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By David Spero, BSN, RN | September 13, 2022
Of all diabetes complications, foot problems may have the biggest impact on people’s lives and medical expenses. According to Azura Vascular Care, about 73,000 people in the U.S. with diabetes have leg or foot amputations each year. In various studies, foot ulcers account for 20% to 50% of hospital admissions in people with diabetes.
“Diabetic feet are the number one cause of hospitalization people with diabetes,” says foot expert Jon Bloom, MD. “Diabetic foot is one of the big causes of death and cost. If patients need amputation, their lives get much harder and their 5-year survival rate is less than 50%.”
And COVID-19 has made the feet of people with diabetes more vulnerable. A study in the Journal of the American Podiatric Medical Association reported that the odds of undergoing amputation were 10.8 times higher early the pandemic versus before the pandemic. People were not getting the recommended preventive care because of social distancing, the study found, “resulting in more severe infections, more emergencies, and necessitating more amputations.”
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So, now is the time for people with diabetes to give their feet some love by taking foot care seriously. Dr. Bloom is CEO of a company called Podimetrics. They make a product called a SmartMat. Patients stand on the mat or sit with their feet on it for 20 seconds per day, and the mat measures temperature in various locations of the feet. It sends daily reports by cell phone to a computer and a group of specially trained nurses.
The Podimetrics computer program has learned over years what patterns of foot temperature mean for the risk of ulcers and infections. Dr. Bloom says the program can predict a foot ulcer up to five weeks before the ulcer appears. Having seen these warning signs, Podimetric nurses will call patients and providers, recommending prevention measure such as staying off the feet as much as possible.
Studies by Podimetrics show that “For every 6.4 patients who get Podimetrics, you prevent one amputation and two hospitalizations.” A major study with Kaiser Permanente found once-daily foot monitoring led to a complete elimination of major diabetic amputations. The study also found a 52% drop in all-cause hospital admissions and a 40% reduction in emergency room visits in SmartMat users.
If you get care through the VA or an HMO, you can ask your doctor for a SmartMat. If you get care somewhere else, you may have to advocate with your provider. Start by going to the Podimetrics web site and filling out this contact form.
Diabetes is the single biggest risk factor for amputations, but Mayo Clinic lists many more dangers. Three main risks to reduce are:
Seven factors to be aware of and manage are
It’s important to get these under control, before ‘risks’ turn into realities.
Not everyone with diabetes needs computerized mats to save their feet, but they do need to take care of them every day. Here are ten strategies from specialists interviewed by Diabetes Self-Management and Mayo Clinic:
Check for blisters, sores, tenderness, and any other changes from normal. Podiatrist Neil Scheffler, DPM, says it’s important to check feet every day, to get used to what normal looks like. Check the top and bottom and between the toes. You may need a mirror to see the bottoms of your feet, or get someone to help you. If you see something out of the ordinary, call a foot professional. Some changes are more urgent than others, according to Dr. Scheffler. Signs of infection should be treated right away.
Dry gently, especially between the toes.
Sprinkling talcum powder or cornstarch between the toes will absorb moisture that can break down skin. Using cream or lotion on the tops and bottoms of the feet keeps them from drying and cracking, which allows bacteria to enter. Dr. Scheffler advises using lotion on the feet but not between the toes. Podiatrist Stephanie Wu, DPM, MSc, recommends, “Wear socks to bed after applying your cream of choice to facilitate better cream absorption.”
The Diabetes Self-Management panel agreed, “Don’t remove calluses yourself.” Don’t use sharp objects like nail files on corns, warts, or bunions. See your doctor or foot specialist for removal of any of these lesions.
Carefully file sharp ends with an emery board. Get help if you are unable to trim your nails yourself. Be very careful about pedicures, if you need them at all.
To prevent injury to your feet, don’t go barefoot, even around the house. You don’t know what’s on that floor that could cause infection.
Shoes are a major cause of diabetes foot infections and ulcers. Too-tight shoes, especially high heels, will squeeze the toes, causing scrapes and skin breakdowns. Loose pieces of stitching material or leather can poke the foot. Value health and comfort over style.
Buy comfortable shoes that provide support and cushioning for the heel, arch, and ball of the foot. Special orthopedic and “diabetic” shoes can help some people, says podiatrist Keith Beauchamp, DPM. “A diabetic shoe offers extra depth and insoles that are formed to the diabetic patient’s foot, with attention to accommodating for deformities to reduce risk of ulceration and potential amputation. In some cases, diabetic shoes can save a life.”
Most patients, podiatrist Pedro Smukler, DPM, believes, may not need diabetic shoes. “You need to make sure your shoe fits right and protects your feet,” he says. “They should have room for orthotics if you’re using them.”
Choosing shoes should not be rushed, says certified pedorthist Dennis Janisse, CPed. “Shoes should be cherry-picked with your foot-care expert. This is not something people should do on their own.”
Orthotics and insoles go inside shoes and help many people. “Orthotics are inserted in shoes to change the way you walk and the way weight is distributed to your foot,” says Dr. Beauchamp. Insoles are softer, cushioning, moisture-absorbing pads. People should consult a foot expert on how to obtain and use either of them. Inspect shoes before putting them on.
There might be a sharp thread or a pebble in your shoe. Try running your hand all over the inside of the shoes before putting them on. Wear clean, dry socks.
Wear socks made of fibers that keep your skin dry, such as moisture-wicking fabric. Don’t wear socks with tight elastic bands that reduce circulation or socks with seams that could irritate your skin.
Diabetic socks help some people. Dr. Scheffler says, “Diabetic socks are usually the ones without seams, so they won’t rub, and some have a wider top, which is helpful if your legs are large or swollen.” Dr. Wu says, “Diabetic socks are for people who have lost protective sensation. The bottoms and toes should be white so you can see if there is any bleeding or if a foreign object is sticking to the foot or shoe.” Schedule regular foot checkups.
SmartMats are great, but podiatric care is also important. “Including a podiatrist in your care can reduce amputation rates by as much as 85 percent,” says American Podiatric Medicine Association President Frank Spinosa, DPM. “Regular checkups by a podiatrist are one of the easiest ways to prevent most foot complications. Podimetrics SmartMats can help podiatrists but are not meant to replace them, according to Dr. Bloom. Don’t wait on getting foot ulcer treatment.
Diabetic foot ulcers are dangerous. Waiting longer than six weeks for care increases the likelihood that the ulcer will result in an amputation.
Want to learn more about keeping your feet healthy with diabetes? Read “Caring for Your Feet When You Have Diabetes,” “How to Choose Footwear” and “Tips for Healthy Feet With Diabetes.”
David Spero, BSN, RN on social media
A nurse for 25 years at University of California San Francisco and Kaiser hospitals, and one of the first professional health coaches. Nurse Spero is author of Diabetes: Sugar-Coated Crisis and The Art of Getting Well: Maximizing Health When You Have a Chronic Illness, as well as co-author of Diabetes Heroes and the diabetes chapter in Where There is No Doctor. He writes for Diabetes Self-Management, Pain-Free Living, and Everyday Health.
Disclaimer of Medical Advice: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information, which comes from qualified medical writers, does not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs.
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