The Foot Book
By Jonathan D. Rose, DPM and Vincent J. Martorana, DPM
Copyright © 2011 by The Johns Hopkins University Press
Provided with permission by The Johns Hopkins University Press. All rights reserved.
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Prevention is the Best Medicine
The best thing you can do as a person with diabetes is take care of yourself and, as much as possible, prevent the disorder from taking its toll on your health. To help you with this prevention, you should have a primary care physician or family doctor, and you may have regular appointments with other specialists, such as an endocrinologist, a podiatrist, and an eye specialist. Ideally, you should see a nutritionist, if not regularly than at least for an initial consultation. There are a few basic actions that you should do without fail: regularly visit your primary care physician to ensure strict control of blood sugar levels, take all medications exactly as prescribed, eat a healthy diet, refrain from smoking, and participate in regular exercise, unless given other instructions from a physician. Exercise improves bone health, promotes circulation, and helps to stabilize blood sugar levels.
Because of the complications for the feet that we outlined earlier, you should be referred to a podiatrist as soon as a diagnosis of diabetes is made. The podiatrist evaluates your medical history and performs a physical examination to develop a foot care program tailored to you. Typically, you should see a podiatrist once a year for an assessment, although some people require more frequent evaluations. If you have or are at particular risk of developing the neurological or vascular complications described earlier, you should go to a podiatrist every two to three months for preventive foot care, including trimming of nails, corns, and calluses. You should also inspect your feet every day to look for changes in the skin, the toenails, or the shape of the foot. Report any abnormalities to your podiatrist or primary care physician. A callus or wart can sometimes conceal a more serious problem, such as an abscess.
If you have diabetes, proper hygiene and skin care are essential. Wash your feet every day with mild soap and water, paying particular attention between the toes. If the web spaces aren't cleaned, dead skin can accumulate, and fungal and bacterial infections may develop and result in ulcers. We don't recommend soaking feet, as they will lead to dry skin, which is more likely to crack and may put you at risk of infection. Moisturize the skin on your feet twice daily, but don't apply lotion between the toes, because this may encourage a fungal infection or athlete's foot. Cut toenails straight across or file them. Avoid cutting deep into the corners of the nail, because of the increased risk of causing an ingrown toenail. If a nail does become ingrown, immediately consult a podiatrist. Feet that are excessively moist from perspiration can benefit from the use of nonmedicated foot powders, but avoid letting the powder build up between the toes. Antiperspirants can also be used for moist feet.
As a person with diabetes, you should always wear shoes when walking. Walking barefoot increases the chance of getting a puncture wound or an object embedded in the foot, either of which can lead to serious infection and even amputation. If you have peripheral neuropathy, wear shoes when swimming – in a lake, a river, or even a swimming pool.
A podiatrist can recommend the most appropriate type of shoe to wear, depending on the shape of your foot and whether you have peripheral neuropathy or poor circulation. Choose shoes made of a breathable, soft material such as natural leather. Avoid shoes made of plastic of other synthetic materials as well as high-heeled shoes because of the abnormal pressure they put on the forefoot and toes. Before putting on a shoe, always check it for objects, prominent seams, or rough areas that could harm the skin. Wear seamless socks with moisture-absorbing capabilities, and protect your feet from extremes of hot and cold. Individuals with poor circulation, loss fo feeling in their feet, significant deformity of the foot, or a history of developing ulcers will benefit from wearing therapeutic shoes designed with special features not provided by off-the-shelf footwear.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...