Transcription:
Living with Diabetes: Keep Your Feet Healthy

Bill Klaproth (Host): People with diabetes suffer from high blood sugar levels and over time and left unchecked, it can cause nerve damage and circulation issues and these problems can cause or contribute to foot problems. Here to talk with us more is Dr. Jason Woods, a physician at Schneck Medical Center. Dr. Woods, thank you for your time today. So, what are the effects of diabetes on your feet?

Dr. Jason Woods (Guest): Well, thanks for having me, Bill. I’m happy to talk about this topic as it’s a very important one in our community. As you outlined in your intro there, you know, the big things that we see that affect our diabetic patients are impairment in their nerve function and their vascular system. So, what that means is that their blood glucose is elevated over a long period of time. It starts to impair their ability to feel their feet and, many times, that ends up resulting in significant complications. So, a simple blister or a spot of irritation that somebody without neuropathy would very quickly notice, somebody with neuropathy will kind of ignore that because they don’t feel that feedback of pain. And, those little sores can go on to become infected and complicating their whole situation down there. Additionally, as diabetes progresses over time, their blood flow to their feet becomes impaired. That’s often, initially, manifested with some very subtle color changes to the feet or their feet go cold. But, as time goes on, that can be a significant factor in patients’ ability to heal. So, really, neuropathy and vascular impairment are the two main aspects that result in diabetic foot complications in my practice.

Bill: So, that’s interesting. You don’t feel that there’s a problem down there. You don’t feel the pain. Normally, you would look and go, “Geeze, my…Oh, I’ve got a blister here.” You just you don’t know what’s there and then it gets worse and gets infected and then you said you start feeling the tingling or the numbness. Is that when you know there’s a big problem? When your feet are always cold or you do feel a tingling or a numbness?

Dr. Woods: You know, that’s an interesting observation. Some people with neuropathy, they do feel pain. You know, they feel this tingling. People will describe it as a pins-and-needles type sensation or a cold feeling. And, some people don’t feel that at all and they just go straight to numbness. But, I’d say most people have a mixture of the two. You know, when I test them in the office to see how well they feel, they don’t feel things that they should but yet they have this overriding burning, tingling type sensation on their feet. That’s usually one of the first things we see patients have is this burning, tingling type sensation. So, that definitely throws up a red flag that this whole has process has started and then actually, you know, it progressed quite a bit.

Bill: Right. So, Dr. Woods, and say somebody doesn’t feel something on their foot and sometimes people with diabetes are less flexible and maybe they don’t have the dexterity to check and see the bottom of their feet, so then, they should go see a podiatrist, is that right? Or, how do they check their feet and how do they care for their feet at that point?

Dr. Woods: Well, first of all, if someone has diabetes, current guidelines would be for once a year for them to be seen by a podiatrist. And then, from there, that podiatrist is trained to kind of stratify how often that patient needs to be seen. You know, with more complications associated with their feet, you know, more frequent follow-up may be necessary. But, at least once a year is a good starting point. Every diabetic patient should be performing daily foot inspections of themselves. That does become difficult with age and inflexibility to be able to see the bottoms of your feet. And, if that’s the case, you have a family member check them. A mirror can be a helpful tool in helping you see the bottoms of your feet. So, it is challenging but usually educating people about neuropathy and the fact that you might not feel the problem, so don’t wait until you feel the problem. You know, that’s a big aspect of this and just providing that education to allow people to know what to look for.

Bill: And, what if someone ignores the signs and it gets worse? What are the complications, then, if this goes unchecked?

Dr. Woods: Well, the big complications we see are kind of like I said before. You know, it usually starts with either a blister or a callus or something that initially isn’t too threatening but, as time goes on, they subsequently get an infection. That infection advances. That infection can either may them quite sick or become quite deeply embedded into even the bone. And, once a diabetic patient has infection that deep, it’s very difficult to treat with simply antibiotics and many times surgery is required. And, many times that’s how people end up with you know losing part of their foot or even their whole leg. It’s something simple that just kind of spirals out of control.

Bill: So, that’s spiraling out of control that leads to a really severe infection and that’s where we have heard of people get, unfortunately, getting toes and, you know, even more, their feet amputated. Is that right?

Dr. Woods: Correct.

Bill: So, is there a way to prevent these symptoms? Can somebody do something to kind of ward this off?

Dr. Woods: Sure. And, the tough thing about diabetes is usually day one, when you’re diagnosed with it, it’s not something that makes you terribly. . .Now, some people you know they find out in kind of a shocking manner where they’re you know going to ketoacidosis or something severe, but, most people you know, it’s not a real shocking thing to them. They’re told, “Well, you need to make some lifestyle changes. Change your diet.” And, you know, nothing really grabs their attention. But, the sad thing is after years and years and years of not managing their diabetes effectively is when we see these problems. So, by the time I’m seeing people with these problems, most of the time, we’ve kind of missed the boat. And so, how I would answer that is the best way to prevent the symptoms is when you’re initially told, “Hey, you have diabetes,” or, “You’re prediabetic,” or anything to do with impaired blood sugar, is to take that seriously and to do everything in your power to work with your family physician and managing that blood sugar effectively. The other big thing from my perspective is just daily inspection. At the first sign, if you’ve got a spot on your foot, that is questionable at all, it’s best to have it evaluated by either a family physician or a podiatrist or somebody who is looking out for your best interest.

Bill: Well, that makes sense. Employ the necessary lifestyle changes that a physician has prescribed for you. Like you said, do the daily foot checks. And then, at some point, is there a special kind of foot wear available for those with diabetes?

Dr. Woods: Sure. Absolutely, and that’s a commonly prescribed thing. You know, diabetics, that have foot complications—so, either circulatory problems or neuropathy--would qualify under most insurance plans to get what you call “diabetics shoes”. Diabetic shoes are shoes that are specially designed to have a very soft accommodative insert in the shoe that helps prevent friction and prevent a lot of episodes of blisters and things like that. The shoes themselves are usually what we all extra depth shoes. So, they’re wider, deeper. They can accommodate for deformities that you know a normal off-the-shelf shoe might actually rub the foot. You know, a diabetics shoes less likely to do that. So, yes, diabetic shoes are an important tool in prevention of these sorts of complications that we’re speaking of.

Bill: And, who do those get prescribed to? Are those people that are already having foot complications?

Dr. Woods: Usually, you know, both from a preventative standpoint and people who have had complications. You know, you’ve heard the phrase, “an ounce of prevention is worth a pound of cure.” You know, definitely, we don’t wait for people to get diabetic foot ulcers to prescribe diabetic shoes. People who have risk factors such as abnormal alignment to the foot might make that foot prone to ulcerate, impaired circulation and impaired sensation. You know, those are the type of people that would qualify and we’d want to urge them to get into diabetic shoes before they get a foot ulcer because once they have an ulcer, it’s a different. It’s a much more uphill battle getting one to heal.

Bill: Right. So, before is the key right there. And, wrap it up for us if you would, Dr. Woods. Why should someone choose Schneck for their diabetes and foot care needs?

Dr. Woods: Well, I think we’re very fortunate here at Schneck. We’ve got excellent doctors in all different specialties. We’ve got a great endocrinology service and so management of diabetes at that level, they do a great job with working with patients there. You know, my practice is very busy with patients with these sorts of complications, so I have a lot of experience with that. And so, I feel like, patients, when they come to Schneck for both their diabetic care and their foot care, are in good hands.

Bill: Excellent. Thank you so much, Dr. Woods. I really appreciate your time today. And for more information, visit www.schneckmed.org. That’s www.schneckmed.org. This is Schneck Radio. I’m Bill Klaproth. Thanks for listening.