Submitted by Theodore B. McKee, DPM, Blue Ridge Footcare & Surgery, PLC, Staunton
Diabetes is an epidemic in the global medical community, affecting over some 400 million individuals. As providers, we know the myriad complications our patients can face: injuries secondary to neuropathic complications, ulcerations, infections, loss of sight, multiple dermatological issues, and limb loss. The American Diabetes Association reports that as of 2015, 30.3 million Americans, or 9.4% of the population, is diabetic. Diabetes is the 7th leading cause of death in the United States as of 2015, with 79,535 death certificates, listing it as the primary underlying cause of death. Furthermore, a total of 252,806 death certificates lists diabetes as a secondary underlying, or contributing cause of death.1
Feet are greatly affected by diabetes and its subsequent complications. Diabetic patients are at a great risk for the development of diabetic foot ulcerations. This is due to the lack of epicritic sensation. Any foot deformity can lead to increased pressure in shoe wear. Due to the lack of protective sensation, ulcerations can develop from rubbing, infections can ensue, and partial or full amputations of the lower extremity eventually can occur. Foot ulcerations continue to remain a major health care problem. They are common, result in considerable suffering, frequently recur, are associated with high mortality, and add considerable health care costs.2 These episodes can potentially be avoided with frequent podiatric care, regular visits to the patient’s endocrinologist/primary care to monitor A1c levels and disease management, and most importantly, education. We as providers can help our patients become educated consumers in the healthcare system, and perhaps set a lasting ripple effect that will dwindle the number of those affected by the dangers of diabetes through education and preventative maintenance.
The American Podiatric Medical Association suggests the following measures to help patients avoid complications with their feet 3:
- Check for a loss of sensation in the feet, known as neuropathy
- Examine skin for calluses, blisters, sores, excessively dry or cracked skin, or any other unusual conditions, especially between the toes
- Look for signs of decreased circulation: such as fragile, shiny, skin with loss of hair
- Check the feet for extreme temperatures (excessive warmth or coldness)
- Inspect nails for thickening, ingrown corners, excessive length, and fungal infections
- Inspect socks or pantyhose for blood or discharge
- Examine footwear for torn linings, foreign objects like rocks or small pebbles, improper fit, and irritating seams
Therapeutic Diabetic Shoes
Proper footwear is an essential aspect of care for those with diabetes. The APMA recommends that diabetic patients, even those in the early stages of diabetes, wear proper and protective shoe gear to avoid callus breakdown and offset potential ulcerations. If there is any clinical evidence of paresthesias, diabetic neuropathy, or decreased sensation, in conjunction with diabetes, the patient would benefit from wearing therapeutic shoes. Therapeutics shoes are a small step to help the patient avoid unwanted complications and potentially damaging effects to their feet.
Footwear for people with diabetes should achieve the following objectives 4:
Relieve areas of excessive pressure: Areas of excessive pressure on the foot can lead to skin breakdown or ulcers. Diabetic shoes and inserts should help to provide relief of these high-pressure areas, thus reducing the occurrence of related problems.
Accommodate, stabilize and support deformities: Deformities resulting from orthopedic and other conditions such as: Charcot involvement, bunions, hammer toes and prior amputation sites must be accommodated within the shoe gear. Deformities need to be stabilized to alleviate pain for the patient and to avoid further destruction. By accommodating and controlling these deformities, the progression of future complications can be halted significantly.
In conclusion, diabetes is a worldwide epidemic that affects the patient in many ways. Its reach is growing exponentially on a yearly basis. November is Diabetes Awareness month. We are reminded, as healthcare professionals, to find as many ways as possible to aid our patients who suffer with diabetes. Through education and prevention, the medical community can help to curb the effects of diabetes and its multitude of complications.
References
- American Diabetes Association. (2018) Statistics About Diabetes. http://www.diabetes.org/diabetes-basics/statistics/
- Jeffcoate, W. J., Vileikyte, L., Boyko, E. J., Armstrong, D. G., & Boulton, A. J. (2018). Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes care, 41(4), 645-652.
- American Podiatric Medical Association (2015) Footprints: Reflect on Your Feet. November 2015. https://www.apma.org/files/APMA_Footprints_FALL2015Newsletter_FINAL.pdf
- American Orthopaedic Foot and Ankle Society. (2018) Shoes and Orthotics for Diabetics. http://www.aofas.org/footcaremd/conditions/diabetic-foot/Pages/Shoes-and-Orthotics-for-Diabetics.aspx