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DESCRIPTION
Of the sixteen million
Americans with diabetes, 25% will develop foot problems related to the
disease. Diabetes is a disease that affects every part of the body, even
when the diabetes is under control. Diabetics, because of the nature of
their disease, have fewer defenses against everyday wear and tear, especially
where the feet are concerned. Increased blood sugar affects the feet in
the following ways:
- The sugar affects
the nerves of the feet, causing peripheral neuropathy. Peripheral neuropathy
is a disease which can produce anything from strange feelings in the
feet (burning, tingling, numbness, etc.), to a complete loss of feeling
in the feet. The lack of proper feeling makes the diabetic more likely
to injure their feet without knowing it. This makes the diabetic more
susceptible to infections; fractures which are not felt, and do not
heal properly; and severe bone and joint disease which changes the contour
of the foot. See Charcot Foot for more information.
- Sugar also affects
the smaller blood vessels in the feet causing peripheral vascular disease
(P.V.D.). P.V.D. decreases the amount of blood, nutrients, and oxygen
that are brought to the skin, fat, muscles, joints, and bones of the
feet. This causes: tissues to be absorbed, an inability to properly
heal everything from small cuts to broken bones, and just plain fatigue
and weakness of the feet.
- Absorption of the
natural protective fatty pad on the bottom of the feet. This is due
to P.V.D. and/or the natural aging process. When the fat pad becomes
thinned or completely absorbed, it cannot protect the skin properly
from normal bone pressure. This puts tremendous stress on the skin which
underlies these bones, and can cause inflammation, calluses, and eventually
skin ulcers which may become infected. These problems may become worse
without the diabetic knowing it, if peripheral neuropathy is present.
It is very important
for diabetics to take the necessary precautions to prevent all foot related
injuries. Due to the consequences of neuropathy, daily observation of
the feet is critical. When a diabetic patient takes the necessary preventative
footcare measures, it greatly reduces the risks of serious foot conditions.
TREATMENT
- Inspect your
feet daily for blisters, cuts, and scratches. The use of a mirror
can aid in seeing the bottom of your feet. Examine the tops, bottoms,
and between your toes. Look for inflammed areas, cuts, peeling and
breaks in the skin, rashes, and swelling. Press on your nail to see
if they are painful or ingrown. Touch your feet and make sure the
temperature is the same in both, and that they are not cooler then
the rest of your body. Test to see that you have good feeling in the
bottom of both feet, by gently moving your finger from heel to toes.
- Wash your feet
daily. Dry carefully, especially between your toes.
- Avoid extreme
temperatures. Test water with your hands or elbow before bathing.
- If your feet
feel cold at night, wear socks.
- Inspect the insides
of your shoes daily for foreign objects, nail points, torn linings,
and rough areas.
- For dry feet,
use a very thin coat of lubricating oil such as baby oil. Apply this
after bathing and drying your feet. At bed time, massage a moisturizing
cream into your feet to prevent dry skin and cracks. Do not use chemical
corn and callus removers; they usually contain an acid, which can
burn sensitive diabetic skin.
- Wear properly
fitted shoes, with uppers made of soft materials. The toe box (the
area where the toes lie in the shoe) should be deep and wide to reduce
pressure on the toes, and the heels should be no higher than 3/4 inch.
Seamless socks and shoes cause less problems then those with seams.
Always wear shoes and socks; they protect the feet from injury. Do
not walk barefoot!
- Place protective
slippers or shoes right beside your bed to wear as soon as you get
out of bed to avoid walking barefooted.
- In the winter
months take special precautions. Wear wool socks and protective foot
gear, such as fleece lined boots.
- The best time
to trim toenails is after bathing. The nails are softer and easier
to trim at that time. Cut your toenails straight across and not too
short. Do not cut into the corners of your nails. Consult a doctor
if your nails are too thick and difficult to cut. (if the skin around
the nail is red, swollen, moist, or painful, you may have an infection,
see a healthcare professional immediately.
- Use of custom
molded orthotics can be very beneficial to provide appropriate support
and cushioning. If custom foot orthotics are not available then use
a good cushioning type of insole to help protect the foot.
- Wiggle your
toes and move your ankles up and down for 5 minutes, 2 or 3 times
a day. This increases the blood flow to your feet.
Therapeutic
Shoe Bill
In an effort
to assist you in protecting your feet and avoid complications from your
diabetes Medicare enacted the Therapeutic Shoe Bill. Designed to prevent
lower limb amputations prevalent in long-term diabetic patients, this
Medicare benefit has the potential to prevent patient suffering, prolong
patient life, and save money. Consider the following:
- 86,000 amputations
per year
- 50% contralateral
amputation within 3-5 years
- Average
cost to Medicare per amputation $25,000 - $40,000
- Direct costs:
$600 million / year
- After healing
of initial ulcer, re-ulceration occurred in 58% of patients who resumed
wearing their own footwear, compared to 28% of those who wore therapeutic
footwear.
- 22% of diabetics
never check their feet.
- The presence
of plantar callus is highly predictive of subsequent ulceration in patients
with diabetic neuropathy.
- The most
common cause of self-injury by diabetics is ill fitting new shoes.
Experts agree that
most of these amputations are preventable with appropriate footwear and
orthoses. Despite the benefit of offering eligible patients footwear at
little or no cost, there has been less than 5% utilization of this important
program nationally! Most diabetes patients are unaware of the benefits
available to them under the Therapeutic Shoe Bill, and should be informed
of this valuable benefit. Ask your physician if this program may be of
benefit to you.
Under the Medicare program coverage is limited to one of the following
within 1 calendar year:
1 pair of off-the-shelf
depth shoes and 3 additional pairs of multi-density inserts.
1 pair of off-the-shelf depth shoes including a modification, and 2 additional
pairs of multi-density inserts.
1 pair of custom molded shoes and 2 additional pairs of multi-density
inserts.
If
you feel you may qualify for the Therapeutic Shoe Bill ask your physician.
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