Get Smart With Your Feet
By Keith Everett, DPM
Kaiser Permanente, Mission Bay, San Diego, CA

You've heard all the bad news about diabetes and foot problems - it can lead to loss of feeling in the feet, sores that won't heal, and amputation. Well, the good news is that simple preventative care can help you avoid the more common problems.

A person with diabetes needs to watch for early signs of nerve damage, poor circulation and poorly fitting shoes.

Described below are ways for you to recognize early signs of potential foot problems. Early recognition of a problem is one of the most powerful ways to prevent serious complications from occurring.

Peripheral Neuropathy

This is nerve damage, and most often occurs 10-15 years after the onset of diabetes. However, it can develop much sooner when blood sugar levels are poorly controlled or the diabetes goes undetected for a prolonged period of time. Neuropathy is a loss of feeling in the feet. When there is no feeling in the feet, it is easy for the feet to become hurt without knowing it. Think about it - feet take abuse every day. We walk on them, kick things with them, and shove them into uncomfortable shoes. Sore feet tell you that something is wrong. Without that signal, injured feet won't get the attention they need in order to heal.

Neuropathy is easy to diagnose. A simple test can let you know if your feet are in need of special care and attention. The Semmes-Weinstein monofilament, a small plastic wand, is used to touch the bottom of your foot. This can be obtained through your doctor or pharmacist.

The following procedure is the best way for you to check your feet for nerve damage. You will need a friend or family member to help you.

Sit in a comfortable chair in your bare feet with your feet up. Close your eyes. The person helping you should hold the wand with the handle parallel to your foot and the plastic filament pointed towards the bottom of your foot. Then have the person touch the bottom of your foot with the filament just until the filament bends. He or she should touch your feet under the big toe and across the ball of the foot, going back and forth from one spot to another, one foot to another, and in no particular order. Each time you feel it touch you, let your helper know. If you can feel the filament's touch most of the time, you probably have enough feeling in your feet to know if you have a foot injury. If you cannot feel it most of the time, you need to carefully inspect your feet every day for injury. If there is injury, you should contact your primary care doctor for advice.

Remember: There is no perfect test. Even if you have feeling in your feet, it is possible to have a foot injury without knowing it. So it's important to inspect your feet daily even if you don't have neuropathy. There is no cure for neuropathy, but strict blood sugar control can prolong or maybe even prevent this condition.

Poor Circulation

Watch your feet for signs of poor circulation. Cold feet, thin shiny skin, and feet that appear reddish-purple when dangling can all be signs of decreased blood flow to the legs and feet. Pain in the calf muscles when walking (a condition called intermittent claudication) is also an indication of poor circulation. Diabetes plays a role in this, but so do heredity and diet. The best prevention is exercise! Get out and get those muscles moving! Walking, cycling and swimming are all excellent ways to keep the blood flowing in your legs. Treadmills and stationary bikes are fine. The important thing is to do it. As always, check with your physician before beginning an exercise program.

If you think you have poor circulation but aren't sure, talk to your physician. He or she can check the pulses in your feet and may send you for a simple, noninvasive test if needed. Surgery is usually indicated only when the circulation problems are disabling or threaten the survival of a limb. There are medications that may help with the pain of intermittent claudication, but they do not improve the overall circulation to the legs.

Poorly Fitting Shoes

Help prevent foot problems by choosing shoes that fit well and are appropriate for the activity that you are doing. Always have your feet measured when buying a pair of shoes. Feet do change size and shape as we get older. Use the size as a guide only, as it is more important that your shoes fit properly. If you have neuropathy, you cannot use how the shoes feel as a guide to how they fit. With shoes being imported from all over the world, not all size 8 shoes are created equal. A shoe should fit snug, but not tight, around the heel and instep, with enough room at the end for the toes to stretch forward as you walk. Shoes with rounded toe areas are generally going to fit better. Also look for shoes that are well padded.

Your feet should last a lifetime, and the above suggestions can help to make that happen.

Vtla Kaliseji's Note: In addition to the above warning signs, it's important to watch for cracks in heels, dry skin, which could leave your feet open to infection. An application of a good moisturizer, such as Curel will help, but never put any lotion between your toes. The area between your toes should always be clean and dry.

Another helpful item are heel cups, to help provide support for your heels and feet. The best I've tried are TULIs, which have to be obtained or ordered by your doctor. They really absorb the shock far better than any other cups I've tried, and are easy to hide in pumps as well as athletic shoes. TULIs are available in different sizes and are designed to fit your weight as well as your feet. They are worth their weight in gold.

It is also wise to visually inspect your feet nightly.