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Diabetic care takes foothold

January 4, 2012

Dr. Juan Torres

Taking care of feet is more important than many realize and takes more than pulling on socks and lacing up shoes each day, especially for diabetics.

“Diabetic foot ulcers are the most common reason for amputation of lower extremities in the U.S.,” Auglaize County Medical Director Dr. Juan Torres said.

The ulcers most often occur on the ball of the foot or the bottom of the big toe, he explained. They also can occur on the sides of the foot, usually due to poorly fitting shoes.

More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes, according to the American Diabetes Association with 65,700 such amputations occurring in 2006, the most recent year statistics were available.

Every ulcer should be seen by a physician right away to provide the right treatment.

Most amputations are preventable with regular care and proper footware, according to the American Diabetes Association.

Infections in the feet can spread to the legs with serious infections becoming life-threatening.

Nearly 8.5 percent of the U.S. population — 25.8 million people — has been diagnosed with diabetes, according to the American Diabetes Association, which also reports that 7 million people are undiagnosed and 79 million people have prediabetes.

Approximately 2 million new cases of diabetes were diagnosed in people 20 and older in 2010. The disease is more prevalent in men than women, but only slightly, and in adults as they increase in age. Blacks and Hispanics are most prone to the disease.

It is also more prevalent in the southeastern United States and there has been an increase in much of the country, including Ohio, in recent years. Diabetes has a direct link to obesity, which also has increased and better studies have led to more diagnoses of prediabetes.

Twenty-five percent of hospital admissions in the U.S. are for diabetic patients, with the most common reason being for foot ulcers, said Torres, who explained that if the ulcers are detected and treated accurately, it would prevent 85 percent of amputations.

For the most part, people aren’t noticing problems or seeking treatment until it is too late and even ordinary problems can get worse and lead to serious complications in diabetic people.

Those with diabetes are prone to problems because of their poor circulation as an insufficient amount of oxygen is making it to the tissue with blood vessels that are narrowed and hardened. Smoking makes the arteries harden faster.

Diabetes also causes neuropathy, a loss of nerve sensation in the feet which keeps the sore areas from hurting, so those with them often may not even know there is a problem, Torres said.

“When you begin to lose sensation, you begin to have problems,” Torres said.

It can lessen the ability to feel pain, heat or cold, meaning a person could have a blister or other injury and not know until the skin breaks down and becomes infected.

Nerve damage also can lead to changes in the shape of feet and toes.

“Malformation of feet caused by shoes and standing can cause pressure which also leads to problem areas,” Torres said.

Its recommended that special therapeutic shoes be worn by those with diabetes, rather than forcing deformed feet and toes into regular shoes.

Diabetes can cause skin changes. At times feet can become dry with peeling and cracking skin as the nerves that control oil and moisture in the foot no longer work.

After bathing, feet should be dried and sealed with a thin coat of plain petroleum jelly or unscented hand cream with care taken not to put oils or creams between the toes as extra moisture also can lead to infection. Feet also should not be soaked as that can dry out skin.

Calluses occur more often and build up faster on the feet of people with diabetes because of the high-pressure areas under the foot. Again, therapeutic shoes and inserts are recommended, some of which may be covered by insurance.

If not trimmed, calluses can get very thick and then break down, turning into ulcers or open sores. Only health care providers should cut calluses and chemical agents should not be used at home to try to remove them.

Using a pumice stone every day on wet skin with lotion applied immediately after is the best approach to keeping calluses under control.

Torres recommended checking feet every day for cracks, swelling and changes in the skin. He said to be wary of wet socks soaked with fluid after being worn and to make sure physicians check feet during routine visits.

“Use a lubricating cream and take good care of your feet,” Torres said.

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