When it comes to caring for your feet, the focus should be on taking preventative measures—especially if you have diabetes, according to Dr. Diane Johnson, a Podiatry Specialist in private practice in Shadyside. “When it comes to foot health, there are so many problems that you can run into, so it’s a good idea to have a baseline visit with a podiatrist and then continue to have visits at least twice a year,” she says. “Because people with diabetes are more prone to foot problems, a foot care specialist should be part of your healthcare team.”
Dr. Johnson breaks down foot health into the following general areas:
Circulation: Most people are aware that something like smoking affects and lungs and breathing, but it can also affect circulation throughout the body. Since the feet are farthest away from heart, circulation issues tend to manifest more readily. “When we do an intake on a patient, we ask if they are a smoker for this reason. We check blood flow—basically, the pulse in the foot. In long-term smokers, typically there’s not a good pulse, which leads us to do other tests that diagnose poor circulation,” Dr. Johnson explains.
Vascularity: This relates to the nerve health of the feet. As a symptom, you may notice a tingling or prickly feeling in your feet. For those with diabetes, diabetic neuropathy may be an issue. “If you have enough nerve damage, you can have trauma to your foot and not know it; for example, not being able to feel a sewing needle in your foot,” Dr. Johnson comments. “If you are a long-term drinker, you may have alcoholic neuropathy, which can damage the foot to the same degree as diabetic neuropathy.”
Dermatology: The condition of the skin on your feet is important. Moles are very important to monitor, as they can transform and break open. Dry skin may be an issue, as can athlete’s foot or foot fungus (where your feet are dry and itchy). “It’s important to know the difference, because if you think it’s just dry skin and you’re slathering on moisturizer, that is basically feeding the fungus because it thrives where there is moisture. For athlete’s foot, you would need an anti-fungal like Lamisil, Tinactin or Desenex. Fungus nail—or ‘onychomycosis’—is when you have a nail that’s thick, crumbled, discolored or cracked. Corns, calluses and ingrown toenails can also be a problem, along with any other skin condition like psoriasis.”
Muscular and skeletal: This would include conditions like hammertoes, bunions and flat foot. “Rarely do we see a normal arched foot,” Dr. Johnson says. “We may prescribe a custom insert. This can be a valuable tool, and even a lot of pro athletes function better with these inside their shoes. The treatment can range from very conservative, like bunion shields for inside of the shoe or taking Motrin and Tylenol, to injecting a local anesthetic and steroid to control inflammation. In some cases, a procedure to surgically correct the bunion or hammertoe may be best.”
Tips for taking care of your feet
Keep your feet healthy by following some simple steps.
Visit your podiatrist every three months or at least twice per year as part of your preventative care regime. Seek care immediately if you injure your foot, or if you have cuts or breaks in the skin, or an ingrown nail. Check with your insurance company, as they dictate what
Make sure your regular doctor checks your feet at your annual checkup. Remember to take off your socks and shoes while you wait for your physical examination.
Wash and inspect your feet daily. Dry them fully, especially between the toes. Look for red spots, cuts, swelling and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
Stay as active as possible. Plan your physical activity program with your healthcare team.
Trim your toenails regularly or visit your podiatrist every three months to have this done for you. Your podiatrist can also trim corns and calluses.
Wear shoes and socks. Don’t walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them to make sure there are no objects inside.
Protect your feet from hot and cold. Wear shoes on hot pavement and don’t put your feet into hot water with testing it first. Don’t use hot water bottles, heating pads or electric blankets, as you can burn your feet without realizing it.
Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles throughout the day. Don’t cross your legs for long periods of time. Don’t smoke.
Take care of your diabetes. Work with your healthcare team to keep your blood glucose in your target range.
Ask your doctor about Medicare coverage for special shoes.
Dr. Diane Johnson is a Podiatry Specialist in private practice. Her offices are in the Centre Commons building, located at 5750 Centre Ave., Ste. 190, Shadyside. She can be reached at (412) 362-9440. To learn more about diabetic foot care, visit diabetes.org.
Local places to purchase shoes if you are diabetic:
If you are in need of special shoes due to your diabetic condition, there are several places around Allegheny County that might be a “right fit” for you. If you are heading out to try on shoes, remember to go in the afternoon versus morning, so that your feet are at their regular size by mid-day. Also check with your insurance company so you are clear on what is covered. Bring your insurance card and prescription from your podiatrist with you. Once you get to the store, make sure that you have your foot measured—both the length and width—because even if you know your shoe size, your feet can change.
Best-Made Shoes, 5143 Liberty Ave., Pittsburgh (412) 621-9363
This shoe store employs board certified pedorthists and help you determine your insurance coverage (and even file the paperwork for your claim). They offer diabetic shoes in a variety of styles and colors, as well as shoe inserts. The shoes can be purchased off the rack in the store, or custom ordered to fit your specific needs.
(Dr. Johnson recommends New Balance and Brooks tennis shoes, which can be purchased at Macy’s and other places.)
By Gina Mazza
For Pittsburgh Senior News