Helping Diabetics Manage Their Foot Care Needs

Preventing foot problems is essential for both children and adult diabetics, according to Harold Reinhartz. D.P.M, a podiatrist with 29 years experience. Regular examinations, proper foot care, and properly fitted shoes are fundamental needs for diabetics to reduce the risk of bleeding sores, ulcers and hard-to-treat infections.

Diabetes is a chronic disease that will cause more than 178,000 deaths in the United States this year, according to the American Diabetes Association.

“Diabetes accounts for 50 percent of all non-traumatic amputations of the lower extremities,” says Louis Chaykin, M.D., a leading Miami endocrinologist and former president of the American Diabetes Association/Florida Affiliate. “At least half of the 50,000 amputations that occur annually as a result of diabetes complications could be prevented by appropriate footware.”

While physicians expect the current 16 million diabetics in the United States to double in the next 30 years, researchers have made relatively little progress in treating the disease since 1921, when insulin injections first began.

That makes preventive care even more important, says Dr. Reinhartz, who is a co-founder of Footcare Express, a Miami store specializing in prescription foot orthotics, custom shoes and foot care products. “Diabetics are apt to have serious problems with their feet, especially when blood circulation or nerves are impaired,” he says. “When blood circulation is poor, the tissue in the foot is less able to fight infection and to regrow skin over a wound. If the nerves to the foot are impaired, an injury can occur without pain and may go unnoticed.”

Dr. Reinhartz said a recent survey of diabetic patients at a Veterans Affairs hospital found that 50 percent had circulation and nerve damage, plus some type of foot deformity.

Charles Adler, D.P.M., a board-certified podiatrist who is chief of podiatry at Columbia Aventura Hospital and Medical Center and president of the Dade County Podiatric Association, says it’s very important for diabetics to wear the right shoes and orthotic devices. “Young and healthy diabetics with good circulation can use functional orthotics to prevent future problems. Older diabetics, especially those with calluses, corns or hammertoes, should use soft orthotics to offload pressure from those areas.”

Footcare Expess the nation’s first “one-stop footshop,” uses a high-tech approach to correcting foot problems in diabetics. After a physical examination of the foot, a computerized gait analysis is performed using the new F-Scan equipment Paper-thin, disposable sensors are placed in a person’s shoes to show the reactive forces between the foot and footwear as they occur. Next, a video motion analysis is used to study the person’s gait while walking or lightly jogging on a treadmill. Finally, a laser scanner generates a three-dimensional computerized image of the feet showing any pressure points or potential problem areas.

Our experienced technicians then design and fabricate foot orthotics to prescribed specifications, using an on-site CAD-CAM laboratory to make custom-fitted devices in about an hour.

Footcare Express also sells compression hosiery, special lotions, special extra-depth shoes, diabetic socks, insoles with magnets to increase circulation and other foot care products for diabetics to prevent chafing and protect the skin. For example, Footcare Express sells special Juzo compression hose for diabetics that provides support from the toes all the way up the leg.

“Diabetics should always check their shoes and socks to make sure nothing is sharp or rubbing,” says Kustra. “It’s a good idea to check the bottom of the feet at the end of each day. Use a mirror if necessary.”

A diabetic can come to FootLabs to identify pressure points on the foot where sores or ulcers might eventually arise, and determine how well the feet are functioning biomechanically. “We can then provide an over-the-counter device or an accommodative orthotic to prevent that person from having problems later on,” says Kustra. An accommodative orthotic is a soft and flexible cushion that supports and protects the foot.

The federal Medicare program reimburses diabetics for one special pair of shoes and three sets of inserts per year, says Reinhartz. A prescription and a note from the doctor are necessary. For diabetics covered by private insurance companies, Footcare Express can provide a letter of medical necessity.

Since cuts, scrapes, blisters and puncture wounds are part of childhood, diabetic children should always wear some kind of footwear, says Dr. Reinhartz. If splinters become lodged in the foot, or if an infection or puncture wound occurs, the child should be treated promptly by a professional.

As children grow, the shape and structure of their feet changes. That means a regular evaluation is important to identify and correct potential problem areas.

Poor circulation is a chronic problem in persons with adult- onset or Type II diabetes. Chronically tired or painful feet, along with symptoms such as numb, tingling, cold or blue feet or swelling that will not go down indicate poor circulation. Cramping may occur at night, during rest or while walking a short distance. Smoking, caffeine and stress usually increase the severity of these symptoms.

“Diabetics who suffer from these symptoms may benefit from properly fitted shoes or custom orthotics,” says Dr. Adler. “For example, cramping and fatigue may occur because the bones in the foot are not aligned correctly to propel the body forward when walking. These types of biomechanical problems can be corrected easily.”

Diabetic neuropathy can cause a person to lose the ability to feel pain, heat and cold in the foot. Protective footwear is especially important in these cases, since a small cut, a splinter, or a bruise may not be noticed until a serious infection occurs.

Many diabetics also suffer from dry skin, which may lead to itching, fissures and cracks in the skin’s surface. Moisturizers and lubricating creams may help prevent problems from developing, according to Dr. Reinhartz.

“If you have diabetes, you should have your feet examined at least yearly to determine the level of risk for foot ulcers,” he says. “At Footcare Express, we work closely with physicians to provide the right footwear and assure a high quality of life for diabetics.”

Recommendations for Diabetics

If you are a diabetic, the American Podiatric Medical Association recommends:

• The shoes should always fit properly.
• The widest part of the shoe should match the widest part of your foot.
• The shoe should fit the natural outline of your foot and be snug, but not tight.
• The shoe should have a firm heel counter to keep the foot in place.
• The heel should give a wide base of support.
• The toe area should be round and high to allow space for toe deformities.
• The upper portion of the shoe should be soft and flexible.
• The lining should be smooth and free of ridges, wrinkles or seams.
• New shoes should be worn for short periods of time until they are broken in and comfortable.
• If you have a deformity, you should wear special shoes or have an accommodative orthotic prescribed for your shoes.