Neil M. Scheffler - 21 Things You Need to Know About Diabetes and Your Feet

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2012 by the American Diabetes Association, Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.

Printed in the United States of America
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or information in this publication.

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American Diabetes Association
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Alexandria, Virginia 22311

DOI: 10.2337/9781580404778

Library of Congress Cataloging-in-Publication Data

Scheffler, Neil M.
21 things you need to know about diabetes and your feet / by Neil M. Scheffler, DPM, FACFAS.
pages cm
Includes bibliographical references and index.
ISBN 978-1-58040-477-8 (alk. paper)
1. Foot--Diseases--Popular works. 2. Diabetes--Complications--Popular works. 3. Foot--Care and hygiene--Popular works. I. American Diabetes Association. II. Title. III. Title: Twenty-one things you need to know about diabetes and your feet.
RC951.S34 2012
616.462--dc23
2012036748
eISBN: 9781580405324

This book is dedicated to my wife, Eleanor,
who puts up with all the time I spend on my computer.
Thanks also to those podiatrists
who helped train me during my residency:
Drs. Irvin Donick, Larry Block, Steven Berlin and Lanny Rubin.
I can never thank you enough.

Table of Contents

Diabetes has become an epidemic in this country. This epidemic is costing hundreds of billions of dollars each year in direct and indirect costs while destroying the lives of those with this disease, as well as those of their friends and families. The personal costs to patients include financial as well as non-economic, emotional, social, and psychological burdens. The risk for death among people with diabetes is about twice that of people of similar age without diabetes.

According to data from the 2011 National Diabetes Fact Sheet, 25.8 million children and adults in the United States8.3% of the populationhave diabetes. 79 million people have prediabetes. 1.9 million new cases of diabetes were diagnosed in people aged 20 years and older in 2010, and there is no end in sight. Diabetes rates in adults ages 65 and up may surge in the next 20 years as the population of senior adults is expected to double to more than 71 million by 2030.

Lower extremity complications of diabetes account for more in-patient hospital days than any other complication of the disease. More than 60% of lower-limb amputations due to causes other than trauma occur annually in people with diabetes; this number is more than 65,000.

If you want to be active and independent all of your lifewhether or not you have diabetesyou need to have healthy feet. Most people take their feet for granted, but people with diabetes do not have that luxury. You are challenged by complications of diabetes that can make it easier for you to develop a foot ulcer that may not heal. Nonhealing ulcers often lead to amputation, which will severely limit what you can do for yourself.

The good news is that by taking good care of your feet, you can often prevent diabetic foot complications. If you take care of your feet every day and get good medical care as soon as you suspect you might need it, youre much more likely to avoid getting the infections that make amputation necessary. According to the Center for Disease Control (CDC), comprehensive foot care programs, i.e., those that include risk assessment, foot-care education, and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.

This book will help you protect your feet. You will learn about the major lower extremity complications of diabetes: vascular disease (circulation problems), diabetic neuropathy (nerve problems), and foot deformities (such as bunions and hammertoes). You will see how these can affect your feet, how to prevent them, or, if they do happen, what you can do about it. Reading this book is the first step in preventing amputations and keeping your feet happy and healthy. Lets get started!!

Perhaps you have heard about the team approach to treating diabetes. You may be interested in putting together a team for your foot care. Who should be on this team? How often should you see them and what should you expect?

The most important member of the team is YOU. You need to practice good foot hygiene, wear your prescribed shoes and inserts, and in general take charge of your own foot health. You need to assemble your team and help them to help you.

A podiatrist is a foot and ankle specialist who you should see at least once a year. If you have foot problems, such as poor circulation, nerve problems, wounds, or deformities you will need more frequent visits. You can see a podiatrist for routine foot care if you are unable to reach or see your feet. Podiatrists are doctors of podiatric medicine (DPM) and, in most states, diagnose and treat conditions of the feet and ankles. They perform routine foot care, such as toenail trimming, callus removal, and treatment of ingrown toenails, and they perform foot surgery on bones and soft tissue, such as bunion or hammertoe surgery. If necessary, a podiatrist can operate on infected bones and do amputations (some orthopedists do foot surgery as well). Podiatrists study how your feet and legs work when you move and walk (biomechanics). Podiatrists can identify bone and joint deformities that put unusual pressure on the skin of your feet. They can design insoles or braces to help your feet work normally and order special footwear if you need it. Podiatrists are trained in the treatment of the diabetic foot, including the treatment of wounds and infections. Your podiatrist will do a thorough history and exam and should treat any current problems and advise you about preventing future foot issues. He/she should suggest changes in shoes and socks. You should call your podiatrist immediately if you see any changes in your feet.