The Diabetes Resource Coalition of Long Island and the Suffolk County Podiatric Medical Association wish to remind all diabetic patients about the importance of regular foot care. All patients with diabetes are urged to take off their shoes and socks at every doctor visit. Since your feet are responsible for supporting all your body weight while they move you from place to place, they are forced to work harder than many other body parts. It only makes sense that they should be checked at least as often as the rest of your body.

This is especially true in the diabetic population. "Diabetics are at a higher risk for foot problems than most other people," states Dr. B. Thomas Kempf, President of the Suffolk County Podiatric Medical Association. There are three main contributing factors to diabetic foot complications. They are loss of protective sensation, poor circulation, and compromised immune systems.

Loss of protective sensation, also known as peripheral neuropathy, is a condition in which diabetes affects the nerves of the extremities, often leading to numbness of the feet. This leaves the patient with an inability to feel pain, heat, or cold. Diabetes also affects the blood vessels, and this can frequently cause poor circulation to the feet. To make matters worse, diabetics usually have immune systems that do not fight off infection as successfully as the average person. According to Dr. Kempf, "If you are unable to feel the pain from a small cut on your foot, you might not even realize your foot is injured, and it will not get treated properly. The cut will be slow to heal due to poor circulation. As you continue to walk on this open wound, there is a great potential for infection to set in. The infection will spread very quickly as a result of a diabetic's weak immune system. When you combine numbness of the feet, lack of blood flow, and a compromised immune system, it is easy to see how it can lead to disaster."

Fortunately, there are simple steps you can take to avoid these problems. All diabetics should see a podiatrist at least twice a year for professional foot care. People with diabetes should inspect there own feet daily, for cuts, scrapes, areas of redness or blisters. Anything out of the ordinary should be examined by your podiatrist immediately. All shoes should be inspected before they are put on. Check the inside for foreign objects such as pebbles and rocks, or even small children's toys. Do not walk barefoot. Lastly, keep your blood sugar under control. All of the many complications of diabetes can be better avoided with tight control of blood glucose levels.

Knowledge and awareness are your best weapons in the fight against diabetes.

Information provided by B. Thomas Kempf, DPM, Oakdale, Quality Foot Care.


Diabetes and Wound Healing

Approximately 15% of people with Diabetes will develop a wound (ulcer) of the foot or leg. Complications from Diabetes such as nerve damage, foot deformities, and poor circulation (blood flow) increase your risk of developing a lower extremity foot ulcer. If you have neuropathy (nerve damage) or poor circulation, you are at risk for developing skin problems and infections. People with diabetes often have dry, cracked skin, which makes it easy for germs to enter and cause infection. Learn to spot the first signs of infection. These include:

  • Redness
  • Swelling
  • Foul Odor
  • Pain
  • Unusual drainage

See your physician or podiatrist promptly; do not delay treatment.

If a wound does develop, healing depends on many factors which include:

  • Keeping your glucose level as close to normal as possible
  • Maintaining good eating habits with a diet adequate in calories, protein, vitamins and minerals to promote wound healing
  • Keeping all pressure off the wound
  • Using devices such as special shoes, walkers and crutches as ordered by your physician
  • Taking medications and applying wound dressings as prescribed by your physician

Smoking damages and constricts blood vessels and can delay wound healing.

You have the opportunity to significantly affect your condition in a very positive way.
Actively participating in your own care is one of the smartest things you can do.

Information provided by John T. Mather Memorial Hospital Wound Treatment Center 631-474-4590.

If you would like a list of podiatrists in your area go to www.nyspma.org or call 866-996-4400.


THE NEW YORK STATE PODIATRIC MEDICAL ASSOCIATION URGES NEW YORKERS TO "KNOCK YOUR SOCKS OFF" AT EVERY DOCTORS' VISIT
Preventative Foot Screenings Could Reduce Diabetic Foot Amputations 45 to 85 Percent

Did you know diabetes is the leading cause of non-traumatic foot amputations each year? The feet often show the first signs of more severe medical conditions, such as diabetes, but they often are overlooked by primary health care physicians. The New York State Podiatric Medical Association's "Knock Your Socks Off" campaign encourages patients to ask their primary healthcare physician to exam their feet as part of their regular check-up.

"All too often, people have symptoms of diabetes, such as numbness in the feet, and don't even know it," says NYSPMA President Larry Santi, DPM . "Early detection is paramount and something as simple as taking your shoes and socks off for a foot screening could assist in diagnosis of diabetes earlier."

Close to 5.2 million people in the U.S. have diabetes and don't even know it, according to the American Diabetes Association. With foot disease as the most common complication of diabetes leading to hospitalization, the New York State Podiatric Medical Association suggests looking for these foot related diabetes warning signs:

  • Redness
  • Numbness
  • Swelling
  • Cold to the touch due to a lack of blood circulation
  • Inflammation

Out of the 13 million people diagnosed with diabetes in the US, 60 to 70 percent have mild to severe forms of diabetic nerve damage, which often includes impaired sensation or pain in the feet and hands. For this very reason, The New York State Podiatric Medical Association has selected the "Knock Your Socks Off" campaign to raise awareness about the importance of having feet, like any other part of the body, checked regularly.

For more information about the NYSPMA "Knock Your Socks Off" campaign call 866-996-4400.

Information provided by New York State Podiatric Medical Association.

The New York State Podiatric Medical Association is the State's leading professional society for foot specialists representing over 80% of New York podiatrists. The NYSPMA is the largest statewide component of the American Podiatric Medical Association. For free foot health information, contact the APMA at 1-800-FOOTCARE (1-800-366-8227) or visit www.apma.org.


Frequently Asked Questions About Diabetes and the Feet

The human foot has been called the mirror of health and podiatrists are often the first doctors to see signs of systemic conditions, particularly diabetes. But all too often patients forget to ask their primary care physicians to "knock their socks off" and check their feet. Thirteen million people suffer from diabetes, but a whopping 5.2 million are undiagnosed. That's why it's important, whether you have diabetes or not, to know what signs and symptoms of diabetes you should be on the look out for and to have your feet checked every time you visit the doctor's office.

1. Why should I ask my doctor to "knock my socks off"?
Feet do more work than most parts of the body, so it only makes sense to have them checked as often as you do the rest of your body. And since the feet are said to be mirrors of our general health, it's especially important to remind your primary care physician, who sees you on a regular basis, to check for any signs of diabetes or other diseases that often show up in the feet first.

2. Is it normal for my feet to hurt?
Foot pain is not normal and is often a sign of a more serious medical problem. It is a misconception that foot pain is something that everyone suffers from and many people don't realize that foot problems can often be treated easily and with a high rate of success. You should see your podiatrist if you experience anything abnormal.

3. I have been diagnosed with diabetes. Should I be worried about the bunions and hammertoes that I've been living with?
Bone deformities such as bunions and hammertoes are usually progressive and your podiatrist may recommend correcting them before they get severe. Bone deformities can cause ulcers (sores) that may lead to severe infections and even amputation. Many podiatrists feel that it is better to correct those deformities while your diabetes is under control, earlier in life.

4. How long does it normally take for a sore to heal?
Healthy individuals can expect a sore to improve daily. Sores that do not improve or worsen over time should be evaluated by a podiatrist and may be a symptom of other conditions. Pressure, infection and bone deformities can all contribute to sores, or ulcers, and may need to be addressed in order for the ulcers to heal.

5. Will my nails continue to grow be ingrown?
Some ingrown nails are a result of leaving a spicule in the skin and will not be a problem once that spicule is removed. However, if a nail grows curved and ingrown it will likely continue to grow that way because the root of the nail is telling it to do so. Your podiatrist may recommend a permanent removal of that portion of the nail to prevent the ingrown part from returning. Untreated ingrown nails can cause infections that can be severe for a person with diabetes.

6. Why do my feet feel cold?
Cold feet may be a sign of circulation problems. Lack of blood flow to the feet and toes is common for those with diabetes and can make your feet feel cold. Another sign of decreased blood flow is the loss of hair growth on the toes or feet. Decreased blood flow can make it difficult for people with diabetes to heal sores or infections.

7. Is there a special examination to evaluate how much feeling I have in my feet?
Diabetic neuropathy is a common complication of diabetes. Signs of neuropathy include: muscle weakness in the legs, pain in the feet and legs, tingling, burning, or numbness in the feet and hands, and decreased pain sensations and loss of feeling. Podiatrists are trained to evaluate the foot for sensation as well as circulation. Many podiatrists who specialize in the care of people with diabetes have more specific means to determine specific levels of neuropathy, such as monofilament wires. If you are experiencing any of the signs of neuropathy, call your doctor right away.

8. I've noticed a burning sensation in my feet. Is there anything I can do to stop it?
There are some over the counter creams that can help people with the burning sensation. It is important to have your podiatrist explain how to use these creams properly. Certain medications and ointments could pose risks for those with diabetes and should be avoided.

9. Are there special shoes or inserts that I can wear to keep my feet more comfortable?
Custom orthotic inserts are often made for shoes to help control the way your foot functions. These orthotics are used for many problems, including heel pain, arch pain and bunions. Special diabetic shoes are also available, and may be covered by Medicare. Ask your podiatrist for more information about shoe programs.

10. How should I inspect my feet at home?
Those who suffer from diabetes should check their feet every day. He or she should look for areas of irritation (redness), areas of inflammation (swelling) or any other changes to the feet. Often, people with diabetes lose their sensation and cannot feel an abnormality on their foot so a daily visual inspection becomes very important. If the person with diabetes is older or unable to check their own feet, he or she should ask a friend or family member to assist them. It is also important to check shoes daily for anything that may be hidden inside.

Information provided by New York State Podiatric Medical Association.


Know Your ABCs

If you have diabetes, and you experience any of the following symptoms in your feet, call your doctor immediately:

A - Aches and pain in the legs, either at rest or while walking.

B - Bleeding within the skin around corns or calluses.

C - Color changes of the skin.

D - Dry cracks in the skin, especially around the heel.

E - Edema - swelling of the foot or ankle.

F - Fungus-infected or ingrown toenails.

G - Gaping (open) sores, with or without drainage, that are slow to heal.

H - Higher skin temperture.

I - Injury to your feet.

Information provided by Yehuda Nezaria, DPM, Podiatric Medicine and Surgery.


Regular Foot Exams Critical for People With Diabetes

National Diabetes Month has Podiatrists Speaking Out

(New York, NY – October 31, 2011) This November, National Diabetes Month, members of the New York State Podiatric Medical Association (NYSPMA) are speaking out on the important link between regular foot exams and diabetes management. Two recent studies show that the care provided by podiatrists can save limbs, lives and healthcare dollars.

For those who have or are at risk of diabetes, a podiatrist can detect signs and symptoms of the disease and provide treatments that help to prevent lower-limb amputations. The Thomson Reuters Healthcare Study concludes that doctors of podiatric medicine are critical to saving limbs from amputation, which can happen as a result of untreated complications from diabetes.

Additionally, the Thomson Reuters Study also addresses the saving of healthcare dollars, with patients who saw a podiatrist incurring lower costs as well as fewer amputations.

“If you extrapolate the results from the study in one year $1.97 billion could be saved in the commercial insurance group, and $1.53 billion could be saved in the Medicare group,” said Vito J. Rizzo, DPM, president of NYSPMA.

Another study done by Duke University* concluded that persons visiting a podiatrist and/or a lower-extremity clinician specialist within a year before developing all-stage complications were between 23 percent and 69 percent less likely to have an amputation compared with individuals who visited other health professionals.

According to the American Diabetes Association, approximately 60 – 70% of the people with diabetes have mild to severe forms of nerve damage that could result in foot problems. They also estimate the total national cost of diagnosed diabetes in the United States is $174 billion.

“Nearly 26 million children and adults in the United States have diabetes,” said Dr. Jamie Hopkins, president of the Suffolk Division of the NYSPMA. “During November, foot specialists across the state are working to educate patients on the important role regular foot exams are in managing diabetes, helping to save limbs and lives, he added.”

Every 30 seconds, a lower limb is lost to diabetes somewhere in the world. People with diabetes are more prone to develop foot infections, called foot ulcers, which can quickly result in amputation.  Preventing amputation means knowing the main warning signs. Other common diabetes warning signs in the feet besides ulcers include:

  • Redness
  • Numbness
  • Swelling
  • Cold to touch
  • Inflammation
  • Change in shape
  • Slow-healing cuts

The NYSPMA recommends that if any of these symptoms are discovered to visit a podiatrist immediately.  Including a podiatrist on the diabetes management team can drastically improve a patient’s ability to manage diabetes successfully.

The New York State Podiatric Medical Association is the largest statewide component of the American Podiatric Medical Association and its affiliated national network of certifying boards and professional colleges. Established in 1895, NYSPMA has over 1,200 members across 13 divisions in New York State. Visit www.nyspma.org for more information.

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For more information on the Thomson Reuters Healthcare Study visit: http://www.apma.org/study-summary.

* Duke Study: Sloan, F. A., Feinglos, M. N. and Grossman, D. S., RESEARCH ARTICLE: Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of US Elderly. Health Services Research, no. doi: 10.1111/j.1475-6773.2010.01157.x