By Myles Rubin Samotin, MD – Board Certified Orthopaedic Surgeon, Fellowship Trained in Foot and Ankle –
The number of people suffering from diabetes has grown exponentially over the past few decades. Some of you have first-hand experience or have a relative who uses insulin daily requiring numerous blood draws to try and maintain normal blood sugar levels. But to the great majority of you, diabetes is treated with a pill and you believe you will never be affected by the symptoms of diabetes; problems with nerves, blood vessels, heart, eyes and other organs, including our feet. How wrong that thinking is!
When you are first diagnosed with diabetes, you must take great care to treat all the symptoms that diabetes can cause, including numerous feet problems to. With great diligence you can minimize the health risks associated with diabetes and your feet. Numerous problems can arise; seeking medical care for proper diagnosis and treatment is important. What happens if you neglect your feet? Let me explain.
The major concerns regarding the feet revolve around the problems that diabetes causes to your nerves and blood vessels. Tiny nerves (digital nerves) and blood vessels (capillaries) which are mainly found in extremities (hands and especially feet) undergo changes making them unable to perform properly. Therefore, your nerves do not respond to pain or injury stimuli preventing you from feeling that your feet have been injured. If they are injured, it is more difficult for them to heal than other body parts when your blood vessels do not perform properly. Also, normal sweat secretion and oil production that lubricates the skin of the foot is impaired. The immune system can also be compromised making it more difficult for the body to heal itself.
In order to prevent problems with your feet caused by diabetes, you must be ever vigilant. Daily checking of your feet is mandatory. Due to nerve damage, your feet cannot feel hot or cold temperatures well, so you must test water with your hands. Proper trimming of your toenails is essential. Always keep your feet warm. Sitting cross-legged can decrease the blood supply to your feet. Never walk barefoot or in sandals or thongs. Footwear must be chosen very carefully. Pointed-toe shoe styles and high heels must be given up and replaced with shoes with bigger toe boxes and leather upper material. New shoes must be broken in over a period of time, to allow your feet to get used to them. The types of socks and stockings must also be chosen carefully as elastic tops can cause skin problems. Socks with holes can cause the foot to get wounds without you realizing it.
If you follow these tips, then you generally don’t have medical problems with your feet. But sometimes, try as hard as you might, you still can have problems with your feet. The important thing is to know when you should seek medical attention. Waiting too long can lead to major disasters.
If you have diabetes, I would highly suggest seeking an expert in foot and ankle, who has the understanding of both the foot anatomy and the medical expertise to properly treat diabetes. An orthopedic foot and ankle specialist have knowledge in both areas: foot anatomy and medical treatment of wounds, infections and proper antibiotic uses.
But when should I seek an orthopedic foot and ankle specialist? If you have diabetes, you should follow up within 72 hours. You should see him for any significant trauma to your toes, feet or legs; mild-to moderate pain in your feet or legs; any new blister, ulcer or wound, new areas of warmth, redness, or swelling; ingrown toenails; any new numbness in your feet or legs; constant itching which could signify a fungal infection; or difficulty walking.
Again, with due diligence and care, most problems can be detected and treated early. But if problems become bad, an orthopedic foot and ankle specialist may need to take you to the operating room for debridement of wounds, skin grafting or possibly fixing a fracture that you were unaware of.
My best suggestion if you have diabetes, whether recently diagnosed or if you have had it for years, is to be aware that feet problems can become major issues if not treated. You should see an orthopedic foot and ankle specialist who is very familiar with the foot problems associated with diabetes. As a Board Certified Orthopaedic Surgeon M.D. with a Sub-specialty, Fellowship Trained in Foot & Ankle surgery, I am the only surgeon with these qualifications in our area. I believe this makes me uniquely able to deal with these problems in a state-of-the-art atmosphere and method that will keep you in good hands and provide you with the most desired result.
Myles Rubin Samotin, MD
Board Certified Orthopaedic Surgeon
Fellowship Trained, Sub-specialist in Foot and Ankle Surgery
Columbia University, Maimonides Medical Center,
Hospital for Joint Diseases, New York City
713 E. Marion Avenue, Suite 135