Take these steps for winter diabetic foot care
Parkland podiatrist says cold-weather precautions help prevent complications
As part of the world-wide epidemic of diabetes, physicians report that lower extremity amputations are dramatically increasing. At least 50 percent of those with diabetes develop neuropathy (nerve damage) that can cause tingling, pain, numbness and weakness in the foot. Foot ulcers affect more than 15 percent of people with diabetes and can lead to infections that invade the bone as well as soft tissues, often requiring amputation of the lower extremity.
During the winter, lower temperatures combined with precipitation from rain, sleet or snow can lead to temperature- and moisture-related foot problems for patients with diabetes.
“Neuropathy can diminish a person’s ability to feel heat and cold,” said Javier LaFontaine, DPM, MS, podiatrist at Parkland Health & Hospital System. “Because of the loss of sensation, patients may not be aware of the risk of frostbite or hypothermia. Or they may be injured by putting their feet too close to a space heater or fireplace. In addition, damp socks collect and trap moisture between the toes where bacteria can thrive, which can lead to infection.”
Diabetes causes poor circulation to the extremities, making the foot less able to combat infections and heal normally. High levels of blood glucose in diabetic patients make it difficult for the body to fight infection, Dr. La Fontaine said.
One of the 12,000 patients seen annually at Parkland’s Diabetic Foot Clinic, Samuel Whitaker, 59, was diagnosed with type 2 diabetes more than 25 years ago. In his 40s the disease led to amputation of all of his toes. Although he spent several years in orthopedic boots and using a wheelchair, Whitaker now walks unassisted in normal athletic shoes, thanks to extreme determination and a positive attitude.
At 6’1”, the Grand Prairie resident today is a slender 178 pounds and enjoys swimming to stay active. But it took him years to come to terms with his diabetes.
“I was hard-headed,” he confessed. “I didn’t take good care of myself. My weight got up to 358 pounds.” When his blood sugar soared to 788, a doctor in Houston where he then lived told him, “You’re lucky to be alive.”
Poor nutrition, lack of exercise and a reluctance to change had caught up with him.
“I had to learn how to eat the right way,” Whitaker said. Giving up his favorite sugary drinks and juices, he switched to water, diet sodas or tea sweetened with sugar substitutes. Importantly, he also learned about portion control.
“The best way to control your diabetes is to know what you put in your mouth,” he said. “Now I eat just half of a hamburger, wrap the other half and save it for the next meal.”
Regular doctor visits at Parkland are now part of his normal routine, but it took him a while to accept that fact. “Once you get diabetes, you need to go to the doctor for the rest of your life,” he said.
The American Diabetes Association estimates that 28 million people in this country have diabetes and it remains the 7th leading cause of death in the U.S. Preventing serious foot complications should be a priority for anyone with diabetes, Dr. La Fontaine stated. “I urge any patient with cuts or breaks in their skin, changes in foot color, shape or level of sensitivity to see a foot care specialist immediately.”
“The number one thing for people with diabetes is to take care of yourself. Eat right, take your medicine and examine your feet every day,” Whitaker said.
Dr. La Fontaine provided the following tips for patients with diabetes to help maintain foot health and avoid complications:
• Manage your diabetes. Work closely with your healthcare provider to keep your blood glucose in target range.
• Check your feet daily. Examine your bare feet for cuts, blisters, sores and swelling. Use a mirror to check the bottoms of your feet, or ask someone else to help.
• Wash your feet daily and dry them carefully, especially between the toes.
• Moisturize your skin daily, rubbing a thin coat of lotion on the tops and bottoms of your feet, but not between the toes where moisture can lead to the development of fungus.
• Wear appropriate footwear that protects your feet and fits properly; ask your physician if you qualify for Medicare coverage for special shoes.
• Stay active. Develop an exercise and activity schedule with your healthcare provider to promote fitness and a healthy weight.
• Keep toenails trimmed. Cut your toenails straight across and file edges smooth with an emery board. Get professional help if you’re not able to do this yourself.
• Protect your feet by wearing shoes and socks. Never walk barefoot. Wear 100 percent cotton white socks that are breathable and will show blood stains if you have a wound.
• Protect your feet from temperature extremes. Test water with your elbow before putting your feet in bathtub. To prevent burning your feet without realizing it, never use heating pads, space heaters, electric blankets or hot water bottles.
• Improve circulation. Elevate your feet whenever possible when sitting. Avoid crossing your legs for long periods and wiggle your toes and ankles several times a day.
• Don’t smoke. Smoking is bad for circulation and is a risk factor for many serious conditions, including cancer, heart disease, diabetes and stroke.
To learn more about foot health and diabetes, visit www.diabetes.org. For more information about services available at Parkland, visit www.parklandhospital.com
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