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People with diabetes can end up with many foot problems. The scariest and most problematic of these is a diabetic foot ulcer. My name is Dr. Andrew Schneider and I'm a podiatrist in Houston, Texas. A diabetic foot ulcer is a hole that forms on the bottom of the foot. It's a complication of diabetes that can lead to infection and even amputation.
When you're diagnosed with diabetes, there's a lot of information thrown at you. Lots of information about checking your blood sugar, along with the devices to do so. Things you can eat. Things you shouldn't eat. It can get overwhelming!
Along with that is usual information about how to care for your feet. That's because much of the effect of diabetes is focused on your feet. In fact, caring for your feet properly and making sure they stay healthy will help prevent the complications that affect your feet. The most severe of these complications is a diabetic foot ulcer.
First and foremost, in order for your feet to be healthy, YOU need to be healthy. I can't overstate how important it is to control your blood sugar. Whether you take insulin or use medication, maintaining a healthy blood sugar level minimizes the adverse effect of diabetes.
But medication isn't enough. It's also vital that you manage your diet to minimize sugars and foods that break down into sugar. It's not a choice of one or the other. You have to do both. This will help to prevent the two big risk actors for your feet because of diabetes: Peripheral Arterial Disease
and Peripheral Neuropathy.
Peripheral Arterial Disease occurs when you have poor blood flow to the feet. When this happens, you're at greater risk of forming diabetic foot ulcers. An already existing ulcer won't heal when don't have enough blood flow to your feet. That's because the blood carries oxygen and healing factors to the site of the ulcer. If the flow is restricted, these important resources can't make it there. I may do a circulation test in the office called an Ankle Brachial Index or ABI. This simple, quick, non-invasive test
compares a circulation in your ankle to the circulation in your arm. If I do find there is a potential problem, I'll refer you to a circulation specialist who will do more advanced studies and treatment to restore blood flow to your feet.
One last thing about circulation. Smoking seriously compromises the peripheral circulation. If you add diabetes and smoking together, the risk is extraordinarily high. So whether you're diabetic or not, I advise you to stop smoking. It's not worth putting your feet and your life at risk.
Peripheral Neuropathy is also a serious complication of diabetes. It leads to a numbing of the nerves in your feet. This may lead to a breakdown of skin as an ulcer forms, and because you can't feel it, you wouldn't even know about it until it's too late.
Because you may not be aware of your feet having less sensation, it's good to develop the routine to inspect your feet every night before you go to bed. Look at the bottom of your feet and between your toes. What you're looking for is any redness, blistering, callusing, bleeding, soreness, sores that form, or pus. Anything that wasn't there yesterday.
It's also important that you wear well-fitting shoes. Shoes that have enough room for your feet without causing areas of pressure. A blister caused by a shoe can easily form into a diabetic foot ulcer. You should also not go barefoot even around the house. When your feet don't have good sensation, you can step on something and not even realize you have something in your foot until you inspect your feet that night.
There are two ways that I use to predict the formation of a diabetic foot ulcer before it forms. The first is when you're in the office, I use a system called Revealix to identify any areas of increased temperature of your feet. It's been well established that there's an increase in temperature before a diabetic foot ulcer forms. Revealix is able to take a thermal image of your feet and identify areas of increased temperature.
Another tool that I use to monitor the risk of developing a diabetic foot ulcer is with remote patient monitoring. I utilize specialized socks or insoles that are designed to monitor the temperature of your feet. If there's a change that may indicate a problem, a message is then to our office and a team of nurses to alert you to the potential problem so we can address it.