A Step Ahead - Sole Foot and Ankle Specialists Blog

Posts for category: Diabetic Foot Care

Every November the health care community at large educates the public on diabetes.  In the United States the month of November is Diabetes Awareness month.   According to the 2017 report from the CDC – Centers for Disease Control and Prevention – there are 30.3 million Americans – 9.4 percent of the U.S. population - have diabetes.  Another 84.1 million Americans have prediabetes a condition that if not treated often leads to type 2 diabetes within five years.

Diabetes can be accompanied by a handful of secondary complications that can range from mild to severe.  The most common areas that can be affected by diabetes are the feet, the eyes, kidneys and skin.  Diabetic patients can experience decreased sensation – neuropathy – in their feet.  This can lead to a decrease in the ability to recognize injury and can lead to infections, ulcers and possibly amputation.  Each year over half of all amputations in the United States, most of which involve the lower extremity, are caused by complications due to diabetes.  Thankfully, diabetes linked amputations have been on the decline. 

If you have a family history of diabetes or any of the following risk factors, take the opportunity this month to be tested.  Diabetes is diagnosed by a fasting blood glucose level.  The test is simple and pain-free.  Risk factors for diabetes include the following:  family history of diabetes, obesity, inactivity, increased age, history of gestational diabetes, polycystic ovarian syndrome, high blood pressure, and abnormal cholesterol and triglyceride levels.

While we focus on those who currently suffer from this disease, there is good news for the 84.1 million who are prediabetic.  There are ways to prevent diabetes that include healthy lifestyle modifications.  Proper diet, exercise and weight loss can bring a person on the verge of a diabetes diagnosis back to a good bill of health. 

The best outcome for handing diabetes is working as a team with your providers.  Diabetic patients are encouraged to visit a podiatrist once a year for an annual foot examination.  If any other secondary complications develop such and peripheral neuropathy or peripheral vascular disease, the visits will be more frequent.

To learn more about diabetes or find free screenings in your area go to www.diabetes.org.

If your doctor has diagnosed you having diabetes and need a podiatrist to be on your team, please call our office to schedule an appointment with Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale Arizona.

Did you know that there over 7 million Americans unaware they have diabetes or are considered prediabetic? According to the American Diabetes Association (ADA) statistics, there were approximately 30 million people with diabetes in 2015, with nearly 25% of those people being 65 years or older and increasing each year. This year, March 27th is American Diabetes Association Alert Day, and the ADA uses this day to raise awareness about this debilitating disease, and provide individuals the opportunity to take a free Type 2 Diabetes Risk Test.

About Type 2 Diabetes

Diabetes is a disease that occurs when a person’s blood sugar levels are too high. Over time, having high blood sugar can lead to more serious health problems all over the body including: heart disease, kidney disease, dental disease, stroke, nerve damage, and foot problems. There are numerous types of diabetes, but the two most common are type 1 and type 2 diabetes. Type 2 diabetes is more common than type 1 and usually develops in adult life, whereas type 1  diabetes occurs more often in childhood. People who have type 2 diabetes often do not know they have it until a serious complication arises (i.e. heart attack, stroke, kidney failure, vision loss, foot ulcer formation, or even lower limb amputations).

There are numerous factors that increase the risk of a person developing type 2 diabetes such as: age, family history of diabetes, being inactive, having high blood pressure, poor diet, and weight control. The ADA created a simple, easy-to-use test to assess your risk of developing type 2 diabetes.  You can take the test by going to Type 2 Diabetes Risk Test

Why Diabetics Should See a Podiatrist

Your podiatrist plays a crucial role in managing serious side effects of diabetes and your foot health. Since the feet are the farthest structures from the heart, signs and symptoms of diabetes can appear first in the foot, such as peripheral neuropathy, and vascular issues. If your podiatrist suspects diabetes, they will perform specific neuro and vascular exams to determine the presence, or progression of diabetes complications. Signs and symptoms to lookout for include: loss of sensation in your feet, cold feet, changes in skin color, and wounds that do not seem to be healing. Your podiatrist can act as the first line of defense in detecting these changes and help protect and manage your feet from serious, life-threatening complications of diabetes.

If you would like more information about diabetes, you can visit the following websites that provide valuable information:

American Diabetes Association

National Institute of Diabetes and Digestive and Kidney Diseases

American Podiatric Medical Association (APMA) - Diabetes Awareness

Diabetes Care Education

Diabetes Self-Management Patient Education

If you or someone you know has diabetes, or thinks they might be at risk, please do not hesitate to schedule an appointment with Dr. Jay C. Larson  at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you to ensure your feet stay healthy.

Are you a diabetic who is currently suffering pain due to neuropathy or recent amputation? If so, you probably already know it can be a difficult journey to find proper pain relief. Often, patients who suffer from diabetic neuropathy have an intense, sharp, stabbing, and burning pain that they cannot seem to relieve. They try every type of pain reliever or remedy, but have little success in treating their pain. An unfortunate truth is sometimes patients only find relief in strong, addictive painkillers such as opioids (morphine, Vicodin, Oxycontin, etc.), become dependent upon them for pain relief, and end up needing stronger doses due to their body becoming tolerant of the drug; this can become expensive and detrimental to the patient’s health. If this is your situation and are interested in a possible alternative, there have been tremendous successes in treating diabetic neuropathy pain with certain medications as Neurontin® (Gabapentin) and Lyrica® (Pregabalin).

What are Neurontin® and Lyrica®

There are countless medications on the market that have been repurposed to treat other conditions. Neurontin® (also known as Gabapentin) and Lyrica® (known as Pregabalin) are two medications originally made to help treat people with seizures. However, Neurontin® and Lyrica® have shown to provide pain relief in patients who suffer from diabetic neuropathy and provide an alternative to addicting painkillers. Neurontin® has been a beneficial treatment option for patients who have had amputations or complaints of phantom limb pains after an amputation. Lyrica® has also been shown to provide pain relief in patients who suffer from diabetic neuropathy.

What are the Possible Side Effects? Can I take these if I am on other Meds?

Every medication you take will come with the possibility of side effects. With these two medications, the most common side effects tend to be sedation, dysphoria, or the inability to concentrate. It is for this reason, if you begin taking these medications, they should be taken at night, rather than during the day. The good news is these medications do not get metabolized too quickly and this allows you to take them with other medications. Also, these provide the patient with a safer way to manage their pain without the concern of becoming addicted to the medications (as seen with opioid painkillers).

If you are experiencing severe pain due to diabetic neuropathy and have yet to find a way to manage your pain, please do not hesitate to schedule an appointment with Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and see if Lyrica® or Neurontin® are suitable medications to help you manage your pain.

As we continue our focus this month on the topic of diabetes (especially as it relates to the foot and ankle) we hope to empower and educate you on how to effectively cope with a disease that can be overwhelming.  Whether you yourself have diabetes, or you care for a friend or loved one with the disease, we want to assure you that with a few adjustments and regular visits to your podiatrist, foot and ankle diabetic complications can be successfully managed.  Real effort, determination, compliance, and patience are prerequisites for success.  With that being said, today’s discussion centers around diabetic ulcers and what you can do as either a caregiver or a patient to speed up or enhance their healing. 

The Persistent Ulcer

Ulcers have been afflicting diabetics since the disease was first recognized.  They have been a source of frustration for both the patient and the doctor.  It is not an unusual occurrence for one ulcer to heal just for another one to appear in a different location, or even the ulcer recurs in the same place.   In some instances additional circumstances may preclude an ulcer from healing.  The following 5 tips are by no means a guarantee that an ulcer will heal, but can create the most favorable environment for success to occur.

1. Good Blood Sugar Control

Recent studies have shown that the most important factor in diabetic wound healing is the establishment of normal glucose control.  The sugar in our blood plays many key and complex roles in how are tissues heal on a molecular level.  If we have excess levels over a prolonged period, unfavorable molecular byproducts can build up resulting in a delayed healing.  In addition to these byproducts, too much glucose interferes with the inflammatory process needed for wound healing by preventing certain compounds and products such as Vitamin C to be used in the healing process.  In general, monitoring your HbA1c provides a good predictive value as to how quickly your wounds will heal.  Recent studies have shown that the closer your HbA1c is to normal, the quicker your wound will heal.

2.  Stop Smoking

If you don’t smoke or have never smoked, feel free to move on two tip #3.  For those of you currently smoking please listen up, as many substances in tobacco have a direct negative consequences on wound healing.  For example, nicotine found in cigarettes causes blood vessels to constrict which diminishes the amount of blood flow and nutrients delivered to the site of the wound.  One cigarette can constrict blood vessels in this fashion for up to 90 minutes. This shows that a full pack of cigarettes would have this effect on blood vessels all day long.

3. Wear your boot and other devices at home.

One of the mainstay treatments of diabetic wounds and ulcers is to relieve pressure from the site of the wound allowing it to heal without further damage. This is achieved by wearing either casts, walking boots, pads, and other devices.  For the most part, patients do really well wearing these devices when out of the house, however this has proven to not be the case when at home.  In another recent study, researchers determined that people were just as active at their houses as they are when they leave their homes.  It was also shown that study participants who were the most diligent only wore their devices 60% of the time.  In addition, while out and about, 85% of patients wore their boots, but when at home, only 15% of patients continued to wear their boot or offloading device.  Moral of the story is that although it might seem more comfortable to not wear the boot at home, you are really doing yourself a disservice.

4. Proper Nutrition

It goes without saying that nutrition plays a major role in all physiologic processes in our bodies, so it is with wound healing.  As we have already discussed, Carbohydrates or sugar plays a vital role that will either enhance or hurt wound healing.  Protein and amino acids are likewise very important in the healing cascade.  Vitamins such as Vitamin C and Vitamin A play critical roles in cellular mechanisms to promote the proper inflammation needed to achieve wound resolution.  Deficiencies or excesses in any of these areas can impede healing and may even be detrimental to overall health.  Consult with your doctor to determine if you may be lacking in any of these nutrients.  Do your very best to consume a balanced diet rich in appropriate amounts of carbohydrates, protein, fats, vitamins, and minerals.

5. Reduce Stress Levels

Usually when someone mentions stress as a possible cause for adverse health outcomes, it is quickly brushed aside.  The reality is however, that stress causes the body to respond by releasing a product called cortisol.  This has many physiological consequences, including delayed healing.  Stress can also deplete stores of Vitamin A, Zinc, and amino acids such as arginine that are all players in wound resolution.  While it is easier said than done, reducing stress while in the face of ulcer complications may decrease your healing time.  This can be difficult as ulcers can be frightening and distressing, but do the best that you can.   If you are experiencing excessive anxiety from your ulcer, seek the professional advice of your doctor as he or she may be able to prescribe cognitive behavioral therapy, medications, or professional counseling.  Also, seek out wholesome activities that you find enjoyable and soothing.

Conclusion

With these few tips in mind, always remember that you can count on a multispecialty team of professionals who have your best interests in mind. Don’t hesitate to schedule an appointment with Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona.

In the past we have written extensively about the complications that arise from diabetes.  These have included complications such as cardiovascular problems, peripheral neuropathy, atherosclerosis, foot ulcers, infection susceptibility and many others.  You quickly get the sense that diabetes is a multisystem illness with expansive impact on your body.  The focus of this article, however, is centered on preventing diabetic foot ulcers.

Why is this important?

Diabetic foot ulcers can be a major complication of diabetes.  Often an ulcer may become so deep and infected that it reaches the bone.  The infection then enters the bone and unless the infection can be resolved, will lead to amputation.  In a diabetic, amputations may begin with a toe here and a toe there, but its possible that ulcers may continue to form and the need for amputation can eventually result in a complete foot amputation or even a below the knee amputation.  In the setting of these types of amputations, additional problems arise.  While a healthy person who has undergone an amputation may do very well with a prosthesis, a diabetic with a amputation regardless of the prosthetic device, will place undue stress on the heart, and will often experience heart problems and other complications.  Often diabetics who have undergone major amputation have the same prognosis as a person with colon cancer.  With this in mind, it is easy to see why prevention of the ulcer is the name of the game, and is imperative.

How can I prevent a diabetic foot ulcer?

The most important component in preventing a diabetic foot ulcer is daily foot awareness!  Diabetics should form a solid habit of examining and caring for their feet on a regular basis. 

Things to do:

  • Daily foot inspections (have another person help if need be)

  • Daily shoe inspections (remove any debris or irritants, check for shoe breakdown)

  • Proper Hygiene (gentle cleansing, topical moisturizers, nail clipping, etc.)

  • Proper shoe gear (fully supportive, fully cushioned, proper fitting with adequate space)

  • Thick absorbent socks

  • Regular visits to your podiatrist: evaluate extent of neuropathy, evaluate biomechanical concerns, evaluate for musculoskeletal deformities, etc.

 

Things to avoid:

  • Home remedies

  • Hot soaks

  • Heating pads

  • Harsh substances (hydrogen peroxide, betadine, etc.)

  • Anything that would exacerbate the wound or impede it’s healing

 

Keep in mind, the smallest of wounds or skin abrasions can become the largest of ulcers. Because of diabetic peripheral neuropathy, often an individual cannot feel the wound or ulcer and is unaware of what is causing it.  Any minor skin abrasion or wound on the foot should be treated with gentle cleansing, applying a topical antibiotic, and appropriate dressing and padding of the wound to prevent it from progressing.  It is always good practice to follow up with your podiatrist for proper management of any wound you may have received especially if you already have a history of ulcers or amputations. Additional conservative care may include custom orthotics.  These function to help correct any biomechanical causes of inappropriate pressures, which may be contributing to ulcer formation.

In the event that conservative care fails, there are often surgical options to reduce ulcer formation and promote healing.  The goal of these surgeries are to reduce the tightness or tension in the calf and Achilles tendon, which will in turn diminish the pressure placed on the forefoot.  This is often done in the setting of an ulcer that will not heal or recurring ulcers.

Conclusion

As in all cases education, foot awareness, prevention, and conservative care are the mainstays of treatment. Occasionally progressive treatment such as surgery may be warranted.  Regular visits to your podiatrist are imperative to management of any ulcers or wounds and to avoid amputation.  If you have or know of anyone who has diabetic foot complications, don’t hesitate to schedule an appointment with Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona.



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