Got Diabetes? Take These Steps to Avoid Foot Problems

By Jane Farrell

If you have diabetes and think you are otherwise healthy, it can be easy to ignore the doctor’s good advice.

But that can catch up with you. One of the challenging complications of diabetes occurs when patients’ high blood sugar damages the blood vessels, which leads to poor blood circulation in the legs and feet. When the feet are deprived of oxygen-rich blood, a condition called diabetic foot can develop, causing foot ulcers that heal very slowly, or not at all. As the disease progresses it can lead to gangrene and even amputation.

“Around 80 percent of diabetes-related lower extremity amputations start out as a foot ulcer,” said vascular surgeon Dr. Anil P. Hingorani, a member of the Society for Vascular Surgery. Vascular surgeons typically have many patients with diabetes, who need specialized vascular care to keep their feet healthy. For these patients, it is extremely important to pay attention to foot health, and to never ignore an open sore on the foot.

Diabetes patients with lower extremity wounds should be evaluated by a podiatrist, physician or an advanced health practitioner, Hingorani said.

If foot ulcers develop and don’t heal, it may be a sign that the legs and feet are not getting enough oxygen-rich blood due to narrowed, hardened arteries that are made worse by diabetes.

At that point, patients should see a vascular surgeon who can evaluate the patient’s vascular health as well as the foot ulcer. That doesn’t mean they will have to have surgery, but vascular surgeons are highly trained to know exactly how to treat diabetic foot complications. Patients who have regular Medicare (not an HMO) can see a surgeon without a referral. (A “find a specialist” search tool is here.)

Meanwhile, if you are willing to take a few simple steps to prevent diabetic foot disease, the following tips may help:

1. See the doctor regularly. Patients with diabetes should see a doctor or a clinician who is trained in foot care once a year or more often, depending on their level of risk for foot problems. If you have had previous foot sores, an amputation or diabetes-related eye problems, you may need to see someone more often.

You should also be checked more often if you have neuropathy (a lack of sensation in the feet) ischemia (a dangerous condition that cuts off blood circulation) or if your feet are becoming deformed by diabetes.

2. Learn to take care of your feet. Patients with diabetes should be educated about how to take care of their feet. You need to know how to check your feet for sores or cuts, the best ways to keep feet clean and dry.
3. Wear the right shoes. Diabetes patients do not need to buy therapeutic shoes if they have an average risk of diabetic foot, but special shoes are important for high-risk patients. During your foot checkups, ask if you need special shoes.

Even if you don’t qualify for therapeutic shoes, it is very important to wear shoes that fit comfortably. A study of 400 diabetic patients with healed ulcers found that 50 percent of women and 27 percent of men were wearing dangerous shoes, with: open toes or heels, no laces, a shallow or narrow toe box or high heels that put pressure on the ball of the foot.

The best shoes have broad and square toes, three or four lacing eyes per side, a padded tongue, are of lightweight materials and are big enough inside to accommodate a cushioned sole or orthotic inlay.

4. Avoid preventative surgery. Newer research recommends against getting a preventative stent or surgical revascularization of your leg arteries if you don’t have diabetic foot or other symptoms associated with peripheral artery disease.
5. Stay updated on best treatments. If you get a plantar foot ulcer, the best practice is to not walk on the ulcer. Your physician may prescribe a total contact cast or a fixed-ankle walking boot. This has not always been the standard treatment, but has recently been changed.

For many patients with diabetes, the illness requires careful attention to daily routine. Foot care should be part of that health maintenance.

The Society for Vascular Surgery® (SVS) is a 5,800-plus member, not-for-profit professional medical society, composed primarily of specialty-trained vascular surgeons, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. For more information, visit http://www.vascular.org/.