Caitlin Whyte (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

 Welcome to Be Well with Skagitregionalhealth.org. I'm Caitlin Whyte. And with me is Dr. Emily Chau, a wound care specialist from Skagit Regional Health. Today we are discussing diabetic foot care. To start off our episode today, why is diabetic foot care critically important from a wound care professional's perspective?

Emily F. Chau, DPM, AACFAS: So diabetic foot care, for all of us in wound care, it's, it's very, very important because it's almost like the prevention so that way you don't have to come see us in wound care. And the biggest thing I think for us is if you're not doing the prevention and you're coming to see us, it's more work, honestly.

Because with wound care, there's a lot involved, weekly visits, changing your dressings. There's limitations on the things you can do. So, if you can take care of your foot beforehand, that just prevents all these future hassles for you as a patient. And then there's always that hypothetical risk of needing surgery and amputation if you're not taking care of your foot. Because diabetic injuries, especially wounds can turn south really quick.

Host: Well, why are people with diabetes more prone to foot complications and what risk factors should they be aware of?

Emily F. Chau, DPM, AACFAS: People with diabetes, they're more prone to foot complications purely just because of how diabetes can almost wreak havoc in patient's bodies. So, diabetes can contribute to a whole host of issues besides just having, you know, an elevated blood sugar. It can lead to things like neuropathy, which is a loss of sensation in the foot.

And, it can also lead to poor blood flow where the excess sugar in your body basically coats the blood vessels and it prevents blood flow. Almost like a, almost like a clot. It's called glycosylation to be technical. But these things, they make people more prone to foot complications because it hinders healing when you do get an injury or a wound.

And then especially with patients who have that neuropathy, that loss of sensation, they don't feel it when they get the wound. And they can show up at the wound care center after having a wound for like weeks and not realize it. And it can already be something that could be life-threatening.

So that's the main reason why they're more prone to complications is that diabetes just prevents you from healing and it can contribute to the formation of wounds because you just don't know that it's formed. In terms of the risk factors, they should be aware of, it's those things they should be aware of developing neuropathy, getting that numbness and tingling and loss of feeling in their feet.

They should be aware of their blood flow, getting checked out. If a doctor says that they can't feel pulses in their feet, that's sometimes an indication of an underlying issue, but also diabetes can contribute to that lack of blood flow.

Host: Well, on that note, when should someone with diabetes seek out medical advice for any foot related concerns? And how is a typical diagnosis then made?

Emily F. Chau, DPM, AACFAS: There's a couple different standards of care, but in my opinion, anybody with diabetes who is starting to feel a loss of sensation in their foot or has some sort of deformity, meaning that they're getting calluses in certain areas because their foot structure isn't exactly normal; these people should be seeing someone on a regular basis to get their feet checked. But specifically, from a wound care perspective, you should seek medical advice for foot related concerns almost as soon as you notice any sort of drainage or wound forming, or even a callous that's got a little red spot that might have been dried blood.

Those are all kinds of signs to seek out either a podiatrist or your primary care doctor or a wound care specialist to make sure it doesn't become a more serious issue. And then a diagnosis for any sort of wound related issue is more visual, but for things like neuropathy or a vascular issue possibly related to diabetes, those can be more technical.

 Neurologists can do nerve tests. And then things like x-rays can show what a foot structure of a patient looks like, and they might be more prone to getting wounds, especially if they're a diabetic because of certain bony prominences, pressure points is what I would say.

Host: Well, how can that timely intervention prevents the progression of foot issues into more serious problems?

Emily F. Chau, DPM, AACFAS: Yeah, so timing is definitely important with diabetic wounds. Because, the one thing I always tell my patients is that these wounds can turn south really fast because you're always on your foot. So, timely prevention, like getting a callous taken care of before it becomes bad, or getting a superficial cut or a little pressure sore offloaded with boots or something like that can be really, really important because these wounds can progress into larger open sores, wounds that are infected relatively quickly. And having that timely intervention also prevents you from ending up in the hospital sometimes with these diabetic foot infections, getting things like abscesses or infections that can travel up your foot, your leg, can affect your life even.

Host: Mm. Mm-hmm. Well, what everyday practices can people with diabetes adopt to minimize the risk of those foot problems?

Emily F. Chau, DPM, AACFAS: For patients with diabetes, at home and creating a ritual almost is important, in terms of checking your feet. So, I always tell patients either at night or something like that, after a long day, you'll want to examine your feet for any calluses or breakdown or I always recommend patients wear white socks if they've had a history of wounds or  calluses that could break down, because that's how you can see the drainage. And then patients with diabetes who've developed neuropathy or are the beginning of neuropathy where they're starting to lose sensation, if you're going to soak your feet or take a shower or anything like that; I tell them to check the water temperature with their elbow or with a thermometer so they're not causing any burns because they might not be able to feel the temperature.

So, these are kind of like little practices that people can implement to prevent any issues with their feet. Just chronically checking your feet, making sure that nothing is going wrong, checking your shoes to make sure they're not worn down. A lot of it can be attributed to foot, or a lot of injuries sometimes can be attributed to footwear and foot gear.

Making sure your shoes are wide enough or they're not wearing down, they're offering enough support. These little practices that you know, if people take for granted can be really helpful in preventing patients from getting a wound.

Host: Absolutely. Well, could you also recommend some footcare routines that would help prevent issues as well?

Emily F. Chau, DPM, AACFAS: For me, foot care routines for my patients vary depending on the severity of your how your diabetes has affected your feet. People who have just like diabetes but no neuropathy and they have great blood flow, I tell them that when you're checking your feet, if you see a callous, you can kind of use a pumice stone to shave it down or you can soak your feet to kind of keep it clean.

But you know, if you are a diabetic with neuropathy, I recommend then that you have somebody else check your feet also, just so you have somebody else lay eyes on it and help you care for your nails and your calluses because you might not feel if you've gone too far and you might create wounds.

 And then other foot care routines are, I always tell people, you have to moisturize your feet in the winter. We live in Washington. Dry cracked skin can become wounds. So, it's those small little rituals that are important. And then a bigger important thing for me to recommend for patients is make sure you're seeing a podiatrist as part of your routine almost to get nails trimmed appropriately, calluses maintained, especially in the setting of having sensation loss or blood flow issues.

Host: Well, what new technologies or other advancements in wound care are improving outcomes for diabetic patients?

Emily F. Chau, DPM, AACFAS: So, there's actually quite a bit in the wound care field for just general wound healing, especially for diabetics. A lot of things are being implemented or covered by insurance if you have diabetes. One of the big things that we offer here at the Skagit Regional wound care clinics both in Arlington and in Auburn is something called hyperbaric oxygen.

And this is a great treatment to help patients who have diabetes, who have that poor blood flow. Because the purpose is meant to push oxygen, like a hundred percent oxygen into your body to promote healing in the cells that might not get enough blood flow or enough oxygen to them. So that's one of the big things that is I would say new in the sense it's been around for a few years, but it's also being studied a lot more. And it's been shown to help a lot of patients with diabetic foot wounds heal. Other things like you have a lot of skin substitutes are what they call them. So instead of taking your own skin, there are these manufactured skin substitutes that can be applied to diabetic foot wounds to help them heal when they've stalled or become problematic.

And a lot of doctors who work with diabetic feet and diabetic wounds also will use something called a total contact cast. And this is important for patients who have wounds on the bottom of their feet from pressure, and that total contact cast allows them to walk in a protected manner when usually without that cast, they'd be almost, I wouldn't say sedentary, but it would be close. They wouldn't be able to use that limb that's affected. So, this cast gives them a little more freedom. So those are kind of the big three things that are improving outcomes for our diabetic patients is more appropriate offloading and better healing potential. And then there's lots of other advancements that keep coming out.

Changes in new infection treatments and monitoring. It's always changing in wound care is what I say. So, there's always new advancements.

Host: Beautiful. Well, on that note, what is your final piece of advice for anyone concerned about maintaining foot health with diabetes?

Emily F. Chau, DPM, AACFAS: I think my final piece of advice kind of is an accumulation of what I've been saying, but I think everybody who has concerns about their, their foot, when they're a diabetic should establish care and maintenance with their primary care doctor as overall prevention and monitoring their health.

And then I think establishing care with a podiatrist is also a really important aspect because both of those aspects are for prevention and a podiatrist can check their feet before it becomes an issue. They can maintain things, get them diabetic shoes and inserts that can offload their feet.

 Then I think just overall maintaining health, if you know you are diabetic and you have high blood sugar, making sure you're checking your labs, checking your blood sugar daily. Because all those things will impact how you will heal. And that is really important if you do end up getting a wound.

So, it's not just, I think, checking your feet, it's also about making sure as a whole your lifestyle is conducive to healing.

Host: That was Dr. Emily Chau. For more information, go to skagitregionalhealth.org. And if you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Caitlin Whyte and this is Be Well with SkagitRegionalHealth.org. Thanks for listening.