When you have diabetes, the importance of foot health and annual foot exams cannot be underestimated.
Research conducted by the Center for Disease Control and Prevention (CDC) shows that diabetes often causes problems with feet and legs, and these problems can be severe.
According to the CDC, amputations in people with diabetes account for more than 60% of the amputations of legs and feet not resulting from an injury.
Additionally, people with diabetes were eight times as likely to lose a leg or foot to amputation as people without diabetes.
Marco Ucciferri, podiatrist with Summit Medical Group, explains how diabetes affects foot health, discusses warning signs of failing foot health in diabetics and what the diabetic patient must do to keep their feet protected and healthy.
Selected Podcast
Diabetes and Foot Health
Featured Speaker:
Dr. Ucciferri has practiced with Foot and Ankle Care Associates of New Jersey since 2003. His hospital appointments have included Hoboken University Medical Center, Somerset Medical Center, and Surgicare of Central Jersey.
Born in Italy and raised in the United States, Dr. Ucciferri says, "I became a doctor so that I can make patients feel better and help the community." He adds, "I believe in preventive health care to preempt problems before they happen."
Marco Ucciferri, DPM
Marco Ucciferri, DPM, expertise includes child, adolescent, and adult foot and ankle medicine, foot and ankle trauma, and reconstructive surgery.Dr. Ucciferri has practiced with Foot and Ankle Care Associates of New Jersey since 2003. His hospital appointments have included Hoboken University Medical Center, Somerset Medical Center, and Surgicare of Central Jersey.
Born in Italy and raised in the United States, Dr. Ucciferri says, "I became a doctor so that I can make patients feel better and help the community." He adds, "I believe in preventive health care to preempt problems before they happen."
Transcription:
Diabetes and Foot Health
Melanie Cole (Host): When you have diabetes, the importance of foot health and annual foot exams cannot be underestimated. Research conducted by the Center of Disease Control and Prevention shows that diabetes often causes problems with feet and legs and these problems can be severe. My guest today is Dr. Marco Ucciferri. He’s a podiatrist with Summit Medical Group. Welcome to the show. Tell us a little bit about some of the complications that arise with people’s feet when they have diabetes.
Dr. Marco Ucciferri (Guest): Sure. Some of the complications that patients have are usually vascular and neurological, with the neurological portion being the most common. You get neuropathy and neuritis, where patients end up having loss of sensation in their feet, which leads to patients having problems with possible ulcerations, infections, and sequelae of amputation to the foot.
Melanie: Doctor, why does neuropathy happen when someone has diabetes? Why do they get that nerve damaged that can lessen their ability to really feel what’s going on in their feet?
Dr. Ucciferri: Well, neuropathy happens from high glucose levels in the blood. Basically, patients who either cheat or don’t follow their dietary needs end up having high blood glucose, then the blood glucose ends up metabolizing in the nerve. And alcohol. Alcohol deadens the nerve peripherally, and you start having numbness. Initially, it starts out toward the toes and progressively, as time goes on, patients who are really bad with the diabetes end up getting it almost up to the knee, to the point of you can really put a needle onto their leg or their foot and they don’t feel any of it. Complete numbness.
Melanie: Wow! They can have problems like stepping on something and not even really realize it. Now, what about foot ulcers? How do those happen? What are they?
Dr. Ucciferri: Well, foot ulcers are basically a breakdown of the skin on the bottom of the foot, sometimes the back of the heel. Again, when you have neuropathy, you lose the sensation of the foot which allows you to know if something is painful. Patients typically that don’t have neuropathy end up getting a callus and the callus causes pain, and then the patient stops either to the podiatrist or changes their shoes and they get better. Patients with neuropathy can’t feel that, and the callus ends up breaking down to an opening of the skin to a sore, which can become infected. Basically, loss of sensation creates this annoying pain that they can’t feel that ends up causing a wound on the bottom of the foot.
Melanie: What happens if they notice this wound and it’s not healing properly?
Dr. Ucciferri: Well, if they notice the wound is not healing properly, they should obviously seek medical aid as soon as possible. These wounds can really go down quite rapidly to the point of gangrene or even possible infection to the body. So I explain to patients: if you cannot visualize your feet, have someone look at your feet in the family. And when you see there are a ulcerative lesion like a callus or a sore, to make sure you follow up with a podiatrist. And at that point, they can begin some conservative treatments, whether it’s offloading pressure or wound care at that time.
Melanie: What can they do, doctor, about the skin changes that happen with the skin on your foot? And if you’re getting really dry or getting those calluses, people tend to go for creams and pumice stones and oils. What should they be doing?
Dr. Ucciferri: Initially, when patients have dry skin, it’s just this plain dry skin. Everyone knows what dry skin is. On their hands, you get dry skin. Usually, I explain to patients the best stuff to use is an emollienttype of moisturizer such as Aquaphor or Eucerin. Or even the best I found patients have told me over the years is Vaseline or a derivative of Vaseline, like petroleum jelly, which works really well to keep moisture to the skin. Because keeping the moisture to the skin keeps the skin pliable and keeps it healthy from breaking down as much and creating calluses. When this gets much more symptomatic, these calluses get worse, so you can try some over-the-counter creams and you’re not getting improvement, first thing to do is just go see the podiatrist or dermatologist, and they can really evaluate you to see if there’s any type of problem, be it pressure, weight-bearing issues, shoe gear issues that can be causing this callusing of the skin.
Melanie: As a podiatrist, do you take care of calluses and trim them down? Or do people soak in a footbath? What if they want to get a pedicure?
Dr. Ucciferri: Well, pedicures are really not the greatest things for things like this, especially as a diabetic patient. Diabetic patients should really not be getting pedicures because sometimes they are very hard on your feet, you get the pedicure can be over-aggressive. And I’ve had patients come with wounds post pedicures. But patients who have a callus or something like that, usually they come to the office. We pare them down or shave them down, and then we figure out why you’re getting the calluses. So it’s prevent the problem. You don’t just come in to get the callus shaved. We can offload the pressure to the area or talk about shoe gear or talk about a preventative device, like a custom-molded orthotic or diabetic shoe that would offload the pressure to that area so it stops you from getting that callus.
Melanie: What’s a diabetic shoe?
Dr. Ucciferri: A diabetic shoe is a shoe that’s actually mandated by the government. Medicare covers diabetics for a diabetic shoe, which is a custom-molded shoe. Basically, it’s any type of shoe ranging from a sneaker to Hush Puppies to a loafer type of shoe, but the inside of the shoe is custom-made to that patient’s foot. Basically, we make a mold of the patient’s foot, the mold gets into a lab, the lab produces this insole that goes into the shoe that’s custom for the patient and prevents any type of breakdown of the skin or irritation or callusing.
Melanie: Wow! That’s cool. They have a special shoe that they can wear that can help prevent some of these things. What else can they do at home? What about exercise, Dr. Ucciferri? Is walking long distances or running off limits for diabetics, or is this good for them?
Dr. Ucciferri: No, it’s actually very good for them. But again, always check with your physician or primary doctor about starting an exercise program, and also make sure you have the appropriate shoes. I always explain to patients when they start an exercise program, whether you’re 20 years old or 90 years old, you want to make sure you’re doing the right thing—stretching, pre-imposed exercise. Begin at a slow pace. You don’t want to start running a 5K marathon anytime as soon as you start exercising. Basically, you want to slowly increase your rate of exercise. Exercising is extremely important for diabetics, for everything. Keeping that blood glucose low prevents you from having the neuropathy. And patients with neuropathy actually do better with exercise because it increases the blood flow to the feet, which helps tremendously. But again, you have to be sure that you don’t have any ulcers or sores or anything like that that would make a problem. But using appropriate shoes and inserts, custom-molded orthotics, again, are extremely helpful to prevent any further problem.
Melanie: What would you say about getting exams? How often should they see you if they’re a diabetic to have their feet examined? And can they do some of these exams at home?
Dr. Ucciferri: A podiatry exam for a non-symptomatic diabetic patient is usually once a year. Most primary care doctors will send a patient for both eyes and feet as a diabetic. As far as exams at home, I explain to patients it’s very much visualizing it, and sometimes having someone else visualize their feet. If there’s any irritations on the foot, red marks, bruising, changes in skin, either tone or texture, even nails—sometimes nails become infected or you get a paronychia in that nail—anything can really be visualized. Because again, you can’t go by sensation. You can’t even go by using your hands. Sometimes, your hands will have neuropathy in them, too, so you can’t feel. I always explain to patient, if you can,make sure someone else looks at them, and that’s the best way to examine your feet at home. Do that on a daily basis, if you can, on the foot.
Melanie: What about foot massages and soaking in baths, some things to improve circulation down there?
Dr. Ucciferri: Basically, those things are really not recommended. Foot bathing actually dries up the skin and causes actually cracking of the skin. I’m not big on that. Moisturizing the skin either on a daily basis or twice daily is extremely helpful. Massaging the feet is also helpful. Again, you’re trying to increase blood flow to the area. A massage that our patients use, hand massagersor things like that to increase blood flow to the feet, which is very helpful. But again, not to be over zealous, not to really push too hard because again, you can injure yourself also.
Melanie: In just the last few minutes, doctor, give your best advice for people with diabetes and taking the best care of their feet and why they should come to Summit Medical Group for their foot and diabetic care.
Dr. Ucciferri: Well, first of all, they should come to Summit Medical Group because as a whole, we can treat the patient in one fell swoop. We do everything from head to toe. Having that team approach is extremely helpful for the patient. If there’s an issue, we can call upon vascular, call upon the endocrinologist, call upon a dietitian. We can make it a group effort to help the patient keep out of trouble. As far as the most important thing I tell patients when they’re diabetic is I’d rather see the smallest non-significant problem than have it fester to something terrible. As soon as the patient has a problem, if they’re even concerned about it,I’d rather have that patient come to the office and work it out and say, “Oh, it’s no big deal,” or, “This is what it is.” We can get a hold of it before it becomes a significant problem.
Melanie: It’s great information. Thank you so much. You are listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Diabetes and Foot Health
Melanie Cole (Host): When you have diabetes, the importance of foot health and annual foot exams cannot be underestimated. Research conducted by the Center of Disease Control and Prevention shows that diabetes often causes problems with feet and legs and these problems can be severe. My guest today is Dr. Marco Ucciferri. He’s a podiatrist with Summit Medical Group. Welcome to the show. Tell us a little bit about some of the complications that arise with people’s feet when they have diabetes.
Dr. Marco Ucciferri (Guest): Sure. Some of the complications that patients have are usually vascular and neurological, with the neurological portion being the most common. You get neuropathy and neuritis, where patients end up having loss of sensation in their feet, which leads to patients having problems with possible ulcerations, infections, and sequelae of amputation to the foot.
Melanie: Doctor, why does neuropathy happen when someone has diabetes? Why do they get that nerve damaged that can lessen their ability to really feel what’s going on in their feet?
Dr. Ucciferri: Well, neuropathy happens from high glucose levels in the blood. Basically, patients who either cheat or don’t follow their dietary needs end up having high blood glucose, then the blood glucose ends up metabolizing in the nerve. And alcohol. Alcohol deadens the nerve peripherally, and you start having numbness. Initially, it starts out toward the toes and progressively, as time goes on, patients who are really bad with the diabetes end up getting it almost up to the knee, to the point of you can really put a needle onto their leg or their foot and they don’t feel any of it. Complete numbness.
Melanie: Wow! They can have problems like stepping on something and not even really realize it. Now, what about foot ulcers? How do those happen? What are they?
Dr. Ucciferri: Well, foot ulcers are basically a breakdown of the skin on the bottom of the foot, sometimes the back of the heel. Again, when you have neuropathy, you lose the sensation of the foot which allows you to know if something is painful. Patients typically that don’t have neuropathy end up getting a callus and the callus causes pain, and then the patient stops either to the podiatrist or changes their shoes and they get better. Patients with neuropathy can’t feel that, and the callus ends up breaking down to an opening of the skin to a sore, which can become infected. Basically, loss of sensation creates this annoying pain that they can’t feel that ends up causing a wound on the bottom of the foot.
Melanie: What happens if they notice this wound and it’s not healing properly?
Dr. Ucciferri: Well, if they notice the wound is not healing properly, they should obviously seek medical aid as soon as possible. These wounds can really go down quite rapidly to the point of gangrene or even possible infection to the body. So I explain to patients: if you cannot visualize your feet, have someone look at your feet in the family. And when you see there are a ulcerative lesion like a callus or a sore, to make sure you follow up with a podiatrist. And at that point, they can begin some conservative treatments, whether it’s offloading pressure or wound care at that time.
Melanie: What can they do, doctor, about the skin changes that happen with the skin on your foot? And if you’re getting really dry or getting those calluses, people tend to go for creams and pumice stones and oils. What should they be doing?
Dr. Ucciferri: Initially, when patients have dry skin, it’s just this plain dry skin. Everyone knows what dry skin is. On their hands, you get dry skin. Usually, I explain to patients the best stuff to use is an emollienttype of moisturizer such as Aquaphor or Eucerin. Or even the best I found patients have told me over the years is Vaseline or a derivative of Vaseline, like petroleum jelly, which works really well to keep moisture to the skin. Because keeping the moisture to the skin keeps the skin pliable and keeps it healthy from breaking down as much and creating calluses. When this gets much more symptomatic, these calluses get worse, so you can try some over-the-counter creams and you’re not getting improvement, first thing to do is just go see the podiatrist or dermatologist, and they can really evaluate you to see if there’s any type of problem, be it pressure, weight-bearing issues, shoe gear issues that can be causing this callusing of the skin.
Melanie: As a podiatrist, do you take care of calluses and trim them down? Or do people soak in a footbath? What if they want to get a pedicure?
Dr. Ucciferri: Well, pedicures are really not the greatest things for things like this, especially as a diabetic patient. Diabetic patients should really not be getting pedicures because sometimes they are very hard on your feet, you get the pedicure can be over-aggressive. And I’ve had patients come with wounds post pedicures. But patients who have a callus or something like that, usually they come to the office. We pare them down or shave them down, and then we figure out why you’re getting the calluses. So it’s prevent the problem. You don’t just come in to get the callus shaved. We can offload the pressure to the area or talk about shoe gear or talk about a preventative device, like a custom-molded orthotic or diabetic shoe that would offload the pressure to that area so it stops you from getting that callus.
Melanie: What’s a diabetic shoe?
Dr. Ucciferri: A diabetic shoe is a shoe that’s actually mandated by the government. Medicare covers diabetics for a diabetic shoe, which is a custom-molded shoe. Basically, it’s any type of shoe ranging from a sneaker to Hush Puppies to a loafer type of shoe, but the inside of the shoe is custom-made to that patient’s foot. Basically, we make a mold of the patient’s foot, the mold gets into a lab, the lab produces this insole that goes into the shoe that’s custom for the patient and prevents any type of breakdown of the skin or irritation or callusing.
Melanie: Wow! That’s cool. They have a special shoe that they can wear that can help prevent some of these things. What else can they do at home? What about exercise, Dr. Ucciferri? Is walking long distances or running off limits for diabetics, or is this good for them?
Dr. Ucciferri: No, it’s actually very good for them. But again, always check with your physician or primary doctor about starting an exercise program, and also make sure you have the appropriate shoes. I always explain to patients when they start an exercise program, whether you’re 20 years old or 90 years old, you want to make sure you’re doing the right thing—stretching, pre-imposed exercise. Begin at a slow pace. You don’t want to start running a 5K marathon anytime as soon as you start exercising. Basically, you want to slowly increase your rate of exercise. Exercising is extremely important for diabetics, for everything. Keeping that blood glucose low prevents you from having the neuropathy. And patients with neuropathy actually do better with exercise because it increases the blood flow to the feet, which helps tremendously. But again, you have to be sure that you don’t have any ulcers or sores or anything like that that would make a problem. But using appropriate shoes and inserts, custom-molded orthotics, again, are extremely helpful to prevent any further problem.
Melanie: What would you say about getting exams? How often should they see you if they’re a diabetic to have their feet examined? And can they do some of these exams at home?
Dr. Ucciferri: A podiatry exam for a non-symptomatic diabetic patient is usually once a year. Most primary care doctors will send a patient for both eyes and feet as a diabetic. As far as exams at home, I explain to patients it’s very much visualizing it, and sometimes having someone else visualize their feet. If there’s any irritations on the foot, red marks, bruising, changes in skin, either tone or texture, even nails—sometimes nails become infected or you get a paronychia in that nail—anything can really be visualized. Because again, you can’t go by sensation. You can’t even go by using your hands. Sometimes, your hands will have neuropathy in them, too, so you can’t feel. I always explain to patient, if you can,make sure someone else looks at them, and that’s the best way to examine your feet at home. Do that on a daily basis, if you can, on the foot.
Melanie: What about foot massages and soaking in baths, some things to improve circulation down there?
Dr. Ucciferri: Basically, those things are really not recommended. Foot bathing actually dries up the skin and causes actually cracking of the skin. I’m not big on that. Moisturizing the skin either on a daily basis or twice daily is extremely helpful. Massaging the feet is also helpful. Again, you’re trying to increase blood flow to the area. A massage that our patients use, hand massagersor things like that to increase blood flow to the feet, which is very helpful. But again, not to be over zealous, not to really push too hard because again, you can injure yourself also.
Melanie: In just the last few minutes, doctor, give your best advice for people with diabetes and taking the best care of their feet and why they should come to Summit Medical Group for their foot and diabetic care.
Dr. Ucciferri: Well, first of all, they should come to Summit Medical Group because as a whole, we can treat the patient in one fell swoop. We do everything from head to toe. Having that team approach is extremely helpful for the patient. If there’s an issue, we can call upon vascular, call upon the endocrinologist, call upon a dietitian. We can make it a group effort to help the patient keep out of trouble. As far as the most important thing I tell patients when they’re diabetic is I’d rather see the smallest non-significant problem than have it fester to something terrible. As soon as the patient has a problem, if they’re even concerned about it,I’d rather have that patient come to the office and work it out and say, “Oh, it’s no big deal,” or, “This is what it is.” We can get a hold of it before it becomes a significant problem.
Melanie: It’s great information. Thank you so much. You are listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.