Extra Care for Diabetic Feet
Q: I have diabetes. What can I do to take care of my feet?
A: Foot problems caused by complications of diabetes, such as poor circulation, neuropathy, and infection, are the leading cause of hospitalization of diabetic patients. Between 600,000 to 800,000 people in the US currently suffer from diabetic foot ulcers. According to the American Diabetes Association, any diabetic foot wound that remains unhealed after four weeks is associated with worse outcomes, including amputation.
Follow these guidelines to keep your feet healthy:
Proper Gait: The complex interaction of foot bones and joints allows the vast range of motion exhibited by the foot during walking. Abnormal mechanical loading of the foot, resulting in repetitive pressure applied to the bottom of the foot during walking, plays an important role in the development of foot problems.
Footwear: Good-quality, properly fitting shoes may prevent diabetic foot ulcers from forming just as well as custom therapeutic inserts and footwear. For diabetics, foot-care specialists routinely recommend shoes designed to provide extra toe room, along with customized cork inserts.
Foot Screen: An annual foot screen by a health care provider is recommended for people with diabetes.
Daily Foot Care: It is important to check the feet: wash, dry, and moisturize them every day. Avoid using hot water or hot soaks to the feet.
Toenail Care: Long, thick, or ingrown toenails can produce ulceration or infection. Trim the nails parallel with the end of the toe, and seek assistance from a professional if the nails are too thick to safely trim yourself.
Manage Calluses: Professional removal of calluses is an effective way to reduce pressure, thus decreasing the risk of ulceration. Refrain from “self-surgery” on corns and calluses, as this can lead to infection.
General Health: Maintaining blood-sugar control and proper hygiene; avoiding the use of tight garments, especially tight socks, and leg-crossing can decrease circulation.
Foot Emergencies: Promptly report foot injuries, cuts, or signs of infection to your health care provider.
— Ariana Staruch
Shoe Wear and Tear
Q: My shoes always wear out on the outside of my heel first from walking, is this normal for my shoes wear out this way?
A: Yes. During heel strike, a 10-to-15 degree toe-out from midline is normal. This will cause a wearing out on the outside of the heel first. Over distance, your shoes will show wear indicating your specific type of foot biomechanics and motion that occur while walking. A worn pair of shoes is a great tool for a knowledgeable coach or doctor to look at and understand how you have been moving. If there are any significant abnormalities on your wear pattern, corrective exercises and therapies help normalize your foot function and make walking more efficient and fun. Having some understanding of foot biomechanics also helps you know how to correct your walking gait for maximum efficiency.
On a much more technical side of foot function, my favorite of all the 26 bone in the foot is the cuboid. It is the kingpin of the lateral arch and responsible for helping make the transition from pronation to supination right after heel strike.
There are three arches in the foot, the most well known is the medial arch. This is the focus of most orthotic manufacturers and is represented by the elevation between the heel and big toe of the insert in most shoes and custom orthotics.
The second arch in line is the transverse arch, located just toward the toes from the middle of the foot crossing from the inside to the outside of the foot. It keeps the long bones, or metatarsal, from becoming too compressed within the foot. When sections of the transverse arch collapse, the foot becomes narrower and compresses the nerves between the long metatarsal bones. This may cause a painful neuroma. A metatarsal pad, which lifts and separates the transverse arch, is often a simple cure for this condition.
The last in the series is the lateral arch: This is the unsung hero of good foot function. The lateral arch consists of four bones from the heel to just before the outside two toes. The heel bone, or calcaneus, at the back of the foot connects to the fourth and fifth metatarsals, by way of the cuboid bone in the lateral arch. If you are having any kind of foot problems, make sure all three arches are evaluated.
— Bryan Basisinger
This Issue’s Experts
Arianna Staruch, ND, is a naturopathic physician focused on women’s health issues and can be reached at 503-279-0205 or arianna@clearh2o.org.
Bryan Basisinger, DC, is a Portland State University Athletics team physician and is the owner of Clearwater Clinic and can be reached at 503-279-0205 or bryanb@clearh2o.org. |
