning signs.

Important: There’s one other time to strip off your shoes and socks—each and every time that you see your primary care doctor (not just your podiatrist). Take off your socks as soon as you reach the exam table. That way, both of you will remember to look at and talk about your feet.

STEP #4: Watch out for hot spots. If areas of your skin heat up, that can be a sign of inflammation. If you detect that heat early enough, you may be able to head off an ulcer. Helpful: Consider doing your foot check in the morning before you’ve been walking on your feet all day. But if that doesn’t work for your schedule, just be sure you do your foot check regularly.

Do not be surprised if your doctor asks you to take the temperature of your feet in several spots each day—looking for areas of one foot that are a few degrees warmer than the same areas of the other foot. This can be done with an inexpensive thermometer that can be purchased online, such as Advocate’s Non-Contact Infrared Thermometer or Equinox Digital Non-Contact Infrared Thermometer.

Also: If you and your podiatrist are game, you can try out newer heat-sensing socks. These can be paired with your smartphone or other devices to send alerts to you. One such product, Siren’s Diabetic Socks, is expected to hit the markket soon. You can preorder these socks at Siren.care or 888-459-5470.

STEP #5: Pamper those puppies. Dry skin is more easily damaged, so after washing your feet in warm (not hot) water, apply a rich moisturizing cream. Keep toenails trimmed, straight across—and if that becomes difficult for you, ask your health-care providers for nail-trimming help. Make sure to ask your podiatrist before going to a nail salon. Also, avoid these missteps…

  • Do not put moisturizer between your toes—excess moisture there can promote infection. Use talcum powder or cornstarch in those areas.
  • Do not warm your feet with hot-water bottles or heating pads—you might not feel when it’s too hot. Wear warm socks instead.
  • Do not use acids or chemical corn removers, which could damage the skin and lead to foot ulcers. See a podiatrist for help.
  • Do not attempt “bathroom surgery” on corns, calluses or ingrown toenails. Consult a podiatrist.
  • Do not smoke. Quitting is one of the best things you can do to improve blood flow—to your feet and everywhere else. Do not give up trying if you have not quit yet.
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Source: David G. Armstrong, DPM, MD, PhD, a podiatric surgeon and professor of surgery at Keck School of Medicine of University of Southern California in Los Angeles. Dr. Armstrong is coeditor of the American Diabetes Association’s Clinical Care of the Diabetic Foot. He is also founder and cochair of the International Diabetic Foot Conference (DFCon.com), an international symposium on the diabetic foot, and lead author of “Diabetic Foot Ulcers and Their Recurrence,” published in The New England Journal of Medicine. Date: November 1, 2018 Publication: Bottom Line Health
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