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Defeat Diabetes
150 153rd Ave,
Suite 300

Madeira Beach, FL 33708

Helping Your Feet Last a Lifetime

Posted: Monday, April 05, 2004

By Richard R. Rubin, PhD, CDE

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
. 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.

bullet Do your best to keep your blood glucose levels as close to normal as possible, because this helps slow nerve damage and protects you from infections if your feet do get hurt.
bullet Stop smoking! The nightmare scenario for people with foot problems is an amputation, and 95 percent of all people with diabetes who have amputations are smokers. That's no coincidence: smoking narrows your arteries, restricting blood flow and making it much, much harder to heal foot injuries. Just one more very good reason to not smoke.
bullet Find a safe, enjoyable exercise. Foot problems can limit your mobility, but staying as active as you can help control blood glucose levels and weight, making it easier to get around. Staying active also helps increase your circulation, and it can improve your outlook on life as well.

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

bullet Keep your feet safe. Using a moisturizer on your feet can help prevent your skin from cracking and causing small cuts that could get infected. Never walk barefoot, even in the house, if you have lost feeling in your feet. And check your shoes before you put them on. Remember the patient I told you about. Loss of feeling also means you could burn your feet, in a hot bath for instance, and never know it. So be sure to check the water temperature carefully before you step into the tub.
bullet Check your feet every day. Look for any redness or swelling (this could be a sign of infection), and for ingrown nails or cracked skin (even tiny cracks can lead to big problems). Closely inspecting your feet could be hard for you if you have limited vision or limited mobility. If so, putting a lamp on the floor near your feet and using a magnifying mirror could make the process easier. If you are still having problems seeing your feet, ask your health care provider for suggestions. Maybe a family member would be willing to help.
bullet Get care immediately if you notice any of the early warning signs I just mentioned. This is a key to avoiding serious problems.

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

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