Our feet were made to last a lifetime - so we can stroll, dance, garden, golf and keep up with our children and grandchildren until our days on earth are done. That's what we all dream of. But for people with diabetes, realizing that dream presents special challenges.

Loss of feeling
One of the biggest of those challenges is the fact that many people with diabetes eventually develop a condition called diabetic neuropathy. That's the technical name for the nerve damage that seems to be caused in part by high blood glucose. The first sign of nerve damage in the feet and legs is often a tingling or burning sensation. This discomfort usually increases over time, and many people say they get to a point when anything touching their feet or legs, even bedclothes at night, causes unbearable pain.

Eventually, most people notice that their feet hurt less. This is wonderful in a way, because the pain of neuropathy can be so intense, and because there is no really effective way to relieve this pain.

Feeling no pain is not a good thing
Unfortunately, less pain is usually not a sign that neuropathy is getting better. Instead, it is a sign that those damaged nerves have stopped functioning altogether. When that happens, keeping your feet healthy gets a lot more complicated, because you have lost what is called protective sensation. That's a fancy way of saying that your feet no longer let you know when they hurt. And that's not a good thing. It's like having a smoke alarm with a dead battery: you won't get warned when there is trouble.

I had a patient who walked around all day at work with one of his son's little metal toys in his shoe. He never felt a thing, and only realized he was in trouble when he took off his shoes after he got home from work and found his sock soaked with blood from a deep cut in the bottom of his foot. It took six weeks in the hospital to heal the wound completely. Clearly, feeling no pain is a very mixed blessing.

Without protective sensation my patient hurt himself seriously without ever feeling it. Then, because he also had limited blood circulation and fairly high blood glucose levels (like lots of people with diabetes), it took his foot a very long time to heal. Poor circulation made it hard to get the oxygen and other things the wound needed to heal, and high blood sugars make infections easier to get and harder to get rid of.

Have you lost feeling in your feet?
If you want to help your feet last a lifetime, it's really important to take extra special care of them. For starters, find out if you have diminished protective sensation. If you have some of the symptoms I described earlier, be sure to talk to your health care provider. He or she can help determine whether you have lost feeling in your feet. There is a very simple test that provides an answer. By touching various spots on your feet with a monofilament, a thin, flexible piece of plastic like fishing line, you and your provider can tell how much you can still feel.

Caring for your feet by caring for your diabetes
If you have lost some or all protective sensation, you really have to pamper your sweet feet. Here are some general things that help.

Special foot care tips
There are also some very specific things you can do to protect your feet.

I've been caring for people who have diabetes for a long time, and many of my patients have complications - problems with their eyes, kidneys, heart and feet. Among these complications, foot problems are often the most devastating because they make it so hard for people to do the things they want and need to do. If you can't walk comfortably you can't do much, and foot ulcers make walking comfortably nearly impossible.

So please do everything you can to help your feet last a lifetime. If you do, you could be one of those 85-year-olds who can still run circles around people 30 years younger. Wouldn't that be great?

Richard Rubin, Ph.D., C.D.E., Associate Professor of Medicine and Pediatrics at the Johns Hopkins University School of Medicine, is the co-author of Psyching Out Diabetes: A Positive Approach to Your Negative Emotions, Sweet Kids, and The Johns Hopkins Guide to Diabetes. He also has written extensively on the effects of diabetes education, psychological problems associated with diabetes and techniques for counseling people with diabetes.

Source: LifeScan: Johns Hopkins University: Updated October 2002.

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